36 Developing Burn Specific Documents in the Electronic Medical Record

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S25-S25
Author(s):  
Kari Gabehart ◽  
Sara Tuvell ◽  
Christina L Cook ◽  
David Roggy ◽  
Rajiv Sood
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Fluid Resuscitation ◽  
Wound Care ◽  
Burn Wound ◽  
Monthly Basis ◽  
Team Members ◽  
Handheld Device ◽  
Burn Care ◽  
High Level

Abstract Introduction The challenge with burn documentation needs in electronic medical record systems is recognized and often limited in the foundation of commercial electronic systems. In October 2016, our institution transitioned to a new all-inclusive electronic medical record. The transition to this new Electronic Medical Record (EMR) afforded us the opportunity to develop and build burn specific documentation needs in the new EMR system. In this paper, we share our experiences and the keys to our successful builds to streamline burn patients’ documentation and information. Methods In January 2013, the EMR build team was composed of corporate contractors, dedicated clinical staff from all areas of the hospital that transitioned to the build team, and private contractors experienced in the EMR build process. To our great fortune, our burn team was provided access to four dedicated build team members that worked specifically on meeting our burn team documentation needs. With high level collaboration our team was able to assess foundation abilities of the new system, identify gaps to burn care and collaboratively create and build automated documents to meet our burn needs. In October 2016, the EMR system was implemented with our burn specific documents, flowsheets, and reports. Results Through working with our dedicated build team, we were able to create an electronic Lund-Browder Chart with an avatar that is completed with each admission by our medical team. We developed a fluid resuscitation flowsheet that is documented in real-time; displays fluid resuscitation goals; displays urine output goals. The creation of a standardized wound care note template was necessary as the wound template within the existing EMR system was too cumbersome. Burn wound photo-documentation to include inpatient, outpatient, intra-operative and emergency department needs automatically uploads into the patient’s medical record from an encrypted portable handheld device connected to the EMR. Burn specific reports were developed to meet the specific needs of inquiry whether it is for performance improvement or research. Additionally, the same EMR is used in all phases of care to include the burn clinic which allows for ease and continuity of care. Conclusions An EMR that is all-inclusive has benefitted our team and patient safety by streamlining the review and documentation of information. Having specific and dedicated EMR build specialist allocated to focusing on the needs of the burn unit was invaluable in the build, implementation, and maintenance phases. We continue to work with our EMR specialist to improve processes and documentation practices that impact patient outcomes. Our burn EMR specialist meets with the burn team on a monthly basis to evaluate and assess ongoing needs to further outcomes. Applicability of Research to Practice Within this presentation, we will share our journey, challenges, and successes.

scholarly journals Electronic Medical Record–Based Radiation Oncology Toxicity Recording Instrument Aids Benchmarking and Quality Improvement in the Clinic

2018 ◽  
Vol 14 (3) ◽  
pp. e186-e193 ◽  
Author(s):  
Kevin Albuquerque ◽  
Kellie Rodgers ◽  
Ann Spangler ◽  
Asal Rahimi ◽  
DuWayne Willett
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Radiation Oncology ◽  
Local Population ◽  
Free Text ◽  
Flow Sheet ◽  
High Grade ◽  
Recording Instrument ◽  
Uniform Sample ◽  
High Level

Purpose: The on-treatment visit (OTV) for radiation oncology is essential for patient management. Radiation toxicities recorded during the OTV may be inconsistent because of the use of free text and the lack of treatment site–specific templates. We developed a radiation oncology toxicity recording instrument (ROTOX) in a health system electronic medical record (EMR). Our aims were to assess improvement in documentation of toxicities and to develop clinic toxicity benchmarks. Methods: A ROTOX that was based on National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0) with flow-sheet functionality was developed in the EMR. Improvement in documentation was assessed at various time intervals. High-grade toxicities (ie, grade ≥ 3 by CTCAE) by site were audited to develop benchmarks and to track nursing and physician actions taken in response to these. Results: A random sample of OTV notes from each clinic physician before ROTOX implementation was reviewed and assigned a numerical document quality score (DQS) that was based on completeness and comprehensiveness of toxicity grading. The mean DQS improved from an initial level of 41% to 99% (of the maximum possible DQS) when resampled at 6 months post-ROTOX. This high-level DQS was maintained 3 years after ROTOX implementation at 96% of the maximum. For months 7 to 9 after implementation (during a 3-month period), toxicity grading was recorded in 4,443 OTVs for 698 unique patients; 107 episodes of high-grade toxicity were identified during this period, and toxicity-specific intervention was documented in 95%. Conclusion: An EMR-based ROTOX enables consistent recording of treatment toxicity. In a uniform sample of patients, local population toxicity benchmarks can be developed, and clinic response can be tracked.

Adult thermal burns

2021 ◽  
pp. 155-178
Author(s):  
Jeremy Rawlins ◽  
Isabel Jones
Keyword(s):  
Wound Care ◽  
Surgical Techniques ◽  
Patient Treatment ◽  
Burn Wound ◽  
Severe Injuries ◽  
Burn Care ◽  
The Face ◽  
Life Threatening ◽  
The Many ◽  
Dermal Matrices

Adult burn injuries are heterogeneous in their aetiology and in their severity, and in the many ways in which they affect the burns patient. Treatment should be initiated promptly, ensuring that other life-threatening injuries are dealt with, and that expert burn care is delivered to the patient. First aid followed by emergency management of the patient, fluid resuscitation, and specialist wound care ensures the patient is given the very best opportunity for full recovery and survival. The burn wound may be managed non-surgically, but for deeper and more severe injuries, surgical debridement and wound cover with grafts, cell suspensions, dermal matrices, or flaps is required. Areas of special attention include the face, hands, and perineum—all functionally and aesthetically important, and each with specific dressing needs and surgical techniques that optimize good outcomes. Scar management and physiotherapy are crucial components of adult burn care, with many therapies applied concurrently to ensure good functional and aesthetic recovery. For those patients with ongoing scar and contracture difficulties, scar therapies and reconstructive burns surgery offer the chance of better function and appearance even many years after the original burn. The journey to recovery would not be complete, however, without important psychosocial input for the burns patient, as the psychological scars are often just as painful as the physical ones.

813 Burn Care in the Patient’s Home: Development of a Secure HIPPA Compliant Process to Share Photographs with the Provider

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S245-S246
Author(s):  
Brittany Ayers ◽  
Mark Johnston ◽  
William J Mohr ◽  
Heidi M Altamirano
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Clinic Visit ◽  
Care Plan ◽  
Additional Time ◽  
Healthcare Facilities ◽  
Burn Care ◽  
Outpatient Visits ◽  
Number Of Patients

Abstract Introduction Burn Telemedicine programs are shown to improve care, increase access to specialists, provide real-time education, and reduce rates of missed outpatient visits. Many occur in acute care facilities or outpatient clinics and conducted with video technology. This center has expanded the depth of options for the care team to include a Burn Telemedicine Store and Forward Program. This program is unique in that patients receive an outpatient burn visit from their home. Methods Photographs instead of video are uploaded into the patient’s electronic medical record. The provider reviews the photographs then conducts a phone visit to review the plan of care and recommendations. This program is reserved for patients requiring outpatient evaluation and meet specific criteria including having technology available to upload photographs into the medical record, minor burns not requiring complex dressing changes, or burns located in areas needing range of motion evaluation. Burn telemedicine coordinators assist patients in creating access to their electronic medical record prior to discharge or during their initial clinic visit. Training relating to lighting, camera angles, and number of photos to include is performed. Photographs are uploaded into the medical record within a prescribed timeframe. The phone visit is then scheduled and conducted between the patient and provider. Results Benefits of this program include flexibility for patients to receive follow up care from their home, increased access to burn specialists in areas where healthcare facilities are scarce, and the ability to speak to their providers to review the care plan. Additionally, this program is beneficial to providers who have flexibility to review photographs and formulate the plan within the electronic medical record for this subset of patients instead of having them travel to a busy outpatient burn clinic. The providers bill the patient’s insurance for the phone visit. Finally, this process is fully secure and HIPPA compliant. Challenges have occurred within this program. The telemedicine coordinators have had to assist patients with limited experience with technology to upload photos into the electronic medical record which is time consuming and complex. In addition, some patients are not available during their scheduled phone visit time, resulting in additional time to reschedule their visits. Still this program has helped reduce the number of patients lost to follow up. Conclusions This program is a beneficial option for this subset of patients. Patients comment how much they appreciate the ability to do an outpatient appointment from their home. Applicability of Research to Practice This is applicable as it describes the benefits and challenges of developing a secure option for outpatient burn care. Outpatient visits directly into a patient’s home is unique and innovative.

scholarly journals Impact of Virtual Reality Technology on Pain and Anxiety in Pediatric Burn Patients: A Systematic Review and Meta-Analysis

2022 ◽  
Vol 2 ◽  
Author(s):  
Kathryn L. Smith ◽  
Yang Wang ◽  
Luana Colloca
Keyword(s):  
Systematic Review ◽  
Virtual Reality ◽  
Effect Size ◽  
Pediatric Patients ◽  
Wound Care ◽  
Meta Analysis ◽  
Combined Effect ◽  
Burn Wound ◽  
Virtual Reality Technology ◽  
Burn Care

Introduction: Virtual reality (VR) has the potential to lessen pain and anxiety experienced by pediatric patients undergoing burn wound care procedures. Population-specific variables require novel technological application and thus, a systematic review among studies on its impact is warranted.Objective: The objective of this review was to evaluate the effectiveness of VR on pain in children with burn injuries undergoing wound care procedures.Methods: A systematic literature review was performed using PubMed and CINAHL databases from January 2010 to July 2021 with the keywords “pediatric,” “burn,” “virtual reality,” and “pain.” We included experimental studies of between- and within-subjects designs in which pediatric patients’ exposure to virtual reality technology during burn wound care functioned as the intervention of interest. Two researchers independently performed the literature search, made judgements of inclusion/exclusion based on agreed-upon criteria, abstracted data, and assessed quality of evidence using a standardized appraisal tool. A meta-analysis was conducted to evaluate the effectiveness of the VR on burning procedural pain in pediatric population. Standardized mean difference (SMD) was used as an index of combined effect size, and a random effect model was used for meta-analysis.Results: Ten articles published between January 2010 and July 2021 passed the selection criteria: six randomized controlled trials and four randomized repeated-measures studies. Consistent results among the studies provided support for VR as effective in reducing pain and potentially pain related anxiety in children undergoing burn wound care through preprocedural preparation (n = 2) and procedural intervention (n = 8). A random effects meta-analysis model indicated a moderate and significant combined effect size (SMD = 0.60, 95% CI = 0.28–0.93, p = 0.0031) of VR effects on pain intensity ratings with no significant heterogeneity of VR intervention effects between studies. Only one study reported direct influence of VR intervention on pre-procedural situational anxiety with a moderate effect size (Cohen’s d = 0.575, 95%CI = 0.11–1.04).Conclusion: Children’s exposure to VR during burn care procedures was associated with lower levels of pain and pain related anxiety. Moderate to large effect sizes support the integration of VR into traditional pediatric burn pain protocols irrespective of innovative delivery methods and content required for use in burned pediatric patients.

The interaction between high-level electronic medical record adoption and hospitalist staffing levels: A focus on value-based purchasing

2021 ◽  
pp. 095148482110016
Author(s):  
Kate Jiayi Li ◽  
Mona Al-Amin
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Hospital Performance ◽  
Potential Interaction ◽  
Staffing Level ◽  
Value Based Purchasing ◽  
Individual Level ◽  
Staffing Levels ◽  
Emr Adoption ◽  
High Level

Objective This study sought to understand the relationship of hospital performance with high-level electronic medical record (EMR) adoption, hospitalists staffing levels, and their potential interaction. Materials and methods We evaluated 2,699 non-federal, general acute hospitals using 2016 data merged from four data sources. We performed ordinal logistic regression of hospitals’ total performance score (TPS) on their EMR capability and hospitalists staffing level while controlling for other market- and individual-level characteristics. Results Hospitalists staffing level is shown to be positively correlated with TPS. High-level EMR adoption is associated with both short-term and long-term improvement on TPS. Large, urban, non-federal government hospitals, and academic medical centers tend to have lower TPS compared to their respective counterparts. Hospitals belonging to medium- or large-sized healthcare systems have lower TPS. Higher registered nurse (RN) staffing level is associated with higher TPS, while higher percentage of Medicare or Medicaid share of inpatient days is associated with lower TPS. Discussion Although the main effects of hospitalists staffing level and EMR capability are significant, their interaction is not, suggesting that hospitalists and EMR act through separate mechanisms to help hospitals achieve better performance. When hospitals are not able to invest on both simultaneously, given financial constraints, they can still reap the full benefits from each. Conclusion Hospitalists staffing level and EMR capability are both positively correlated with hospitals’ TPS, and they act independently to bolster hospital performance.

VR for adjunctive analgesia during burn wound care and physical therapy

1999 ◽  
Author(s):  
Hunter G. Hoffman ◽  
David R. Patterson ◽  
Gretchen J. Carrougher ◽  
Thomas A. Furness
Keyword(s):  
Physical Therapy ◽  
Wound Care ◽  
Burn Wound
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