174 An Audit on First Time Shoulder Dislocations: Are We Following BESS Guidelines?

Abstract

Abstract Aim Traumatic shoulder dislocations are the most common joint dislocation in the UK. They are often associated with concurrent injury to the joint and its stabilisers which can occasionally get missed. This can severely affect functional recovery and lead to chronic instability. Our aim was to assess adherence to the BESS guidelines for first time shoulder dislocations in a large acute general hospital. Method We conducted a retrospective review of all patients who attended the emergency department at Birmingham Heartlands Hospital between January and December 2019. A total of 20 patients were selected after verifying data received from the health informatics team. Patient notes, investigations and clinic letters were reviewed. Results The average age of our cohort was 50 with a male to female ratio of 13:7. The cohort was divided into three groups depending on their age i.e.,16–25, 25–40 and >40. Although 85% were seen in a fracture clinic only 25% were seen by a consultant. It was noted that among all three groups only 40% of appropriate imaging was requested. In addition, only 50% were correctly referred to a shoulder surgeon or shoulder clinic to assess shoulder function, however most patients were seen by a physiotherapist. Conclusions We found a large number of concomitant injuries in those investigated for a first-time dislocation. We have therefore designed a pathway to ensure that all patients with a first-time shoulder dislocation are followed up in fracture clinic and appropriate investigations ordered in a timely manner.