Dr Ian Loh1, Ms Yvonne Singer1, Dr Heather Cleland1
1Alfred Health, Prahran, Australia
Severe burn patients (>20%TBSA) experience endocrine, inflammatory, metabolic & immune changes which require tailored nutritional support. Best practice evidence demonstrates that nutritional support should begin within 24 hours of injury & the best route is via enteric feeding. Early enteric feeding (EEF) attenuates the levels of stress hormone, reducing the hyper metabolic response & reduces the rates of stress ulcer, ileus, risk of malnutrition & attenuation of stress hormone levels & the hyper-metabolic response. The Burns Registry of Australia & New Zealand (BRANZ) utilises a clinical quality indicator (QI) to measure individual unit adherence to Enteral/Parenteral feeding within 24 hours of injury. This QI was validated as an appropriate predictor of burn care quality based on a retrospective analysis of BRANZ data, conducted using quantitative registry data from July 2009 to June 2014 (n=11,653).
In 2014, a retrospective cohort study on VABS admissions from 2009-2012 was performed to assess VABS performance in relation to the above QI & identify systemic issues that influence compliance with this QI. VABS developed admission protocols in conjunction with ED, dietetics and within the Burns unit with the aim of improving quality of care based on initial burn injury findings. This study evaluates compliance with the early enteral nutrition guidelines initiated in 2014 & analyses how the installed protocols have affected severe burn patient’s quality of care in the intervening 4 years (2014 -2018).
SET 5 Plastic Surgery trainee with an interest in Burn Surgery
Early Nutritional Support Following Severe Burn Injury (>20%TBSA): A Victorian Adult Burns Service (VABS) systems review
Ian Loh1, Yvonne Singer2, Heather Cleland3
1Plastic Surgery registrar, Alfred Hospital
2Burns Program Director, VABS, Alfred Hospital
3Plastic Surgery, VABS Director, Alfred Hospital