344 Are Rings Removed in Hand Trauma? a Closed Loop Audit

Aim

Constriction injury secondary to jewellery can be a serious consequence of hand injury. National guidelines therefore advise that all jewellery is removed as the initial step in managing hand trauma, prior to any imaging. This audit evaluated adherence to this guideline, and to assess the effect of a patient and clinician centred intervention.

Method

All patients who had plain film radiographs of the hand performed by the emergency department of a major trauma centre were assessed for radiopaque jewellery in situ. Further data were then collected including demographics, mechanism of injury, and resultant surgical procedures.

A 4-month baseline audit was conducted in 2021. Interventions were implemented, including patient- and clinician-facing posters. A post intervention cycle was completed over 5 months in 2022.

Results

7563 individual patients presenting with hand trauma were included in the audit across both cycles. In 2021, 115 of 3542 patients had jewellery identified in situ. In 2022, 107 of 4021 patients had jewellery identified, an improvement of 18.1%.

General demographics of these patients remained broadly similar across both cycles. The patients were predominantly female (64%) and the jewellery seen most frequently was a metal ring, often on the left ring finger (84%). Injury types included lacerations, fractures, and soft tissue injuries. 1 in 4 of these patients required a further surgical procedure from the injury.

Conclusions

This audit demonstrated the success of both patient and clinician facing interventions to improve the rate of removal of jewellery as the first stage of hand trauma.