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Upper extremity trauma is a common injury and post traumatic edema is an expected sequela. Retained rings on the digits prohibit circumferential swelling and may lead to tourniquet syndrome if left in place leading to a devastating and avoidable consequence. 1

Expeditious ring removal in upper extremity trauma is prudent for patient safety. 2

Radiographs are typically obtained early in the triage and treatment of patients suffering from upper extremity trauma. This presented itself as as reliable efficient target to have rings removed prior to this treatment step.

An opportunity to make a systemic change to maximize patient safety and care was identified with efforts made to reduce time from presentation to ring removal.

The authors proposed a hard-stop protocol. The aim was to foster interdisciplinary communication and to improve patient safety and outcomes by promoting early ring removal in the traumatic setting and thus limiting potential for this devastating complication.

Publication Date



Family Medicine


2023 Alvin Yarrows Research Day at Beaumont Hospital Farmington Hills, Farmington Hills, MI, May 4, 2023.

Remove the Ring: A Quality Improvement Initiative  for Upper Extremity Trauma