629 Acute Kidney Injury, Burn Resuscitation, and a Novel, Visualization Approach to Resuscitation Review

Introduction A review of patients who sustained 20% or greater TBSA burns (n = 33) found 58% of the sample to have a stage 1 (n = 5), 2 (n = 4), or 3 (n = 10) acute kidney injury (AKI). Of those who sustained an AKI, 63% did not survive their injuries. An inquiry into the current, resuscitation protocols used at this facility was subsequently conducted. Protocol dictated the Parkland Formula/method as the standard of care for resuscitation needs of the sample. While information for net-totals of inputs and outputs (I&O) and hourly I&O values was easily obtainable, presenting these numbers in table-form was both cumbersome to create and difficult to quickly convey to both clinical and non-clinical staff. Thus, a visual approach was chosen to better understand how each patient was resuscitated in the first 24-hours of burn injury. Methods The software package R (R Core Team, 2020) was used to clean/analyze data, as well as create a graphical illustration of the data via an interactive dashboard using these variables: urine output (UOP); nurse charting of I&Os; fluid orders by provider; pre-hospital fluids; lab values; and vital signs. Using this software an interactive dashboard was created to allow users to interact with the graphs and visualize not only the numerical values associated with resuscitation, but to also see how each of these numbers relate to one another in an hourly timeline (e.g., reducing fluids by half is followed by a decrease in UOP). Results A trend of over-resuscitation in the first 24-hours of burn injury, as compared to the calculated requirements based on the Parkland Formula was observed. Also, irregularities of hourly administration of fluids (e.g., frequent/over blousing) and inadequate hourly charting were observed. Conclusions While this method for assessing resuscitation is a new approach at this facility, the ability to visually recount the resuscitation efforts of each patient has opened the conversation about best practices. Also, more disciplines can participate in the resuscitation efforts due to the ease with which the presented information can be disseminated and explained to both seasoned and novice staff. This has allowed for more stakeholders to participate in the burn program. Finally, further uses and applications of interactive dashboards are being explored for other aspects of burn care management.