756 Homeless and Burned – A Retrospective Analysis of an Especially Challenged Patient Population

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S212-S212
Author(s):  
Mathangi A Chandramouli ◽  
Jamie Heffernan ◽  
Angela Rabbitts ◽  
Philip Chang
Keyword(s):  
Burn Injury ◽  
Discharge Planning ◽  
Average Length ◽  
Wound Care ◽  
Length Of Hospital Stay ◽  
Cold Injury ◽  
Vast Number ◽  
Burn Center ◽  
Number Of Patients ◽  
Average Size

Abstract Introduction The undomiciled burned patient presents more challenges to the burn team with regards to safe disposition. Discharge planning is complicated by the lack of a safe, clean environment to perform requisite wound care, thus prolonging hospital stays. The purpose of our study was to analyze the homeless patients admitted to a major urban burn center. This data would then better help identify trends and characteristics that could inform development of support services for this unfortunate population. Methods Demographic and clinical data from inpatients was collected from a single urban ABA verified burn center over a 3 year period between 1/2016 and 12/2018. Simple descriptive statistical analysis was performed. Results 1985 patients were admitted over the 3 year period. 48 homeless patients were identified (2.4%). The average age of this population was 39.8±16.8 years (range 3 months to 63 years old). There were 5 children (10.4% of the homeless cohort) in this population (ranging from 3 months to 4 years of age). Only 2 homeless burn inpatients were greater than 60 years of age (2% of the homeless cohort). There were 15 females (31%) and 33 males (69%). The mean TBSA was 5.8±9.9%. The average length of hospital stay was 21.9±29 days. 27 of the 48 patients (56%) required operative treatment. The 3 most common etiologies of skin injury were flame burns (29%), scald burns (25%), and cold injury (19%). The vast number of patients (39 out of 48, 81%) were discharged back to “their previous condition” (i.e. homeless shelter or the streets). There was 1 mortality in this group. Conclusions Contrary to widespread assumptions about the homeless being overwhelmingly male and adult, a significant percentage of the homeless burn patients were female with a percentage of patients being pediatric as well. The length of stay was significantly longer for most patients given the relatively small average size of burn injury. Cold injury was more significant etiology in this population compared to the overall burn population. Applicability of Research to Practice This analysis of the undomiciled burn inpatient at a single urban burn center will help better describe this especially challenging population and help focus social support and discharge planning resources for this group.

597 Opioid-limiting Mandate Did Not Increase Readmissions for a Single Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S141-S142
Author(s):  
Kamil Nurczyk ◽  
Sanja Sljivic ◽  
Kaylyn Pogson ◽  
Lori Chrisco ◽  
Rabia Nizamani ◽  
...  
Keyword(s):  
Graft Failure ◽  
Discharge Planning ◽  
Wound Care ◽  
Tertiary Care ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Burn Center ◽  
Chi Squared ◽  
Prescription Opioid Misuse ◽  
The Impact

Abstract Introduction Our state’s Strengthen Opioid Misuse Prevention (“STOP”) Act was enacted on January 1 st 2018 to reduce prescription opioid misuse. We sought to evaluate the impact of opioid-limiting legislation on readmission rates among burn patients to our tertiary care burn center related to uncontrolled pain. Methods Patients were identified using an institutional Burn Center registry and linked to clinical and administrative data. All patients admitted between July 1 st, 2014 to June 20 th, 2019 were eligible for inclusion. Injury mechanism categories and reasons for readmissions were evaluated. Statistical analysis was carried out using chi-squared test and significance was accepted as p< 0.05. Results Of the 7872 total admissions, 160 (2%) were readmissions. Mean number of readmissions for every year was 32. There was an increase in number of readmissions in 2018 observed but it was not statistically significant (2014 n=12, 2015 n=35, 2016 n=21, 2017 n=33, 2018 n=40, 2019 n=19). The reasons for readmission included wound progression, graft failure, infection, and pain. There was an increase in readmissions for infection, wound progression and graft failure after January 2018, p< 0.05. The percentage of patients readmitted for pain increased between 2014 to 2019 but it was not statistically significant. Conclusions The primary reasons for readmissions to our burn center were pain, infection, graft failure, and progression of disease. Despite the opioid-limiting law there was not an increase in readmissions related to pain. Applicability of Research to Practice This study demonstrates that our current discharge planning strategies are managing pain expectations for patients. Our focus should be shifted towards improving infection control and wound care.

Inpatient Data of Occupational Burn Injuries Treated at a Tertiary Burn Center

2019 ◽  
Vol 41 (2) ◽  
pp. 398-401
Author(s):  
Abdulkadir Basaran ◽  
Ozer Ozlu
Keyword(s):  
Hospital Stay ◽  
Burn Injury ◽  
Health And Safety ◽  
Length Of Hospital Stay ◽  
Burn Injuries ◽  
Occupational Accidents ◽  
Cross Sectional ◽  
Work Related ◽  
Burn Center ◽  
Electrical Burns

Abstract Occupational burns are among the important causes of work-related injuries. We aimed to investigate the epidemiology and reasons of occupational burns and thereby to emphasize preventive measures. Between January 2017 and December 2018, the data of major occupational burn injury patients admitted to our burn center were evaluated in this cross-sectional retrospective study. During the study period 342 patients older than 16 years were admitted to the burn center. Among them 80 patients with occupational burns (23.4%) were identified. The mean age of the patients was 34.73 ± 12.3 years. Seventy-eight patients (97.5%) were male. Electrical burns and flame burns were the two leading type of occupational burns. The most common occupation of our patients was construction work. Dangerous behavior, carelessness, lack of protective equipment, and failure to follow instructions were causes of injury. Only 14 patients (17.5%) experienced unavoidable accident. Thirty-seven patients (46.3%) worked on temporary basis. Occupational experience was under 5 years in majority of the cases (62.5%). For the occupational burns the percentage of burned TBSA was 17.08 ± 14.5 (1–60) and the length of hospital stay was 23.94 ± 21.9 days (2–106). There were no significant differences between occupational and nonoccupational burn injuries considering TBSA, total length of hospital stay, and complications (P > .05). Occupational burn injuries are common in less experienced and younger workers. Therefore, recognition of the problem and maintaining awareness is important. In order to prevent occupational accidents and burns, occupational health and safety rules must be obeyed.

scholarly journals African experiences of laparoscopic hysterectomy about a continuous series of 52 cases by the same practitioner: indications, surgical procedures and complications

2018 ◽  
Vol 7 (3) ◽  
pp. 789
Author(s):  
Koffi Abdoul Koffi ◽  
Kacou Edele Aka ◽  
Minata Fomba ◽  
Konan Seni ◽  
Apollinaire Horo ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Average Length ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Laparoscopic Hysterectomy ◽  
Pelvic Surgery ◽  
Continuous Series ◽  
Average Size ◽  
A Prospective Study

Background: Laparoscopy is a modern surgical technique that began in 1940 with Raoul Palmer. The present study aimed to analyse the results of a fifty-two-laparoscopic hysterectomy performed.Methods: A prospective study over a period of seven years from 1st January 2010 to 31st December 2015. A total of 52 patients who underwent a laparoscopic hysterectomy were recruited at the teaching hospital of Yopougon-Abidjan.Results: The mean age was 50.2 years (±3.9 years) (36-62 years). The average parity was 3. Few patients had undergone anterior pelvic surgery for either myomectomy or caesarean section. Uterine fibroid was the major surgical indication with a rate of 61.54%. The average size of the uterus was 12 cm (8-18 cm). Total hysterectomies type II and III with or without adnexectomy were essentially performed with rates of 28.85% and 32.69%, respectively. Sometimes it was associated with a lymphadenectomy or a colpo-suspension. The average length of a hysterectomy is 170 minutes (87-385 minutes). Four cases of laparo-conversions have been noted. Blood loss was approximately 95 ml (±12 ml) with a maximum of 300 ml. The complications were mainly two digestive wounds and a bladder fistula. The average length of hospital stay is three days apart from any complication.Conclusions: The laparoscopic approach is less painful, is associated with less blood loss, shorter hospital stay, faster recovery, fewer complications, and better care. A training period of surgeons associated with the equipment of the health structures is necessary to popularize this procedure surgical.

726 The Use of Xeroform Dressings for Partial Thickness Scald Burn Injuries in a Verified Pediatric Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S194-S195
Author(s):  
Lisa C Vitale ◽  
Jennifer Livingston ◽  
Erica Curtis ◽  
Katherine Oag ◽  
Christina M Shanti ◽  
...  
Keyword(s):  
Burn Injury ◽  
Wound Care ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Wound Complications ◽  
Burn Wound ◽  
Burn Center ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
At Home

Abstract Introduction For children who have suffered a burn injury one of the greatest challenges is managing pain with an adequate yet practical burn wound dressing that will ultimately be managed at home. Medical product companies have created a variety of wound care products available on the market. These products are advertised to be more superior over one another in categories such as decrease in wound infections, minimization of pain, ease of dressing application, increased dressing wear time, and better wound healing. With all the options for burn wound care there are many factors to consider when choosing a burn dressing such as cost, ease of dressing for families at home, comfort, and efficacy. At our ten year verified pediatric burn center we have tried many different burn wound care products, however we have found Xeroform and bacitracin to be the most practical and easy to use for our patient population. Methods A retrospective chart review was performed from 2016–2018 of all cascading scald injuries to children 0–5 years of age treated at our verified pediatric burn center. 179 patients were included in this review. Of those patients a total of 52 patients were excluded, 28 patients had no follow up, 21 patients received alternate dressings, and 3 patients had full thickness injuries requiring a split thickness skin graft (STSG). Charts were reviewed for total body surface area (TBSA), length of stay (LOS), discharge dressing type, complications, and time to healing. All patients included routinely received consistent application of the Xeroform and bacitracin. Results 127 patients discharged with Xeroform dressings were included in this study with an average age of 1.4 years old (range 0–5 years) and average TBSA of 2.5% (range 0.25–13%). The average LOS was 1.6 days (range 1–10 days). In this sample 32 (25%) patients were healed within 7 days. 77 (61%) patients were healed within 7–14 days. 11 (9%) patients were healed within 14–21 days. 7 (5%) patients were healed in greater than 21 days. There were no wound complications identified within this study group. Conclusions Using Xeroform as our standard of practice has streamlined the care provided to our patients. We have demonstrated consistent effective re-epithelization, protection from infection, and ease of dressings for families and burn providers. In our experience Xeroform has provided a versatile way to care for partial thickness burn injuries. Applicability of Research to Practice We suggest Xeroform and bacitracin dressings be used for partial thickness burn injuries in patients under 5 years of age. This dressing may be superior to other products because it allows for bathing while providing good wound epithelization and is easy to use.

581 Basecamp: Burn Efficiency Care Pathway

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.

585 Burn Wound Care for Patients and Families through Video Education

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Beverly Beaucock
Keyword(s):  
Burn Injury ◽  
Wound Care ◽  
Family Education ◽  
Burn Wound ◽  
Family Experience ◽  
Educational Tools ◽  
Burn Center ◽  
Learning Platforms ◽  
Video Education

Abstract Introduction The treatment and care of a burn injury is specialized and can be very intimidating to the patient and family. It is the obligation of the burn team to educate the patient and caregiver at a level where they clearly understand and are comfortable. It is important to be mindful of how others comprehend whether it is visual, auditory, reading/writing, or kinesthetic. When attempting to learn something new, especially when compounded by a burn injury, can be quite challenging. Methods Videos of burn injury cleansing techniques and various applications of dressings were produced to enhance patient and family education. Results Our analysis of feedback from the patient and family indicates an appreciation for other learning platforms and is a complement to written instructions. Conclusions We concluded that by offering video education along with other educational tools, it has enhanced the patient and family experience in the burn center.

51 We Test Everyone… Really? Bias in Drug Screening in an Academic Burn Center

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S37-S38
Author(s):  
Keturah Sloan ◽  
David G Greenhalgh ◽  
Soman Sen ◽  
Tina L Palmieri ◽  
Kathleen S Romanowski
Keyword(s):  
Logistic Regression ◽  
Drug Screening ◽  
Illicit Drugs ◽  
Burn Injury ◽  
Drug Screen ◽  
Urine Drug Screen ◽  
Burn Center ◽  
Number Of Patients ◽  
Urine Drug ◽  
The Mean

Abstract Introduction Previous studies have found that burn-injured patients who use illicit substances, such as methamphetamines, have worse outcomes and longer hospital lengths of stay when compared to those who do not use illicit drugs. It is our units’ stated practice to perform a urine drug screen on all patients admitted with a burn injury. We hypothesize that, while we intend to test all patients, we fall short of this goal. The purpose of this study is to examine our urine drug screening practices. Methods Following IRB approval, a retrospective chart review was conducted using electronic medical records of all adult patients admitted to the burn center from 2016–2018. Data collected included information on the burn injury, drug screening, and demographics. Due to the fact that many patients receive opioids and benzodiazepines for pain and anxiety related to their burn injury, these were not considered positive if present on drug screen without gas chromatography to confirm use. Data analysis was conducted using chi-square, t-test, and logistic regression models. Results A total of 1134 patients (mean age 45.9 ± 17.3 years, 855 males (75.4%), mean burn size (TBSA) 12.1±15.5%) were analyzed. Of the 1134 patients admitted, 65% had a urine drug screen performed. Of those who were not screened, 12.1% had a test ordered but not performed while 87.8% had no test ordered. Globally, amphetamines/methamphetamines were the most commonly detected substances in 262 patients (23.1%) followed by cocaine with 14 patients (0.2%) Those with larger burns were more likely to be tested with the mean burn size of those tested being 15.0% while the mean size of those not tested was 6.6%, p< 0.0001. When looking at the effect of age on drug screening, those at the extremes of age (< 20 years (37.5%), 61–70 years (38.9%), 71–80 years (51.5%) and >80 years (76.9%)) were more likely to not be tested (p< 0.0001). All other age groups had a rate of not testing between 30.3% and 33.3%. Additionally, overall men were more likely to be tested than women (68.3% vs. 54.8%, p< 0.0001). On multivariate logistic regression, age (OR 0.99 (0.98–0.99), p< 0.0001), burn size (OR 1.07 (1.05–1.08), p< 0.0001), and female gender (OR 0.61 (0.45–0.81), p=0.0008) were independently associated with a patient receiving a urine drug screen. Conclusions Although our intention is to perform a urine drug screen on all patients admitted with burn injury, we fall short of this goal. A significant number of patients do not get tested and these tend to be older patients, those with smaller burns, and women. Given that drugs of abuse can alter patient outcomes we need to be more rigorous in our efforts to obtain tests on all patients.

scholarly journals The effectiveness of Dakin’s solution in wound care after debridement in Fournier’s gangrene

2020 ◽  
Vol 7 (7) ◽  
pp. 2156
Author(s):  
Onur Karsli ◽  
Fatih Gokalp
Keyword(s):  
Mortality Rate ◽  
Average Length ◽  
Wound Care ◽  
Length Of Hospital Stay ◽  
Fournier’S Gangrene ◽  
Concomitant Disease ◽  
Perianal Region ◽  
Fournier's Gangrene ◽  
War Wounds ◽  
Fournier Gangrene

Background: Fournier's gangrene (FG) is a specific form of necrotizing fasciitis seen in the external genital organs and perianal region. The basic management of Fournier's gangrene is based on critical surgical debridement. Dakin's solution (sodium hypochlorite) was originally developed to treat war wounds. In this study, we aimed to show potentially efficient of Dakin’s solution on wound healing and reoperation rate.Methods: Thirty-three patients who were debrided due to Fournier Gangrene during 2012-2020 were included in the study. After debridement, wound care was done twice a day by dressing with a sponge moistened with Dakin's solution. Patients' age, concomitant disease, involvement site, re-debridement requirement, complications, and discharge times were recorded.Results: The mean age of 33 male patients who participated in the study was (51-74) 63.93±15.36. Although all patients had scrotal involvement, nine patients had perineal (27.2%), 12 patients had inguinal (36.3%), four patients had a penis and pubic spread (12.1%). The mortality rate was 6%. The average length of hospital stay was 13.1±4.2 days, and the average number of debridements was 1.Conclusions: Fournier gangrene is an important disease characterized by necrotizing infection of the genital, perineal, and perianal region and progresses with high mortality. Our mortality rate was lower than literature and we have linked our mortality rate to using Dakin's solution for wound care. Dressing with Dakin's solution is an effective and reliable method for wound care in FG patients.

scholarly journals RELATIONSHIP BETWEEN ICU WAITING AND MORTALITY RATE IN PATIENTS UNDER MECHANICAL VENTILATION ADMITTED IN EMERGENCY ROOM

2020 ◽  
Author(s):  
Layanna Alves da Silva Andrade ◽  
Monica Lucia Soares Borges ◽  
Geovane Rossone Reis ◽  
Aktor Hugo Teixeira ◽  
Rebeca Oliveira Crispim da Silva ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Hospital Stay ◽  
Average Length ◽  
Total Mortality ◽  
Length Of Hospital Stay ◽  
Field Research ◽  
Average Hospital ◽  
Number Of Patients ◽  
Using Data

Background: The number of patients who remain on prolonged mechanical ventilatory assistance has recently increased. The average length of hospital stay intervenes directly with the number of beds essential for assistance to a given population and is weighted as an indicator of service efficiency. Objective: To investigate the average time in which patients on mechanical ventilation admitted to the emergency department of a hospital remain waiting for a place in the ICU. Materials and Methods: Quantitative field research, where data collection was performed using data from medical records, admission books, death books / outcome of hospitalized patients and in line with pre-established criteria under mechanical ventilation. Mechanical ventilation patients admitted to the ER and the ICU, over 18 years old, were recruited. Results: The research comprises a sample of 67 patients. The average hospital stay was 334 hours and 36 minutes. The general ratio was for every 03 patients who entered for treatment, 01 was discharged and 02 died. The total mortality rate of the sample was 68.65%. Conclusion: The length of stay in ER and ICU in patients on mechanical ventilation is related to the high mortality rate.

816 Geographic Analysis of the Outpatient Burn Population of an Urban Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S247-S247
Author(s):  
Mathangi A Chandramouli ◽  
Jamie Heffernan ◽  
Angela Rabbitts ◽  
Philip Chang
Keyword(s):  
Catchment Area ◽  
Burn Injury ◽  
Age Distribution ◽  
Age Groups ◽  
Significant Shift ◽  
Burn Center ◽  
Number Of Patients ◽  
Patterns Of Injury ◽  
Age Range ◽  
Geospatial Mapping

Abstract Introduction Previous work has utilized geospatial mapping of pediatric burn inpatients at a major urban burn center to analyze the distribution of patients across the catchment area. Over the past several years, our center has seen a significant shift in the number of patients cared for inpatient to outpatient care. The purpose of our study was to geographically identify and compare the incidence and location of burn inpatients versus outpatients within the catchment area. Methods Demographic and clinical data from both inpatient and outpatients was collected from a single urban ABA verified burn center over a 3 year period between 1/2016 and 12/2018 with an age range from 1 month to 101 years old. Geriatric patients were defined as age 60 or greater to facilitate comparison with NBR data which breaks down age by decades. The patients were mapped by their home zip code. Results 1985 burn patients were admitted to this single tertiary burn center between 1/2016 and 12/2018 with an age range from 1 month-101 years of age. During the same time period, 11281 outpatient encounters occurred with an age range of 1 month to 101 years of age. 28.9% of the inpatients were 60 years or older while 17.4% of the outpatient encounters involved patients 60 years or older. For pediatrics (< age 16), 31.4% of the inpatients were 15 years and younger vs. 26% of the outpatient encounters. The top “hotspots” for inpatient burn zip codes vs. outpatient burn zip codes were different for 3 of the 6 zip codes compared. Conclusions The inpatient and outpatient populations at this tertiary urban burn center appear to be different with the geographic distribution of the patient’s domicile and the age distribution. Further analysis of the etiologies of burn injury and socioeconomic status of the patients will elucidate additional trends. Applicability of Research to Practice Applying geospatial mapping to a burn center’s outpatient and inpatient populations may reveal differential patterns of injury that can better focus prevention and outreach efforts in the community better target etiologies and age groups.

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