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Zhang Z, Golin AP, Papp A. Safety and Cost Effectiveness of Outpatient Surgery in Acute Burn Care. J Burn Care Res 2021; 43:37-42. [PMID: 34648032 DOI: 10.1093/jbcr/irab183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Outpatient burn surgery is increasingly utilized in acute burn care. Reports of its safety and efficacy are limited. This study aims to evaluate the safety and cost reduction associated with outpatient burn surgery and to describe our centre's experience. METHODS This was a single centre, retrospective cohort study of consecutive patients who underwent outpatient burn surgery requiring split thickness skin graft or dermal regenerative template from January 2010 - December 2018. Patient demographics, comorbidities, burn etiologies, operative data and postoperative care were reviewed. The primary outcome is complications involving major graft loss requiring reoperation. RESULTS One hundred and sixty-five patients and 173 procedures met the inclusion criteria. The average age was 44 years and 60.6% (100/165) were male. Annual outpatient procedure volume increased 48% from 23 to 34 cases over the 9-year period. The median (IQR) grafted percentage total body surface area was 1.0 (1.0)%. Rate of major graft loss requiring reoperation was 5.2% (9/172) and the most common site was the lower extremity (8/9, 88.9%). Age, sex, co-morbidities, total body surface area, and procedure types were not significantly associated with postoperative complication rates. The outpatient burn surgery model was estimated to save CA$8,170 per patient from inpatient costs. CONCLUSION Demonstration of the safety and cost savings associated with outpatient acute burn surgery is compelling for further utilization. Our experience found the adoption of improved dressing care, appropriate patient selection, increased patient education, adequate pain control, and regimented outpatient multidisciplinary care to be fundamental for effective outpatient surgical burn care.
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Affiliation(s)
- Zach Zhang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Andrew P Golin
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Anthony Papp
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada
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Lacey AM, Maniago E, Gillenwater TJ, Yenikomshian H, Garner WL. Intermediate Skin Substitutes Are Unnecessary in Small (<10% TBSA) Burns. J Burn Care Res 2020; 41:926-928. [PMID: 32485731 DOI: 10.1093/jbcr/iraa077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The use of intermediate skin substitutes between debridement and final autografting is routine for many practitioners. Materials such as xenografts and allografts have been promoted to help with wound coverage before autografting. However, there is limited data for their use in relatively small burn wounds (<10% TBSA). In this study, we analyzed the outcomes of 100 consecutive patients who underwent autografting for burns <10% TBSA at our American Burn Association-verified burn unit in the absence of intermediate skin substitute use. We retrospectively analyzed 100 patients who underwent split thickness skin graft autografting for burns <10% TBSA between November 2017 and June 2019. No patients were treated with intermediate skin substitutes. Analysis included basic demographics, comorbidities, TBSA burned, mechanism of burn, time to grafting, if grafting was performed in a single procedure or staged, graft loss (>50% graft failure), and time to complete healing (no further wound care required). Twelve patients (12%) had unpredictable graft beds, and their procedure was staged. These patients underwent surgical debridement and were dressed in antimicrobial dressing for an average of 5 days before autografting. No patients had intermediate skin substitutes between procedures. Eighty-eight patients (88%) were debrided and grafted in a single stage. In the staged group, there was a 0% rate of graft failure compared with 9.1% rate of graft failure in the primarily grafted group (P = .004). There was a similar length of stay and time to complete healing in the staged group and primarily grafted group (P = .496 and P = .571). There was a significantly shorter time from injury to first procedure between the staged group and the primarily grafted group (8.7 days and 13.5 days, P = .014). In the eight instances of graft failure, infection or inadequate debridement was the cause. Seven of these eight cases required further surgical intervention. Intermediate skin substitutes are an unnecessary step in grafting small burns. These add only complexity and cost to patient care. Many patients can be debrided and grafted in a single stage. Debridement alone with delayed grafting is a highly effective surgical method when the wound bed is not suitable for immediate grafting. The use of intermediate skin substitutes in small burns requires further investigation as this study finds low benefit for this product.
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Demographics and clinical outcomes of adult burn patients admitted to a single provincial burn centre: A 40-year review. Burns 2020; 46:1958-1967. [PMID: 32660831 DOI: 10.1016/j.burns.2020.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/23/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study evaluated trends in demographics and outcomes of cutaneous burns over a forty-year period at a Canadian burn centre. METHODS Retrospective review was performed of all consecutive adult burn admissions to the Vancouver General Hospital (VGH) between 1976 and 2015. Comparison was made to the 2016 American Burn Association - National Burn Repository. RESULTS There were 4105 admissions during study period. Both overall admissions and admissions per 100,000 BC residents declined (p < 0.0001). Males represented three quarters of admissions. There was a decrease in large burns (p < 0.05). Flame burns were most commonly associated with larger TBSA, ICU stays, and mortality. Mortality decreased from 11.3% to 2.8% (p < 0.05). Factors found to affect mortality included: increased length of stay, age and burn size, male gender, and number of complications. Baux50 and rBaux50 increased, from 102.8 to 116.7 and 112.2 to 125.3 respectively (p < 0.05, respectively). CONCLUSIONS This study represents the largest report on burn epidemiology in Canada. The incidence of burns has decreased significantly over the last forty years. Mortality has improved over this time frame, as evident by increases in Baux50 and rBaux50 scores. Further data is largely in concurrence with that of the National Burn Repository's amalgamation of US centres.
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Lidocaine infusion has a 25% opioid-sparing effect on background pain after burns: A prospective, randomised, double-blind, controlled trial. Burns 2020; 46:465-471. [DOI: 10.1016/j.burns.2019.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/06/2019] [Accepted: 08/14/2019] [Indexed: 11/15/2022]
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Abdelrahman I, Steinvall I, Fredrikson M, Sjoberg F, Elmasry M. Use of the burn intervention score to calculate the charges of the care of burns. Burns 2019; 45:303-309. [PMID: 30612888 DOI: 10.1016/j.burns.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/16/2018] [Accepted: 12/10/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND To our knowledge this is the first published estimate of the charges of the care of burns in Sweden. The Linköping Burn Interventional Score has been used to calculate the charges for each burned patient since 1993. The treatment of burns is versatile, and depends on the depth and extension of the burn. This requires a flexible system to detect the actual differences in the care provided. We aimed to describe the model of burn care that we used to calculate the charges incurred during the acute phase until discharge, so it could be reproduced and applied in other burn centres, which would facilitate a future objective comparison of the expenses in burn care. METHODS All patients admitted with burns during the period 2010-15 were included. We analysed clinical and economic data from the daily burn scores during the acute phase of the burn until discharge from the burn centre. RESULTS Total median charge/patient was US$ 28 199 (10th-90th centiles 4668-197 781) for 696 patients admitted. Burns caused by hot objects and electricity resulted in the highest charges/TBSA%, while charges/day were similar for the different causes of injury. Flame burns resulted in the highest mean charges/admission, probably because they had the longest duration of stay. Mean charges/patient increased in a linear fashion among the different age groups. CONCLUSION Our intervention-based estimate of charges has proved to be a valid tool that is sensitive to the procedures that drive the costs of the care of burns such as large TBSA%, intensive care, and operations. The burn score system could be reproduced easily in other burn centres worldwide and facilitate the comparison regardless of the differences in the currency and the economic circumstances.
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Affiliation(s)
- Islam Abdelrahman
- The Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns, Department of Clinical and Experimental Medicine, 8 Linköping University, Linköping, Sweden.
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Folke Sjoberg
- Department of Hand Surgery, Plastic Surgery and Burns, Department of Clinical and Experimental Medicine, 8 Linköping University, Linköping, Sweden; Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden.
| | - Moustafa Elmasry
- The Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt; Department of Hand Surgery, Plastic Surgery and Burns, Department of Clinical and Experimental Medicine, 8 Linköping University, Linköping, Sweden.
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Pompermaier L, Elmasry M, Abdelrahman I, Fredrikson M, Sjöberg F, Steinvall I. Are there any differences in the provided burn care between men and women? A retrospective study. BURNS & TRAUMA 2018; 6:22. [PMID: 30123802 PMCID: PMC6088398 DOI: 10.1186/s41038-018-0125-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/13/2018] [Indexed: 12/22/2022]
Abstract
Background Disparity between medical treatment for men and women has been recorded worldwide. However, it is difficult to find out if the disparities in both the use of resources and outcome depend entirely on sex-related discrimination. Our aim was to investigate if there are differences in burn treatments between the sexes. Methods All patients admitted with burns to Linköping University Hospital during the 16-year period 2000–2015 were included. Interventions were prospectively recorded using the validated Burn SCoring system (BSC). Data were analysed using a multivariable panel regression model adjusted for age, percentage total body surface area (%TBSA), and in-hospital mortality. Results A total of 1363 patients were included, who generated a total of 22,301 daily recordings while they were inpatients. Males were 70% (930/1363). Sex was not an independent factor for daily scores after adjustment for age, %TBSA, and mortality in hospital (model R2=0.60, p < 0.001). Conclusion We found no evidence of inequity between the sexes in treatments given in our burn centre when we had adjusted for size of burn, age, and mortality. BSC seems to be an appropriate model in which to evaluate sex-related differences in the delivery of treatments.
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Affiliation(s)
- Laura Pompermaier
- 1Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden.,2Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,5the Burn Centre, Linköping University Hospital, 58185 Linköping, Sweden
| | - Moustafa Elmasry
- 1Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden.,2Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Islam Abdelrahman
- 2Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,3Department of Surgery, Plastic Surgery Unit, Suez Canal University, Ismailia, Egypt
| | - Mats Fredrikson
- 2Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- 1Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden.,2Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,4Department of Anaesthesia and Intensive Care, Linköping University, Linköping, Sweden
| | - Ingrid Steinvall
- 1Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden.,2Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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7
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Validation of the burn intervention score in a National Burn Centre. Burns 2018; 44:1159-1166. [PMID: 29475745 DOI: 10.1016/j.burns.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/11/2018] [Accepted: 02/02/2018] [Indexed: 11/20/2022]
Abstract
The Linköping burn score has been used for two decades to calculate the cost to the hospital of each burned patient. Our aim was to validate the Burn Score in a dedicated Burn Centre by analysing the associations with burn-specific factors: percentage of total body surface area burned (TBSA%), cause of injury, patients referred from other (non-specialist) centres, and survival, to find out which of these factors resulted in higher scores. Our second aim was to analyse the variation in scores of each category of care (surveillance, respiration, circulation, wound care, mobilisation, laboratory tests, infusions, and operation). We made a retrospective analysis of all burned patients admitted during the period 2000-15. Multivariable regression models were used to analyse predictive factors for an increased daily burn score, the cumulative burn score (the sum of the daily burn scores for each patient) and the total burn score (total sum of burn scores for the whole group throughout the study period) in addition to sub-analysis of the different categories of care that make up the burn score. We retrieved 22301 daily recordings for inpatients. Mobilisation and care of the wound accounted for more than half of the total burn score during the study. Increased TBSA% and age over 45 years were associated with increased cumulative (model R2 0.43, p<0.001) and daily (model R2 0.61, p<0.001) burn scores. Patients who died had higher daily burn scores, while the cumulative burn score decreased with shorter duration of hospital stay (p<0.001). To our knowledge this is the first long term analysis and validation of a system for scoring burn interventions in patients with burns that explores its association with the factors important for outcome. Calculations of costs are based on the score, and it provides an indicator of the nurses' workload. It also gives important information about the different dimensions of the care provided from thorough investigation of the scores for each category.
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Elmasry M, Steinvall I, Abdelrahman I, Olofsson P, Sjoberg F. Changes in patterns of treatment of burned children at the Linkoping Burn Centre, Sweden, 2009–2014. Burns 2017; 43:1111-1119. [DOI: 10.1016/j.burns.2017.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/16/2017] [Accepted: 02/20/2017] [Indexed: 11/26/2022]
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Abdelrahman I, Elmasry M, Steinvall I, Fredrikson M, Sjoberg F. Improvement in mortality at a National Burn Centre since 2000: Was it the result of increased resources? Medicine (Baltimore) 2017; 96:e6727. [PMID: 28640072 PMCID: PMC5484180 DOI: 10.1097/md.0000000000006727] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to find out whether the charging costs (calculated using interventional burn score) increased as mortality decreased.During the last 2 decades, mortality has declined significantly in the Linköping Burn Centre. The burn score that we use has been validated as a measure of workload and is used to calculate the charging costs of each burned patient.We compared the charging costs and mortality in 2 time periods (2000-2007 and 2008-2015). A total of 1363 admissions were included. We investigated the change in the burn score, as a surrogate for total costs per patient. Multivariable regression was used to analyze risk-adjusted mortality and burn score.The median total body surface area % (TBSA%) was 6.5% (10-90 centile 1.0-31.0), age 33 years (1.3-72.2), duration of stay/ TBSA% was 1.4 days (0.3-5.3), and 960 (70%) were males. Crude mortality declined from 7.5% in 2000-2007 to 3.4% in 2008-2015, whereas the cumulative burn score was not increased (P = .08). Regression analysis showed that risk-adjusted mortality decreased (odds ratio 0.42, P = .02), whereas the adjusted burn score did not change (P = .14, model R 0.86).Mortality decreased but there was no increase in the daily use of resources as measured by the interventional burn score. The data suggest that the improvements in quality obtained have been achieved within present routines for care of patients (multidisciplinary/orientated to patients' safety).
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Affiliation(s)
- Islam Abdelrahman
- Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ingrid Steinvall
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjoberg
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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10
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Abstract
The hand is commonly affected in burn injuries. Joints and extensor tendons are vulnerable given their superficial location. Durable coverage that permits relative frictionless tendon gliding and minimizes scar contracture is required to optimize functional outcomes. When soft tissue donor sites are limited, the use of dermal skin substitutes provides stable coverage with minimal scarring, good mobility, and acceptable appearance. A comprehensive review of dermal skin substitutes and their use with burn reconstruction of the hand is provided.
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Affiliation(s)
- Ian C Sando
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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Abdelrahman I, Elmasry M, Olofsson P, Steinvall I, Fredrikson M, Sjoberg F. Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care. PLoS One 2017; 12:e0174579. [PMID: 28362844 PMCID: PMC5376076 DOI: 10.1371/journal.pone.0174579] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 03/06/2017] [Indexed: 11/19/2022] Open
Abstract
Total duration of stay adjusted for percentage of the total body surface area burned (TBSA%) is a commonly used outcome measure in burn care. However, it has been criticised as it is affected by many factors, some of which are not strictly part of burn care. A division into operative stay and postoperative stay may improve this measure. The aim was to evaluate if operative stay can serve as a more standardised measure by: comparing the variation in operative stay/TBSA% with the variation in total stay/TBSA%, and to study different factors associated with operative stay and postoperative stay.
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Affiliation(s)
- Islam Abdelrahman
- Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Pia Olofsson
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ingrid Steinvall
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- * E-mail:
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjoberg
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden
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Capo JT, Kokko KP, Rizzo M, Adams JE, Shamian B, Abernathie B, Melamed E. The use of skin substitutes in the treatment of the hand and upper extremity. Hand (N Y) 2014; 9:156-65. [PMID: 24839416 PMCID: PMC4022963 DOI: 10.1007/s11552-013-9587-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The introduction of skin substitutes in the last decade has dramatically changed how we think about the concept of "non-healing" wounds. Their use has improved prognosis and reduced morbidity in the treatment of open wounds. This article aims to summarize the development of tissue-engineered skin substitutes, discuss their use, and highlight some specific applications in different clinical settings.
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Affiliation(s)
- John T. Capo
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 240 East 18th Street, New York, NY 10003 USA
| | - Kyle P. Kokko
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003 USA
| | - Marco Rizzo
- Department of Orthopaedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 USA
| | - Julie E. Adams
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street Suite R200, Minneapolis, MN 55454 USA
| | - Ben Shamian
- Department of Orthopaedic Surgery, University of Medicine and Dentistry of New Jersey, Doctor’s Office Center 90 Bergen Street, Newark, NJ 07101-1709 USA
| | - Brenon Abernathie
- Division of Plastic Surgery, Department of Surgery, University of Medicine and Dentistry of New Jersey, 140 Bergen Street, Suite E1620, Newark, NJ 07101-1709 USA
| | - Eitan Melamed
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003 USA
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Jansen LA, Hynes SL, Macadam SA, Papp A. Reduced Length of Stay in Hospital for Burn Patients Following a Change in Practice Guidelines. J Burn Care Res 2012; 33:e275-9. [DOI: 10.1097/bcr.0b013e31824d1acb] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Abstract
Several skin substitutes are available that can be used in the management of hand burns; some are intended as temporary covers to expedite healing of shallow burns and others are intended to be used in the surgical management of deep burns. An understanding of skin biology and the relative benefits of each product are needed to determine the optimal role of these products in hand burn management.
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Affiliation(s)
- Richard Benjamin Lou
- Firefighters' Regional Burn Center, 890 Madison Avenue, Suite TG 030, Memphis, TN 38117, USA
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Jeng JC, Bridgeman A, Shivnan L, Thornton PM, Alam H, Clarke TJ, Jablonski KA, Jordan MH. Laser Doppler imaging determines need for excision and grafting in advance of clinical judgment: a prospective blinded trial. Burns 2004; 29:665-70. [PMID: 14556723 DOI: 10.1016/s0305-4179(03)00078-0] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Clinicians' judgment as to which burns require excision and grafting remains one aspect of burn care without objective measurements. This study presents a prospective, blinded trial to assess decision to operate by laser Doppler imaging (numerical criteria) versus the clinical judgment of an experienced burn surgeon. METHODS A number of 23 patients were enrolled in this prospective trial and 41 representative wounds of indeterminate depth were selected for observation. Daily determination of need to operate (burn depth) was made by a single burn surgeon. Laser Doppler imager (LDI) scans of the same wounds were simultaneously obtained, and not revealed to the clinician. Data analysis compared quickness of decision to operate by LDI to the clinician's judgment. Concurrence of decisions by either method was compared. RESULTS A total of 23 patients and 41 wounds were analyzed. LDI and the surgeon agreed in determination of wound depth 56% of the time (23/41, P=0.031). Biopsy confirmation was obtained for 21 wounds. The surgeon's determination of burn depth was accurate in 71.4% of wounds biopsied (15/21). When the LDI scan median flux indicated need for excision, it was 100% accurate (7/7). When both the surgeon and the LDI were correct in assessing wound depth, LDI would have saved median number of 2 days (minimum=0, maximum=4). CONCLUSION LDI allowed for earlier, objective determination of need to operate. Concurrence with clinical judgment in this blinded study was excellent. LDI should be seen as an effective aid to clinical judgment when contemplating excision of burns with indeterminate depth.
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Affiliation(s)
- J C Jeng
- The Burn Center, MedStar Research Institute, Washington, DC, USA.
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16
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Dai YT, Chang Y, Hsieh CY, Tai TY. Effectiveness of a pilot project of discharge planning in Taiwan. Res Nurs Health 2003; 26:53-63. [PMID: 12532367 DOI: 10.1002/nur.10067] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to examine the effects of a nurse-designed discharge-planning project in a teaching hospital in Taiwan. A before-and-after quasi-experimental design was used. Craniotomy (n = 112) and stroke (n = 171) patients were recruited and divided into control and intervention groups. Outcome indicators included length of hospital stay, change in activities of daily living (ADL), rate of nursing home placement, rate of unplanned readmission, and level of satisfaction. In the stroke sample length of hospital stay was shorter in the intervention group than in the control group. In the craniotomy sample unplanned readmission was less frequent in the intervention group than in the control group. No differences were found between the control and intervention groups in other outcome indicators.
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Affiliation(s)
- Yu-Tzu Dai
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
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Katz DL, Mazhari R, Kalus R, Nawaz H. Preventable inpatient time: adequacy of electronic patient information systems. Am J Public Health 1999; 89:1885-9. [PMID: 10589326 PMCID: PMC1509012 DOI: 10.2105/ajph.89.12.1885] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study assessed hospital electronic patient information systems (EPIS) for inclusion of variables associated with avoidable and extended hospitalization (preventable inpatient time). METHODS We searched MEDLINE and HealthSTAR databases to identify predictors of preventable inpatient time. We then audited the admissions process and the handwritten medical record at 1 hospital, and the EPIS at all hospitals, affiliated with the Yale University School of Medicine for inclusion of the predictors. RESULTS Whereas the written medical record included all 58 predictors, the EPIS of the 10 hospitals surveyed included an average of only 38% of the predictors. CONCLUSIONS The conventional approach to information gathering during hospital admission is highly inefficient. Revising EPIS to include predictors of preventable inpatient time could enhance efficiency and quality, while reducing costs, of hospital care.
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Affiliation(s)
- D L Katz
- Department of Preventive Medicine, Griffin Hospital, Derby, Conn. 06418, USA.
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Abstract
The Balanced Scorecard provides a model that can be adapted to the management of any burn center, burn service or burn program. This model enables an organization to translate its mission and vision into specific strategic objectives across the four perspective: (1) the financial perspective; (2) the customer service perspective; (3) the internal business perspective; and (4) the growth and learning perspective. Once the appropriate objectives are identified, the Balanced Scorecard guides the organization to develop reasonable performance measures and establishes targets, initiatives and alternatives to meet programmatic goals and pursue longer-term visionary improvements. We used the burn center at the University of Colorado Health Sciences Center to test whether the Balanced Scorecard methodology was appropriate for the core business plan of a healthcare strategic business unit (i.e. a burn center).
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Affiliation(s)
- T L Wachtel
- Centura Health St. Anthony Central Hospital, University of Colorado Health Sciences Center, Department of Surgery, Denver, USA
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