Retrospective pre-post evaluation of the impact of an evidence-based protocol for management of patients with blunt chest injury under real-world conditions: Chest Injury bundle of care Protocol (ChIP)

This research project helped us determine the impact of implementing an evidence-informed blunt chest injury early activation protocol (ChIP) on patient and hospital outcomes. This study demonstrated how the behaviour change wheel could be used to revise and improve a clinical protocol in the ED context. There were significant and sustained improvements in care practices known to result in better patient outcomes. The incidence of pneumonia following the introduction of ChIP was reduced significantly. In the after-ChIP cohort, more patients received a pain team review, physiotherapy and trauma team review. Findings from this study showed that ChIP reduced the incidence of pneumonia and improved the delivery of healthcare services. There were 1790 patients included. ChIP was associated with 90% decreased odds of unplanned ICU admissions at the intervention sites compared to the control groups in the post-implementation period. The intervention sites had a 58% decrease in non-invasive ventilation use in the post-implementation period compared to the pre-implementation period. There was no significant change in mortality. There were higher odds of care practices known to result in better outcomes and there was improvement in the delivery of health care services.