Assessment of a quality improvement intervention to improve the consistency of total body surface area burn estimates between referring facilities and a pediatric burn center

Leticia Manning Ryan, Philomena Costabile, Susan Ziegfeld, Lisa Puett, Amiee Turner, Valerie Strockbine, Bruce Klein

Research output: Contribution to journalArticle

Abstract

Background: Burns are a significant source of pediatric morbidity and frequently result in transfer of care to a pediatric burn center. Data suggest that referring facilities often overestimate the total body surface area (%TBSA) of burns in comparison to the subsequent assessment at the pediatric burn center. Such discrepancies may trigger inappropriately aggressive interventions with potential for patient harm. Our baseline assessment of data from 106 patients transferred to our pediatric burn center over a one-year period showed that 59/106 (56%) patients had a %TBSA recorded at the time of transfer and 18/59 (31%) had clinically significant differences (>5% difference) in estimates between the referring facility and the pediatric burn center. Methods: Informed by this clinical audit and a root cause analysis, we implemented practices to enhance consistency of clinical assessments between referring facilities and our pediatric burn center. These practices included the use of a common clinical assessment instrument (a standardized Lund and Browder form) that was integrated into the interfacility transfer process as well as educational outreach at referring facilities for providers who treat children with burns, prioritizing facilities with the highest number of discrepancies. Results: Follow up data was reviewed 16–23 months after initiating the intervention. Cumulatively, we found significant improvement in the proportion of patients with %TBSA recorded (94% vs 56%, p < 0.001) that achieved our goal to exceed 90% and a reduction in clinically significant discrepancies that exceeded our goal of 15% (10% vs 31%, p = 0.002). Conclusions: Referring facilities often overestimate the %TBSA in comparison to the subsequent assessment at the pediatric burn center. The consistency of the %TBSA estimates can be improved by interventions that utilize the sharing of a common clinical assessment instrument and standardization of the transfer intake process.

Original languageEnglish (US)
JournalBurns
DOIs
StateAccepted/In press - Jan 1 2019

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Burn Units
Body Surface Area
Quality Improvement
Pediatrics
Burns
Root Cause Analysis
Patient Harm
Clinical Audit
Morbidity

Keywords

  • Burn
  • Pediatric
  • Quality improvement

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Assessment of a quality improvement intervention to improve the consistency of total body surface area burn estimates between referring facilities and a pediatric burn center. / Manning Ryan, Leticia; Costabile, Philomena; Ziegfeld, Susan; Puett, Lisa; Turner, Amiee; Strockbine, Valerie; Klein, Bruce.

In: Burns, 01.01.2019.

Research output: Contribution to journalArticle

Manning Ryan, Leticia ; Costabile, Philomena ; Ziegfeld, Susan ; Puett, Lisa ; Turner, Amiee ; Strockbine, Valerie ; Klein, Bruce. / Assessment of a quality improvement intervention to improve the consistency of total body surface area burn estimates between referring facilities and a pediatric burn center. In: Burns. 2019.
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title = "Assessment of a quality improvement intervention to improve the consistency of total body surface area burn estimates between referring facilities and a pediatric burn center",
abstract = "Background: Burns are a significant source of pediatric morbidity and frequently result in transfer of care to a pediatric burn center. Data suggest that referring facilities often overestimate the total body surface area ({\%}TBSA) of burns in comparison to the subsequent assessment at the pediatric burn center. Such discrepancies may trigger inappropriately aggressive interventions with potential for patient harm. Our baseline assessment of data from 106 patients transferred to our pediatric burn center over a one-year period showed that 59/106 (56{\%}) patients had a {\%}TBSA recorded at the time of transfer and 18/59 (31{\%}) had clinically significant differences (>5{\%} difference) in estimates between the referring facility and the pediatric burn center. Methods: Informed by this clinical audit and a root cause analysis, we implemented practices to enhance consistency of clinical assessments between referring facilities and our pediatric burn center. These practices included the use of a common clinical assessment instrument (a standardized Lund and Browder form) that was integrated into the interfacility transfer process as well as educational outreach at referring facilities for providers who treat children with burns, prioritizing facilities with the highest number of discrepancies. Results: Follow up data was reviewed 16–23 months after initiating the intervention. Cumulatively, we found significant improvement in the proportion of patients with {\%}TBSA recorded (94{\%} vs 56{\%}, p < 0.001) that achieved our goal to exceed 90{\%} and a reduction in clinically significant discrepancies that exceeded our goal of 15{\%} (10{\%} vs 31{\%}, p = 0.002). Conclusions: Referring facilities often overestimate the {\%}TBSA in comparison to the subsequent assessment at the pediatric burn center. The consistency of the {\%}TBSA estimates can be improved by interventions that utilize the sharing of a common clinical assessment instrument and standardization of the transfer intake process.",
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AU - Puett, Lisa

AU - Turner, Amiee

AU - Strockbine, Valerie

AU - Klein, Bruce

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AB - Background: Burns are a significant source of pediatric morbidity and frequently result in transfer of care to a pediatric burn center. Data suggest that referring facilities often overestimate the total body surface area (%TBSA) of burns in comparison to the subsequent assessment at the pediatric burn center. Such discrepancies may trigger inappropriately aggressive interventions with potential for patient harm. Our baseline assessment of data from 106 patients transferred to our pediatric burn center over a one-year period showed that 59/106 (56%) patients had a %TBSA recorded at the time of transfer and 18/59 (31%) had clinically significant differences (>5% difference) in estimates between the referring facility and the pediatric burn center. Methods: Informed by this clinical audit and a root cause analysis, we implemented practices to enhance consistency of clinical assessments between referring facilities and our pediatric burn center. These practices included the use of a common clinical assessment instrument (a standardized Lund and Browder form) that was integrated into the interfacility transfer process as well as educational outreach at referring facilities for providers who treat children with burns, prioritizing facilities with the highest number of discrepancies. Results: Follow up data was reviewed 16–23 months after initiating the intervention. Cumulatively, we found significant improvement in the proportion of patients with %TBSA recorded (94% vs 56%, p < 0.001) that achieved our goal to exceed 90% and a reduction in clinically significant discrepancies that exceeded our goal of 15% (10% vs 31%, p = 0.002). Conclusions: Referring facilities often overestimate the %TBSA in comparison to the subsequent assessment at the pediatric burn center. The consistency of the %TBSA estimates can be improved by interventions that utilize the sharing of a common clinical assessment instrument and standardization of the transfer intake process.

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