Cambridge University Hospitals Early Appropriate Care Pathway: Are we making appropriately guided decisions?

Abstract Addenbrooke’s hospital, the Major Trauma Centre for the east of England, received 1070 major trauma patients between 1st January and 31st December 2014. In order to improve care in orthopaedic trauma, an audit was performed of 59 patients meeting our own selection criteria for orthopaedic polytrauma. The Addenbrooke’s Early Appropriate Care pathway was devised through literature review, internal and external discussion. It facilitates provision of best practice care, according to NCEPOD guidelines and our own literature review, encompassing − multidisciplinary consultant decisions around the patient in our Neurological and Trauma Critical Care Unit, early full body trauma CT scans, serial measurements of lactate and fibrinogen levels, and out-of-hours orthopaedic theatre reserved for life-and-limb threatening injuries. Re-audit was conducted of 15 patients meeting selection criteria, admitted between 1st October 2014 and 31st March 2015. Significant improvements in recording of lactate and fibrinogen were demonstrated, both on admission (lactate − p < 0.000, fibrinogen − p = 0.015), and preoperatively (lactate − p = 0.003, fibrinogen − p = 0.030). Time to trauma CT was unchanged (p = 0.536) with a median time to CT of 0.53 hours at re-audit (IQR 0.48-0.75). The number of patients receiving definitive orthopaedic intervention out-of-hours reduced from 8 to zero (p = 0.195). The approach of facilitating management decisions to be made at early daytime MDT meetings has been adopted. It is anticipated that this pathway will improve outcomes in Addenbrooke’s orthopaedic polytrauma patients and it is recommended that either the GOS-E, or the EQ-5D scoring systems be introduced to assess this.