80 Burn Rehabilitation: How Do You Minimize Delays?

Introduction Timely rehabilitation is vital to the functional outcomes of burn patients. The rehabilitation department at our ABA certified Burn Center determined there was a need for a more effective method to coordinate daily care in the Burn Progressive Care Unit (BPCU). The purpose of this performance improvement project was to evaluate whether our Burn Center had a problem with delays in rehabilitation and if so, develop a plan to reduce disruptions. Methods Lean Six Sigma Process Improvement Methodology guided the team in this project. A 5-question needs assessment Pre-Rehabilitation Worksheet (Pre-RW) was used to evaluate the problem. The Pre-RW asked if there was a delay; reason for delay; length of delay; communication between services; body region, and the number of cutaneous functional units (CFUs) involved. The team then analyzed data from the Pre-RWs using descriptive statistics and a Pareto chart. Results from the Pre-RWs were used to prioritize changes that would mitigate delays. Rehabilitation staff then completed Post-RWs. Pre- and Post-RW results were compared to determine if the changes decreased delays in rehabilitative care. Results From April 24 to August 5, 2018, 140 Pre-RWs were completed in the BPCU; 24 were incomplete/omitted. Rehabilitation encounters that were delayed or canceled were 37.9% (n=53). Of these, 64% were delayed but eventually completed. The top 3 reasons for delay were: dressings down for morning rounds (DFR, 26%); wound care in progress (19%); patient refusal (16%). In 47% of the encounter delays the patients had over 15 CFUs involved. Improvements were made as follows: DFR assessment became part of the bedside rounds process; wound care orders were placed prior to 9 a.m.; patients were offered evening wound care. Communication improved through the use of a whiteboard, hands-free voice-call badges, and a time frame for coordinating the plan of the day. Following the improvements, Post-RWs (n=131) were collected from May 1 to July 30, 2019. 23.8% of all encounters were delayed or canceled. Of these, 51% were delayed but performed. The 3 chief reasons for delay were patient refusal, 38%; untimely dressing changes, 19%; and medical issues, 13%. In 84% of the deficit encounters 0–15 CFUs were involved. Conclusions Our burn center was able to define a problem with delays in rehabilitation and mitigate delays. This project demonstrates that deliberate changes decrease delays in rehabilitation. Applicability of Research to Practice Care of the burn patient requires a structured interdisciplinary, systems approach. Burn centers can improve outcomes by adopting a plan to improve coordination of services.