Abstract
Introduction
Evidence-based criteria for burn patient admission are poorly defined. Attempts have been made by commercial entities to align payors and providers with evidence-based admission criteria to optimize resource use. However, these admission criteria have not be examined critically to see if they are appropriate and effective. We developed an admission criteria algorithm based on these existing standards and have utilized it for nearly 18 months. The purpose of this study is to retrospectively review this algorithm with respect to inpatient needs and outcome to assess its effectiveness.
Methods
A retrospective chart review of patients admitted the burn center over a 1-year period was performed. Incomplete datasets were excluded. Patients were grouped by TBSA, < 10%, 10–20% and > 20%. Appropriateness of admission was measured used length of stay (LOS) as surrogate marker, hospitalizations of < 3 days, unless deceased, were deemed inappropriate (IAP) and 3 days or more as appropriate (AP).
Results
There were complete datasets for 530 patients, < 10% (n=423), 10–20% (n= 72), >20% (n=35). There were no significant differences in age, gender, or payor sources between the groups. Patients with larger TBSA burns were more likely to have suffered a flame/flash injury. All patients in the two larger TBSA groups met admission criteria per algorithm. All IAP were in the < 10% group. When compared to AP, IAP were younger, 31.6 vs. 44.0 years (p< .0001), had smaller TBSA injuries 2.8% vs. 3.5% (p=.0045), had fewer clinical findings 1.4 vs 1.8 (p< .0001), fewer interventions 1.8 vs 2.6 (p< .0001) but were more likely to have suffered burns to the head 30% vs 13% (< .00001) and neck 9% vs 3% (=.0164). AP patients were more likely to have suffered contact burns 27% vs. 17% (p=.0323), full-thickness injuries 39% vs 14% (p< .0001), involvement of a major joint 42% vs 29% (p=.0085), combined burn and trauma 3% vs. 0% (p=.0444) and burns to the buttocks 7% vs 2% (p=.0357). AP patients were also more likely to require IV analgesia 82% vs 71% (p=.0107) and evaluated as likely needing surgery 82% vs 15% (p< .00001).
Conclusions
The admission criteria algorithm performed perfectly in patients with a ≥ 10% TBSA injury. For patients with burn < 10% TBSA the algorithm was not followed as closely leading to some inappropriate admissions. Patients with smaller burns admitted appropriately were more likely to have full thickness burns, contact burns, burns over joints and to require surgery. The algorithm was highly accurate in patients with large burns, however additional refinement is needed for those patients with smaller burn injuries.
Redefining avoidable and inappropriate admissions
