123 Burn Patients’ Pain Experiences and Perceptions at a Regional Burn Center

Abstract Introduction Burns are often painful injuries, associated with a long recovery. Little is known about patients’ pain experience or understanding of burn pain. Patients may also not be receiving sufficient pain education to optimize their pain experience. The aim of this project was to obtain patients’ perspectives to inform future burn pain education efforts at a regional burn center. Methods We conducted mixed-methods interviews in inpatient and outpatient units. Participants were >=14 years with acute burn injury, who received at least two wound care episodes, and were able to cognitively participate. Provider stakeholders designed the interview using a modified Delphi technique. Survey questions focused on patients’ pain experiences, understanding and desire to gain knowledge of burn pain and management. Descriptive quantitative analysis was performed on categorical data. Recorded interview segments were transcribed for content analysis using an online, HIPAA-compliant software. Results We interviewed 21 adult burn patients. Participants reported variable pain and pain management effectiveness, with inpatients reporting more severe pain than outpatients. Only 11% of inpatients reported having received enough pain information, compared to 50% of outpatients. Participants expressed, in decreasing order of importance, a need for more information on burn-related pain, medications and alternative treatments, analgesic weaning, and addiction risk. In-person education ranked as the most desirable education method, followed by pamphlets and video education. Qualitative content analysis yielded 3 major themes: patient’s pain experience, range of expectations, and clinical information/services desired. Mental and physical effects were key parts of participants’ pain experiences, with many participants reporting mental anguish in addition to pain. Most participants’ pain expectations were matched by their experience, while some individuals described higher pain levels than they anticipated. Positive experiences with the burn care team primarily revolved around provided education and information on pain, whereas negative experiences concentrated on wound care events. Participants desired more information on sleep and pain medications, realistic expectations of recovery timelines, and available mental health services. Conclusions Burn patients report variable pain experiences and a strong desire to receive additional pain education. This project informs key strategies to educate burn patients on pain. A high-level of interest in pain, pharmacologic and alternative therapies, weaning and addiction risks indicates a need for newer targeted education materials. Applicability of Research to Practice Burn patients’ perspectives help inform strategies and content creation for education materials that burn centers can provide.

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581 Basecamp: Burn Efficiency Care Pathway

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.207 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S132-S132

Author(s):

Carolyn B Blayney ◽

Nicole S Gibran

Keyword(s):

Burn Injury ◽

Care Pathway ◽

Wound Care ◽

Medical Center ◽

Patient Specific ◽

Improvement Project ◽

Burn Care ◽

Burn Center ◽

Resuscitation Guidelines ◽

Standard Operating

Abstract Introduction Standardizing care has shown in the literature to be a means to improving the culture of safety in any field. Aligning burn surgeons, staff and ancillary services in the Burn ICU, Burn Acute Care floor, Burn Clinic who all have varying ideas, and plans of care creates toxic variation and communication challenges for bedside staff. While attending a medical center leadership development session, Burn Center Leadership collaborated on a project regarding burn center standardization. Methods A multidisciplinary Burn Center retreat in September 2017, launched the effort with a special emphasis on patient and family participation.We elicited feedback on what we did well and areas we could improve on. Using crowdsourcing methodology, the group selected 5 core QI/PI areas: resuscitation, wound care, pain/anxiety/delirium, physical mobility and psychosocial needs.Each multidisciplinary group, led by a non-physician chair and a Physician liaison established assigned tasks, rules of engagement and time frames. Work groups met weekly and reported progress to the Burn center QI committee.The project concluded with dissemination of the work products to staff. Patients and families were updated on the progress made to ensure we were still in alignment with our original goals. Results Burn Center orientation materials, standard operating practice documents and a Burn Center Standard of Care packet was developed. Documents were uploaded to a commonly accessible Burn Center Sharepoint website so there was one central source of information. The final BasECamP output was a daily checklist packet started on all BICU admits, that addressed key QI indicators and directives for care goals; 24 hr resuscitation guidelines, time to TF vs PO within 4 hrs of admit, daily weights, IV vs PO medication for wound care, time to first active mobility and a review of ICU and Hospital LOS per %TBSA. 71 adult burn patients >18 years admitted to the BICU between November 2018 and May 2019 were started on the pathway. Of the 71, 58 were admitted with a burn injury, 4 with TEN, 6 were burn post-ops and there were 3 deaths. The 58 new burn admits are reviewed below. Conclusions The BaSeCamP packet is turned in and reviewed with the team. Data shows significant improvement in knowledge of standard operating procedures, expectations and resource availability. With improved communication across the burn team, staff more clearly understand patient-specific expectations in burn care and are more easily able to educate patients and families about the plan. Applicability of Research to Practice This Process improvement project responds to patient and family feedback that burn teams must coordinate communication and eliminate variability in delivery of care.

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The Effect of Transfer on Outcomes in Burns

Journal of Burn Care & Research ◽

10.1093/jbcr/irab092 ◽

2021 ◽

Author(s):

Nathan E Bodily ◽

Elizabeth H Bruenderman ◽

Neal Bhutiani ◽

Selena The ◽

Jessica E Schucht ◽

...

Keyword(s):

Total Body Surface Area ◽

Infectious Complications ◽

Burn Injuries ◽

Burn Patients ◽

Burn Care ◽

Burn Center ◽

Field Versus ◽

High Acuity ◽

Total Body ◽

Inhalation Burn

Abstract Patients with burn injuries are often initially transported to centers without burn capabilities, requiring subsequent transfer to a higher level of care. This study aimed to evaluate the effect of this treatment delay on outcomes. Adult burn patients meeting American Burn Association (ABA) criteria for transfer at a single burn center were retrospectively identified. A total of 122 patients were evenly divided into two cohorts – those directly admitted to a burn center from the field, versus those transferred to a burn center from an outlying facility. There was no difference between the transfer and direct admit cohorts with respect to age, percent total body surface area burned, concomitant injury, or intubation prior to admission. Transfer patients experienced a longer median time from injury to burn center admission (1 vs. 8 hours, p &lt, 0.01). Directly admitted patients were more likely to have inhalation burn (18 vs. 4, p &lt, 0.01), require intubation after admission (10 vs. 2, p = 0.03), require an emergent procedure (18 vs. 5, p &lt, 0.01), and develop infectious complications (14 vs. 5, p = 0.04). There was no difference in ventilator days, number of operations, length of stay, or mortality. The results suggest that significantly injured, high acuity burn patients were more likely to be immediately identified and taken directly to a burn center. Patients who otherwise met ABA criteria for transfer were not affected by short delays in transfer to definitive burn care.

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583 Burn Care During Six Months Covid-19 Pandemic; Report of A Single Center

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.233 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S143-S143

Author(s):

Cem Aydogan ◽

Ebru H Ayvazoglu Soy ◽

Emin Turk ◽

Hakan Yabanoglu ◽

Tevfik Avci ◽

...

Keyword(s):

Intensive Care ◽

Wound Care ◽

Demographic Data ◽

Total Body Surface Area ◽

Burn Patients ◽

Care Experience ◽

Burn Care ◽

Multidisciplinary Rounds ◽

Novel Coronavirus ◽

Care Surgery

Abstract Introduction The novel coronavirus (SARS-CoV-2) responsible for COVID-19 pandemic caused an unprecedented health care crisis. During pandemic burn centers had to preserve the ongoing burn care in a safe and ethical way. It is crucial to manage inpatients, outpatients, wards and staff carefully to prevent epidemia in burn units. Here, we aimed to report our burn care experience during the six months COVID-19 pandemic. Methods We retrospectively evaluated our ambulatory and hospitalized burn patients during the six months COVID-19 pandemic (from March to September 2020) with respect to the demographic data, wound care, surgery, intensive care management. Based on the model of our infection control team, we formed first to third degree prevention methods while contacting with burn patients in our outpatient clinic, semi-sterile ward (with beds) and intensive care unit (with 4 beds) which were sterilized and ventilated regularly. During hospitalization, we restricted the degree of interaction during multidisciplinary rounds. To screen for nosocomial infections, patients were routinely tested with PCR test. Results 402 burn patients (158 paediatric, 244 adults) were managed as outpatients (n=332;82%) and in patients (n=70; 18%) in our burn centre. Total body surface area percentage of burn in hospitalized patients were 9, 95±2, 76 % in paediatric and 25, 34±3, 49 in adult group. Majority of the burns were scald (86.7% paediatric, 60.5% adults) burns. We successfully performed 66 surgical debridement and grafting procedures. Three adult patients had mechanical ventilation support during follow up and one of them died due to multi organ failure with negative PCR. We detected COVID-19 in 2 patients and both of them were discharged successfully. Conclusions According to our results, when precautions are taken, burn care can be managed successfully without posing any risk to patients during the pandemic period.

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18 The Risks of Sedation and Pain Control in the ICU: Can Increased Sedation Lead to Over-Resuscitation and More Hypotension?

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.023 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S17-S18

Author(s):

John M McClellan ◽

Clifford C Sheckter ◽

Jessie O’Neal ◽

Jeffrey Anderson ◽

Samuel P Mandell

Keyword(s):

Linear Regression ◽

Regression Model ◽

Linear Regression Model ◽

Pain Control ◽

Hemodynamic Instability ◽

Burn Patients ◽

Hemodynamic Changes ◽

Pain Experience ◽

Pain Medications ◽

Initial Care

Abstract Introduction Pain control and sedation of burn patients is a complex and necessary aspect of initial care and resuscitation. Each patient’s pain experience is unique. Balancing pain needs with obtundation and hemodynamic changes can be difficult, even for experienced clinicians. We hypothesize that in the first 48 hours of ICU admission, increased sedation in burned patients will be associated with increased resuscitation and hemodynamic instability. Methods A 6-year (2014–19) retrospective review of our hospital’s burn database collected patients admitted to the ICU with greater than 20% TBSA burns. In the first 48 hours of admission, we compared total amounts of sedation/pain medications (morphine milligram equivalents (MME), propofol, dexmedetomidine, benzodiazepines) given with total resuscitation and hemodynamic data. A linear regression model was chosen to determine if higher amounts of sedation/pain medication could predict greater resuscitation and episodes of hypotension (MAP < 65). Results 208 patients were included with median age, %TBSA, and resuscitation of 43 years (0–99), 31% (20–93), and 3.3 ml/kg/%TBSA (0.13–19.05), respectively. The majority of our patients were white (80%) males (68%). Patients received a combination of MMEs (99% of patients), propofol (31%), dexmedetomidine (11%), and benzodiazepines (73%). Using a multivariable linear regression model, we found associations between total MMEs given and greater resuscitation (95% CI: 0.15–0.54, p=0.01) as well as number of hypotensive events (95% CI: 1.57–2.7, p< 0.001) in the first 48 hours of admission. No associations were noted with other sedative medications when comparing the number of hypotensive events and increased resuscitation. Conclusions While acute pain and sedation management is crucial in treating critically-ill burn patients, it often becomes routine. We find that pain management is not without physiological consequences and should be carefully monitored during resuscitation.

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Factors Affecting the Prevention, Treatment and Rehabilitation of Burn Patients in Iran: A Qualitative Study

Journal of Shahid Sadoughi University of Medical Sciences ◽

10.18502/ssu.v28i7.4265 ◽

2020 ◽

Author(s):

Reza Rezaee ◽

Mehdi Raadabadi ◽

Hamed Nazari

Keyword(s):

Content Analysis ◽

Qualitative Study ◽

Hospital Care ◽

Qualitative Content Analysis ◽

Hospital Treatment ◽

Burn Patients ◽

Analysis Method ◽

Burn Treatment ◽

Factors Affecting ◽

Content Analysis Method

Introduction: After traffic accidents and falls, burns are the third leading cause of accident deaths. Burns are one of the most devastating forms of injuries, and survivors after recovery need many years of rehabilitation and emotional, physical, and economic support. The aim of this study was to identify the factors affecting a comprehensive management system for the treatment of burn patients with qualitative content analysis approach. Methods: This qualitative study was conducted using content analysis method in 2018. The sample consisted of 20 experts in burn scope who were selected through purposeful sampling. Data were collected using a semi-structured face-to-face interview. Content analysis method and MAXQDA 10.0 software were used for data analysis. Results: Analysis of qualitative findings showed that factors affecting burn treatment management included 6 categories of pre-hospital care (5 subcategories), hospital care (12 subcategories), rehabilitation services for burn patients (5 subcategories), medical equipment (1 subcategory), prevention (3 subcategories) and human resources (3 subcategories). Conclusion: According to the results, corrective actions in the field of prevention, pre-hospital, treatment and rehabilitation should be considered. Actions such as home changes, safe child monitoring, burn prevention while cooking, equipping all ambulances with basic equipment related to various types of burns, providing training to pre-hospital ambulance staff on care of burn patients, standardizing bed facilities, the burn section and attention to social skills promotion program is suggested.

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The Patient’s Perspective: Burn Reconstructive Surgery During the COVID-19 Pandemic

Journal of Burn Care & Research ◽

10.1093/jbcr/irab128 ◽

2021 ◽

Author(s):

Paul Won ◽

Karel-Bart Celie ◽

Violeta Perez ◽

T Justin Gillenwater ◽

Haig A Yenikomshian

Keyword(s):

Reconstructive Surgery ◽

Burn Patients ◽

Inclusion Criteria ◽

Burn Treatment ◽

Burn Care ◽

Postoperative Therapy ◽

Burn Center ◽

Increased Risk ◽

Average Patient ◽

Hospital Systems

Abstract During the Covid-19 pandemic, hospital systems delayed or halted elective surgeries and outpatient care, profoundly disrupting reconstructive burn treatment ranging from surgery to postoperative therapy. This study aims to characterize burn patients’ perspectives on reconstructive surgery during Covid-19. A 12-component questionnaire to burn patients awaiting reconstructive surgery at a single ABA verified Burn Center was administered. Responses regarding willingness to undergo reconstruction, perceived medical and personal impacts of Covid-19, and perspectives on telehealth were gathered. Surveys were administered to patients/caregivers over the phone in English and Spanish. Inclusion criteria consisted of burn patients who had elective reconstructive surgeries delayed or canceled as a result of the pandemic. 51 patients met our inclusion criteria. Of those, 23 patients responded to our survey (45%). Average patient age was 23, 43% were male, and a majority (52%) were pediatric. 22 (96%) patients were willing to undergo reconstruction during the Covid-19 pandemic, despite a perceived increased risk. 43% disagreed or strongly disagreed that telehealth adequately enabled communication with their burn care provider. 78% agreed or strongly agreed that they felt more susceptible to Covid-19 as burn patients. 83% agreed or strongly agreed that the Covid-19 pandemic had created stressors specifically related to their burn care. The majority of patients expressed a strong desire to return to surgical and therapeutic care delayed by Covid-19. Patients reported feeling especially vulnerable to the Covid-19 pandemic as burn patients, and cited difficulty obtaining care and financial stressors as the main causes.

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89 The Effect of Trauma Center Status and Burn Verification Process on Burn Patient Outcomes

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.093 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S61-S62

Author(s):

Manuel Castillo-Angeles ◽

Christopher J Burns ◽

John C Kubasiak ◽

Anupama Mehta ◽

Robert Riviello ◽

...

Keyword(s):

Hospital Mortality ◽

Patient Outcomes ◽

Trauma Center ◽

Burn Patients ◽

Trauma Centers ◽

Burn Centers ◽

Adjusted Analysis ◽

Burn Care ◽

Burn Center ◽

Burn Patient

Abstract Introduction Burn center verification was implemented to ensure burn patients receive the best quality of care. As part of the of the organized burn care system, trauma centers that do not have a burn center within the hospital should refer burn patients to a designated burn center. However, more than 30% of burn patients are still being taken care of in non-verified burn centers. Our aim was to determine if trauma center status conferred a benefit in outcomes in a national sample of burn patients. Methods This is a retrospective study using State Inpatient Databases of 22 states in 2014. The inclusion criteria were all patients admitted for burn injury (ICD-9 codes 940–949). Hospitals were categorized as ABA verified centers (VBC) and non-verified burn centers (NVBC), as well as trauma centers (TC) and non-trauma centers (NTC) based on verification status at the time of admission. Main Outcomes were in-hospital mortality and length of hospitalization (LOS). Stratifying by burn center verification status, multivariable regression was used to identify the association between trauma center status and the outcomes. Results A total of 15,982 burn patients were identified. The overall in-hospital mortality rate was 2.45%. In our sample, we only had 26 hospitals that were both a TC and VBC (Table 1). The majority of patients (54%) were treated at a NVBC/TC. In unadjusted analysis, amongst verified centers, there was no difference in mortality between TC and NTCs (3.2% vs. 3.0%, p=0.877), but NTCs had longer LOS (14.7 vs. 10 d, p< 0.001). Amongst non-verified centers, TCs had higher mortality when compared with NTCs (2.4% vs. 1.1%, p< 0.001), but TCs had longer LOS (8.3 vs. 7.2 d, p=0.007). After adjusted analysis, within VBC, TC status was associated with shorter LOS (Coef -3.28, 95% CI -5.37 – -1.19, p=0.002), but not associated with mortality (OR 1.21, 95% CI 0.50 – 2.89, p=0.667). After adjusted analysis, within NVBC, TC status was associated with longer LOS (Coef 2.37, 95% CI 1.70 – 3.04, p< 0.001) and with mortality (OR 3.70, 95% CI 2.10 – 6.51). Conclusions Trauma center status does not confer any benefit for burn patient outcomes within the burn care verification system. Despite the regionalization of burn care through the development of verified burn centers, the majority of burn patients are receiving care at trauma centers with a non-verified burn center within the hospital.

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