The impact of a Protocol harnessing the multidisciplinary approach : Singapore General Hospital Protocol

A.Prof. Si Jack Chong1, Dr Weihao Liang1

1Singapore General Hospital, Singapore, Singapore

Abstract:
Introduction: The multidisciplinary Singapore General Hospital (SGH) Protocol was implemented in May 2014 to standardize treatment for all burns patients, incorporate new techniques and materials, and streamline workflow amongst the entire multidisciplinary team. This study aims to analyse the effects of the Burns Protocol 2 years after its implementation.

Methods: Using a REDCAP electronic database, all burns patients admitted from May 2013 to April 2016 were included. The historical control group comprised of patients admitted from May13 to Apr14 (n=96). The post-implementation prospective study cohort consisted of patients admitted from May14 to Apr16 (n=243). Details included age, gender, comorbidities, Total Body Surface Area (TBSA) burns, time till surgery, number of surgeries, number of positive tissue and blood cultures and length of hospital stay(LOS).

Results: There was no difference in the dermographics. The study group had a significantly shorter time to surgery (20.8h vs 38.1h, p<0.0001). The study group averaged fewer surgeries performed (1.96 vs 2.29, p=0.285), which, after accounting for the extent of burns, was statistically significant (surgeries/TBSA 0.324vs0.506, p=0.0499). The study group also had significantly shorter LOS (12.5d vs 16.8d, p=0.0273), a shorter LOS/ TBSA burns (0.874d vs 1.342d, p=0.0101) and fewer positive tissue cultures (0.6vs1.3, p=0.0003). The study group also trended towards significantly fewer positive blood culture results (0.09 vs 0.35, p=0.0593). In 2016 the overall mortality was less than 1% lower than the 2.7% previously .

Conclusion: The SGH protocol introduced a systematic multidisciplinary management, resulting in improved patient outcomes, lowered costs and improved resource utilization.

Biography:

Dr Chong is currently consultant plastic surgeon, medical director skin bank unit and director emergency preparedness in Singapore Healthcare Group. His area of interest include trauma reconstruction, acute burns management and emergency preparedness.

He spent a year in 2011 in the Royal Adelaide Hospital where the training in burn management laid the foundation for the protocol that was implemented in 2014.

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