Aims and Objectives Blunt chest trauma can cause secondary pneumonia which can significantly increase morbidity and mortality. Trauma presenting to the ED can be high risk mechanisms such as road traffic collisions or that of older patients falling from standing. Literature suggests that if patients are placed on a pathway that includes appropriate imaging, aggressive analgesia, chest physiotherapy (CP) and risk stratification for higher levels of care, then secondary pneumonia can be prevented. The aim was to reduce secondary pneumonia in admitted adult blunt chest trauma patients by 10% in a rural district general hospital.

Method and Design The project was in Airedale General Hospital (AGH) between October 2019-Febuary 2021 and data was collected monthly. In 2023 further data collection was analysed with continuous sampling methods. Inclusion criteria was adult patients attending AGH emergency department (ED) with recent blunt chest trauma. Patients who reattended the ED, who had social reasons for admission and that were incorrectly coded were excluded. Process mapping demonstrated the patient journey and an Ishikawa diagram highlighted factors to overcome.

PDSA (plan, do, study, act) cycles included referral to acute pain team (APT) and CP online in the ED, the implementation of an adult blunt chest trauma pathway, and CP teaching in the ED. The Model of Improvement framework was used to analyse each intervention.

Results and Conclusion From October 2019-July 2020 58 patients were admitted to AGH with blunt chest trauma and 15 (median 25.9%) developed pneumonia. Interventions occurred between August 2020-October 2020 and from August 2020-Febuary 2021 41 patients were admitted to AGH and only 6 (median 11.1%) developed pneumonia, reducing the rate by 14.8%. Mortality remained similar (6%) during this time. By 2023, the rate of secondary pneumonia was reduced to 0% and mortality rate was reduced to 0%.

A blunt chest trauma pathway can reduce secondary pneumonia and mortality.