Improving outcomes for patients with blunt chest injuries by Boosting Regional Anaesthesia and Virtual Enhanced Chest Injury Pathway

The study intervention is the “BRAVE-CHIP” model of care. This model identifies suitable patients with rib fractures and is designed to accelerate their safe transfer into virtual healthcare by using a care bundle that includes the prescription of oral analgesia, prompt use of regional anaesthesia (serratus anterior plane block) and early referral to virtual care involving a multidisciplinary team of nursing, medical and physiotherapy. The model involves each of these components together, and is being assessed in summation. All patients enrolled into this arm will receive: 1. regular paracetamol (oral 1g, 4 times per day) and celecoxib (oral 200mg, once daily) 2. regular and breakthrough oxycodone (oral 5-10mg, 4 times per day, plus 5mg every 2-4 hours as required) 3. a serratus anterior plane block, administered by either Emergency Medicine or Trauma physicians as a single-shot (once only) injection [30-40mL of 0.75% solution] 4. Virtual clinical care commencing the day after hospital discharge (including daily medical, nursing and allied health review with a focus on pain management and respiratory function). It is estimated that patients will receive a minimum of 3 (up to 5) virtual follow-up, which will last for 30-60 minutes in duration. *Medication adherence will be reviewed through direct patient interview during Virtual Care assessment. This will be recorded in the clinical record and transcribed into the trial database. *Virtual pain management will be an assessment of pain scores, review of recent analgesic drug use and advice by the clinicians on how to optimise these medications for better pain control. *Virtual respiratory function assessment will include a review of oxygenation via pulse oximetry (provided to them at the time of hospital discharge) and engagement with physiotherapy through breathing exercise and capacity to both deep breathe & cough.