Patient Reported Experiences of their Treatment and Recovery at the Severe Burn Injury Unit, Royal North Shore Hospital

Julia Kwiet,1 Anne Darton2 ,Dale Forbes3, Peter Hawkins1, Loyola McLean4

1 NSRHS Social Work Department, Royal North Shore Hospital, NSW, 2075 juliakwiet@health.nsw.gov.au 2 Agency for Clinical Innovation Statewide Burn Injury Service (SBIS), NSW 2065 3 SBIS Consumer Representative. NSW 4 Academic Psychiatry, Royal North Shore Hospital, NSW, 2075 

Abstract:

Engaging patients and families is acknowledged as a key component to achieving high quality health care as it will affect their recovery and overall outcome. For this reason it is important to look specifically at our patient’s experiences and bring their voices and needs to the forefront.
This project seeks to capture patient’s reported experiences of their treatment and recovery. This information can help the burns team understand the needs of their patients more fully and assist with improving service delivery and recovery.
A burns specific patient reported experience measure (PREM) will be designed and used to capture burn patient’s perceptions of their health care experience. In particular to understand more about what facilitated and aided recovery and what could be improved upon.
This project was initiated by the SBIS consumer representative and will develop in close collaboration between burns clinicians and consumers. The main objectives are to collect data on what patients and family found helpful in their recovery and foster closer partnerships between consumers and clinicians. This is particular important given the highly complex and chronic condition of severe burn injuries.


Biography:

BQIP: Driving Improved Burn Care Through Registry Data

Ms Yvonne Singer

Abstract:

In recent decades, research and advances in treatment have contributed to significant improvements to burn care, and the quality of life following injury. Nevertheless, significant evidence gaps and high variations in clinical practice remain; the effects of which are largely unknown. The Burn Registry of Australia and New Zealand (BRANZ) collects data on patients admitted to all 17 Australian and New Zealand specialist burns units regarding burn injury, pre-existing conditions, clinical quality indicators, and in-hospital outcomes. As such, the BRANZ is an ideal platform to close knowledge gaps and inform best practices.
A successful 2017 HCF Research Grant has provided the opportunity to use the BRANZ data to quantify practice variation and establish if, and how this variation impacts patient outcomes. This important piece of work sets the standard for the future, and will drive quality improvement initiatives and the development of best practice guidelines, which have great potential to improve the quality of burn care and patient outcomes in the region.
This project is relevant to all Australian and New Zealand burn units and clinicians, whose commitment and collaboration have contributed significantly to the substantial successes of BRANZ thus far, and is reliant on them in the future. Stage one of this multi-centre study is currently underway. This presentation will summarise key findings from Stage one data analysis, discuss its implications, and lay out a plan for the future regarding the use of BRANZ data and the binational Burn Quality Improvement Program as quantitative bases to drive improvements in burn care and patient outcomes.


Biography:

Expanding the army in the fight against burn scars

Ms Madeleine Jacques1, Ms Stephanie Wicks1, Mrs Claire Toose1

1The Childrens Hospital At Westmead, Westmead, Australia

Abstract:

Background:Burn injuries require specialist management to heal and prevent contractures which may lead to devastating life-long functional limitations. The Kidsburns Telehealth service enables equitable state-wide access to specialist burns expertise, allowing a large proportion of minor burn injuries to be treated closer to home. This presentation will provide an update on the Kidsburns Murrumbidgee telehealth project with specific emphasis on the important extension to include allied health.

Main body:Collaborative management of children across NSW has decreased travel time, cost and family disruption, and enabled local supported management of minor burn injuries; this is only effective if an equitable service can be provided otherwise children are treated at CHW. In 2016 >25% of children attending lived outside of Sydney.

In the Murrumbidgee LHD, a structured and supported rollout of such services is in progress, culminating in the development of a collaborative care model. This has been achievable with significant education and up-skilling of local staff. Similar investment to date has not been reciprocated in rural scar management and rehabilitation, resulting in limited capability and capacity to manage burn injury scars outside of CHW. Local allied health outreach strategies are being formulated to address not only the geographical barriers, but additional financial and social factors which impact on a family’s ability to engage in a successful therapy program.

Conclusion: Specialist expertise is required in the treatment of paediatric burn injury and scar prevention/management. The Murrumbidgee telehealth project has supported local burn management but requires more formal collaborative processes to include allied-health staff engagement to deliver ongoing scar management and join the fight against scarring.


Biography:

Madeleine has worked as a Nurse at The Children’s Hospital at Westmead since 2009. She has found a passion in the challenging and unique area of paediatric burn injury and is currently employed as a Nurse Practitioner in the outpatient burns and plastics treatment centre.

The long term impact of burns on the immune system

Mr. Blair Johnson1, Associate Professor Matthew Linden1, Dr Andrew Stevenson2, Dr. Thirthar  Vetrichevvel2, Professor Fiona Wood2, Associate Professor Mark Fear2

1Pathology and Laboratory Medicine, University of Western Australia, Crawley, Australia, 2Burn Injury Research Unit, University Of Western Australia, Crawley, Australia

Abstract:

Burns are a significant cause of morbidity and mortality worldwide (Brusselaers et al., 2010), and while the acute impact of severe burns has been thoroughly studied, the long-term impacts are only more recently coming to light. Epidemiological evidence of long term effects include increased overall mortality risk (Duke et al., 2015) , increased rates of diabetes (Duke et al., 2016), increased cancer risk (Duke et al., 2014) and many others. The mechanisms underpinning this long-term morbidity are yet to be elucidated. However, it is well known that burn injury causes significant acute immune dysfunction and we hypothesise that this disruption to immune function is sustained and is key to the long-term morbidity observed in burn patients.

To investigate the long-term changes in immune function we have investigated the immune profiles of pediatric patients at least 2 years after their burn injury for cellular and cytokine profile changes. We have identified significant changes in the levels of circulating cytokines in patients when compared to age and gender matched non-injured control samples. We have also identified significant changes in circulating antibodies to vaccination antigens in the burn patient cohort.

Together the data suggests that there are long-term changes to circulating immune markers and likely to immune function in the pediatric burn injured population. Further work to understand the functional impacts of these changes and potential links to long-term morbidity will be important to truly understand the impact of burn injury on the lifetime health trajectory of patients.

References
Brusselaers N, Monstrey S, Vogelaers D, et al. (2010) Severe burn injury in Europe: a systematic review of the incidence, etiology, morbidity, and mortality. Critical care 14: R188.
Duke JM, Bauer J, Fear MW, et al. (2014) Burn injury, gender and cancer risk: population-based cohort study using data from Scotland and Western Australia. BMJ open 4: e003845.
Duke JM, Randall SM, Fear MW, et al. (2016) Increased admissions for diabetes mellitus after burn. Burns 42: 1734-1739.
Duke JM, Rea S, Boyd JH, et al. (2015) Mortality after burn injury in children: a 33-year population-based study. Pediatrics 135: e903-e910.


Biography:

Andrew Stevenson is a junior postdoc working at the Burn Injury Research Unit at the University of Western Australia. He was awarded his PhD in 2016 titled “Investigating the role of epigenetics in scar maintenance” from UWA, and has been lucky to continue on this and other research focused on the mechanisms and treatment of fibrosis at the Burn Injury Research Unit.

Benchmarking Burn Data Across the Pacific

Dr Lincoln Tracy1, Ms Yvonne Singer2, Professor Palmer Bessey3, Professor Michael Peck4,5, Mr Bart Phillips6, Dr Judy McInnes1, Miss Heather Cleland2, Professor Belinda Gabbe1,7

1School of Public Health and Preventive Medicine,  Monash University, Melbourne, Australia, 2Victorian Adult Burns Service, The Alfred, Melbourne, Australia, 3William Randolph Hearst Burn Center, Department of Surgery, Weill Cornell Medical College, New York, USA, 4Arizona Burn Center, Maricopa Medical Center, Phoenix, USA, 5University of Arizona College of Medicine, Tuscon, USA, 6BData, Minneapolis, USA, 7Farr Institute, Swansea University Medical School, Swansea University, Swansea, Wales

Abstract:

Introduction: Comparing registry data between countries may offer insights into improving patient care. Preliminary comparisons suggest that burns patients treated in the US are older, and have a higher crude inhalation injury and mortality rate than patients treated in Australia/New Zealand. This study aimed to explore these differences further.

Methods: Admission data between July 2015 and June 2017 were examined. Patients were categorized by age (paediatric <18 years, adult 18-65 years, and seniors ≥65 years) and %TBSA (0-9%, 10-19%, 20-49%, and ≥50%).

Results: There were 5,946 admissions in BRANZ, and 48,012 in the National Burn Repository (NBR). There were more paediatrics in BRANZ (33.0% vs 24.3%, p<0.01), but fewer adults (57.4% vs 64.0%, p<0.05) and seniors (9.6% vs 10.7%, p<0.05). A higher proportion of paediatrics (4.4% vs 2.9%, p<0.05) and adults (8.2% vs 5.6%, p<0.05) in BRANZ had a TBSA ≥20%, but there was no difference for seniors (7.2% vs 7.2%). Inhalation injury for paediatrics was similar (1.3% vs 1.9%), but lower for adults (5.7% vs 6.8%, p<0.05) and seniors 6.1% vs 10.7%, p<0.05) in BRANZ. Deaths for paediatrics were similar (0.2% vs 0.5%), but lower for adults (1.4% vs 2.4%, p<0.05) and seniors (6.1% vs 10.5%, p<0.05) in BRANZ.

Summary and conclusion: Comparing registry data between countries is feasible. More BRANZ patients have large burns than NBR patients, but they are younger. Higher proportions of inhalation injury in adults and seniors may account for higher crude burn mortality in the NBR. Further data harmonization and risk adjustment is required.


Biography:

Dr Lincoln Tracy is a Research Fellow in the School of Public Health and Preventive Medicine at Monash University, where he currently works on the Burns Registry of Australia and New Zealand (BRANZ). He completed his PhD at Monash University in 2017, focusing on modulating the psychological and physiological aspects of pain experience.

Rising to the challenge of long-term follow up research in burns: reducing attrition.

Ms Martha Druery1, Associate Professor Peter Newcombe2, Doctor Cate Cameron3, Professor Jeffrey  Lipman1

1Burns Trauma and Critical Care Research Centre, UQ, Brisbane, Australia, 2School of Psychology, UQ, Brisbane, Australia, 3Jamieson Trauma Institute, RBWH, Brisbane, Australia

Abstract:

It is now well established that prospective long-term burns outcome research is essential for several reasons, including determining the extent to which people recover after a serious burn injury and as a foundation for optimising patient care and quality improvement. Identifying determinants and barriers to acceptable and optimal burns outcomes is central to developing targeted interventions, programs and models of care from all perspectives, whether it be that of the burns survivor, their family, the health service provider or society in general. Interventions and models of care are located within finite health budgets requiring cost-effectiveness analyses to ensure fair access to positive health outcomes and to deliver health services in the most cost-containing way possible, justifying the high financial cost of burn care services.

However, it is equally well established that longitudinal health research presents data retention challenges, particularly for the burns population. Attrition is recognized as the most critical threat for study bias in longitudinal follow up studies, due to the potential for participants who remained in the study to differ from those who did not. Follow up burns cohort studies typically report an attrition rate in the vicinity of 40% at 6 months post-injury. In this paper, the authors report on the methodology of their current Quality of Life Outcomes study, interviewing 274 burns inpatients during initial admission, 3-months, 6-months and 12-months post-injury with a final retention rate of 72%. Methodological procedures and pitfalls will be presented to assist other clinicians or researchers to establish tools for successful data retention practices.


Biography:

Martha Druery is currently enrolled in a Research Higher Degree at UQ, having previously worked as a Social Work Specialist in Intensive Care and Burns across adult and paediatric settings since 1997. She remains actively involved in the burns field with first author publications, private practice adjustment to injury counselling services and volunteer work as a Psychosocial Clinical Advisor with Burnslife, in Queensland. Her PhD is investigating the quantitative relationship between burns outcomes and domains such as injury, treatment, personal and social factors.

WHO Global Burn Registry (GBR)—A standardized platform for burn data collection

Dr Michael Peck1, Dr David Meddings2, Dr Henry Falk3

1Arizona Burn Center, Phoenix, United States, 2World Health Organization, Geneva, Switzerland, 3Emory Rollins School of Public Health, Atlanta, United States

Abstract:

WHO has launched the Global Burn Registry (GBR)—the first global platform for standardized data collection from burn victims. WHO and a global network of experts developed this simple data collection tool following extensive pilot testing which took place in 60 health facilities across 30 countries. The GBR will provide health facilities with a clear picture of the factors most likely to contribute to burns and the populations at greatest risk in their settings, with a view to prioritizing prevention programs.

The GBR is based on an easy-to-use data collection form that takes approximately 5 minutes to complete. Data can be accessed and exported through the online registry interface maintained by WHO. The data collection form, as well as the online interface, are available in English, French and Spanish.

The online interface allows users to view data from their health facility as well as all other participating health facilities. Data from the GBR (which are stripped of reference to information which allows identification of individual patients) are publicly available, and can be accessed and exported for further analysis by researchers and policy- makers, among others. The online platform also provides extensive data visualization and filtering capabilities.

The GBR can be accessed at http://www.who.int/violence_injury_prevention/burns/gbr/en/.


Biography:

Dr. Peck is an Associate Director of the Arizona Burn Center in Phoenix. In addition he is Clinical Professor of Surgery at the University of Arizona College of Medicine and Creighton University School of Medicine in Phoenix, and Adjunct Professor in the Division of Community, Environment and Policy at the Mel and Enid Zuckerman College of Public Health at the University of Arizona Health Sciences Center in Tucson. He currently serves on the Board of Trustees of the American Burn Association as one of the past presidents.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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