60 years Burns Service at the Women’s and Children’s Hospital, South Australia

HP Chong1, E Gibson1, L Quinn1R Cooksey1,D Molony1,A Jeeves1, M Lodge1,B Carney1

1Women’s And Children’s Hospital, North Adelaide, Australia

Abstract:

Introduction: Burns are a preventable cause of pediatric injury with over 100 000 annual hospitalizations. The authors hypothesize that analysis of injury patterns can generate age-specific and injury-specific prevention strategies to reduce these injuries.

Methods: A retrospective study of data from the unit’s local registry was collected over a 50 year period. Cross-tabulations were employed to examine associations. An analysis of variance model was used to examine differences in injury pattern.

Results: Treating burns in children less than 1 year accounted for the majority of inpatient and outpatient service. The most common mechanism of injury was scalds from a hot beverage or hot noodles, followed by contact burn to iron, and friction burns from treadmill.

CONCLUSIONS:
We would like to place emphasis on public education targeting parents with infants to exercise extra precaution in circumstances that can result in these accidental burn injuries.


Biography:

HP Chong is the Burns Fellow at WCH and previous unaccredited registrar at Flinders Medical Centre

The Cause of Death among Patients with Burn Injuries in Burn Unit of Cipto Mangunkusumo Hospital

Aditya Wardhana1,2, Lara Aristya2, Claudio Agustino2, Radhianie Djan1, Zainul Halim1

1 Burn Unit, Cipto Mangunkusumo National General Hospital, Jalan Pangeran Diponegoro No. 71, Jakarta, 10430

2 Faculty of Medicine, Universitas Indonesia, Jalan Salemba Raya No. 6, Jakarta, 10430

Abstract:

Background: Burn injuries are highly associated with disability and mortality worldwide. Although the current advancement of therapy had improved the outcome, there are still many death cases among burn patients.

Objectives: This study aims to investigate the cause of death among patients with burn injuries in order to evaluate our burn unit as the basis in improving standards through a greater depth of understanding the trends of mortality in our burn unit service.

Method: We conducted a retrospective study. The data of burn patients died between January 2016 and December 2017 in Burn Unit of Cipto Mangunkusumo Hospital were collected. Subsequently, several literatures were reviewed to compare the data collected with studies conducted in other burn units.

Result: Eighty-six patients (27,4%) were died during hospitalization, 54 of whom were male (62,8%). The average age was 38,8. Eighty-three patients (96,5%) had burn extent over 20% TBSA and the average length of stay was 11,4 days. The most common cause of death was flame (n=67; 78%). The majority cause of death was multiple organ failure (n=76; 88,4%). Pseudomonas aeruginosa was the most common organism isolated among the death patients (n=30; 27,8%).

Discussion: The major cause of death among patients with burn injuries in our unit was multiple organ failure, triggered primarily by sepsis, which accorded with the literatures reviewed.

 

Keywords: burn, cause of death, mortality


Biography:

Lara Aristya is a medical student of Faculty of Medicine Universitas Indonesia. She has high interest in science and research field. She had participated several research competitions and conferences, both national and international. Lara has done a publication about fluid resuscitation and vasoactive usage for septic shock patient in Cipto Mangunkusumo National General Hospital Intensive Care Unit. She also has been actively participating in several national and international symposiums and workshops about medical field.

Implementing a Nurse Practitioner led burn ambulatory care clinic. Review of the effectivieness of the role 4 years post implementation.

Mr Peter Campbell1

1Royal North Shore Hospital, Concord, Australia

Abstract:

The role of a Nurse Practitioner in the burns ambulatory care environment is a relatively new concept and has required a change in Care Modelling. This paper aims to describe the impact a Nurse Practitioner can have in the burns ambulatory care environment, and the support required from both Nursing & Medicine to enable the role to be implemented and supported. How a Nurse Practitioner can aide in enhancing Multidisciplinary and Interdisciplinary involvement in patient care will be discussed. An analysis of statistics for the past 4 years will be discussed to demonstrate the impact a Nurse Practitioner can have on patient management.

The 4 pillars of Nurse Practitioner practice will be examined to demonstrate what differences in outpatient care can be achieved.


Biography:

Worked in Burns & Plastics for 29 years. Has been a member of ANZBA for 23 years and regularly helps coordinate EMSB courses. Has worked in several roles in burns including Management and clinician positions, he has an OAM for his contribution to burn education and burn development.

Epidemiology of burns patients admitted to the State-wide Adults Burns Service in Queensland: A 10-year Review

Ms Jacelle Warren1, Dr Cate Cameron1, Dr Michael Muller2

1Jamieson Trauma Institute, Herston, Australia, 2Royal Brisbane & Women’s Hospital Burns Unit, Herston, Australia

Abstract:

Introduction:The last epidemiological review of adult burn injuries in Queensland was 15 years ago. It is important to have updated data for this cohort so effective burns services can be maintained, and a base for assessing the impact of new treatments/initiatives (e.g. the introduction of the Skin Culture Centre, introduction of the National Injury Insurance Scheme Queensland (NIISQ)) can be established.

Aims: To describe the incidence, demographic, injury, acute treatment and acute outcomes of adult burn patients admitted to the RBWH Burns Unit.

Methods: A secondary analysis of data is being undertaken on adult burns patients admitted for acute treatment to the RBWH Burns Unit between 01 January 2008 and 31 December 2017.

Results: Between 2008 and 2017, there were 3,950 acute admissions to the RBWH Burns Unit. Males (Median age = 36yrs, IQR = 24 – 51yrs) accounted for 72% of acute admissions. Initial analyses suggest that flame-related burns were common, most burns occurred within a dwelling/yard, and 20% either involved motor vehicle or work-related accidents. As expected, there was frequent use of surgical interventions, ICU admissions and length of acute hospital stays (LOS) longer than 1 week. There were 69 (1.7%) deaths. Trend analyses over the 10 years in relation to demographic, injury, acute treatment and outcomes will be presented.

Conclusion: These finding are relevant to clinicians and trauma care services within Queensland, as well as to external key stakeholders such as WorkCover and Insurance Regulators, in light of the recently introduced NIISQ.


Biography:

Ms Warren is a Biostatistician in the Jamieson Trauma Institute and has previously spent ten years working in data management, data analysis and reporting of injury data collected by the Queensland Trauma Registry (QTR).

Ms Warren has extensive experience with statistical analysis of large injury datasets, both cross-sectional and longitudinal, and has a particular interest in the physical and psychological recovery of injured people.

Reducing waste: The STAR project (Streamlining Theatre equipment And Resources)

Dr Kiran Narula1, Ms Helen Douglas1, Mrs Carina Doran1, Dr Justin Bui2, Ms Esther Dawkins3, Prof Fiona Wood1, Prof Suzanne Rea1

1State Adult Burns Unit, Fiona Stanley Hospital, Perth, Australia, 2Medical Education Unit, Fiona Stanley Hospital, Perth, Australia, 3Institute of Health Leadership, Department of Health, Perth, Australia

Abstract:

Background:Between 20-70% of all hospital waste comes directly from the operating room. Up to 90% of this waste is improperly sorted and sent for costly hazardous-waste processing. Using the Define, Measure, Assess, Improve, Control (DMAIC) model of service improvement, the use of consumables and surgical instruments in our theatres were assessed to estimate environmental and financial waste.

Methods: All surgical procedures performed in adult burns and general surgery theatres over a 4-week period were directly observed, recording number of all consumables (e.g. drapes, bandages, blades) opened and used. The surgical instruments used during the case was also recorded and confirmation of all numbers checked with the scrub nurse and surgeon at the conclusion of the procedure.

Results:Fourteen minor burn (<10% TBSA) operations and 22 general surgery operations were reviewed. In burns theatres 15% (n=113) of consumables opened went unused. In general surgery theatres 29% (n=298) of consumables opened went unused.
Regarding surgical instruments on the tray; in the burns theatre an average of 7 instruments (95% CI ± 1.8; range 0-13) out of 30 were used in each operation whilst in the general surgery an average of 13 instruments (95% CI ± 1.5; range 6-16) out of 24 available were used.

Discussion: Improving efficiency, choosing wisely and eliminating unnecessary waste are concerns for healthcare organisations globally. Reviewing usage of theatre consumables and surgical instrument trays can reveal opportunities for improvement. The use of pre-operative planning strategies, effective surgical briefs and regular audit can assist this process.


Biography:

Kiran is a surgical registrar at Fiona Stanley Hospital. He holds an interest in clinical redesign.

A review of The National Burn Centre referral patterns

Nicholas Solanki1, Sarah Shugg1, Tess Brian1, Richard Wong She1

1The National Burn Centre, Middlemore Hospital, Otahuhu, New Zealand

Abstract:

Introduction: The National Burn Centre (TNBC) at Middlemore Hospital in Auckland first opened in 2006.  Its role is to provide care for the most severely burn-injured patients from around New Zealand, receiving referrals from the regional burns units. In addition, TNBC also treats severe burn patients transferred from Tahiti according to a government agreement.

Methods: A review of the first 10 years of TNBC from 2006 to 2016 was performed to assess referral patterns using data gathered from the burn database at Middlemore Hospital. The primary focus was on acute patients that were transferred from other regions or who met TNBC referral criteria.

Results: Over this period there were 3398 burn admissions to Middlemore Hospital. Of these 361 fulfilled TNBC referral criteria.

Conclusions: 56% of patients were transferred from the ‘local’ region (Auckland and Waikato) while fewer patients were transferred from the units located farther away (Hutt and Christchurch). Just over half of all patients had an injury less than the referral criteria of 30% TBSA, indicating they had smaller but more complex burn injuries. The median age of patients from Auckland was significantly higher (P=0.001, Students T-test). The median length of stay was slightly higher in the patients from Auckland and Tahiti, as patients referred from other regional units were transferred back once their acute surgery was complete.


Biography:

Sarah Shugg is a Plastic and Reconstructive Surgery registrar in NZ currently working as part of the burn team at The National Burn Centre at Middlemore Hospital.”

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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