bluuebunny/crossref_metadata_2025_split huggingface dataset:
556 Hospital Length of Stay for Patients with Small and Medium Burns Impacted by Distance to Burn Center
Authors: Sibbett Stephen , Oh Jamie , Arbabi Saman , Carrougher Gretchen J , Gibran Nicole S 
Published: March 2020

Abstract

Introduction
Understanding contributors to patient length of stay is critical for burn center resource management and efficiency. In this study, we analyzed how distance from patient homes to a burn center impacts hospital length of stay.

Methods
Under IRB approval, we reviewed our trauma registry for burn patients admitted to a regional burn center from 2011 to 2018. Inclusion was limited to patients from the burn center state. Patients were grouped by distance from the home zip code to the burn center (≤100 and &gt;100 miles) according to what might be ground or air transport. Chi-square and Mann-Whitney tests were used to determine differences between groups by race, burn size (TBSA), hospital length of stay (LOS), LOS/TBSA, mortality, and disposition to home. Burn size was categorized by TBSA into small (0–20%), medium (21–50%) and large (51–100%) burns.

Results
Our study population was predominantly white, non-Hispanic males. Mean burn size was significantly higher in patients who traveled more than the &gt;100 miles to the burn center (Table). Mean LOS/TBSA was not significant between the two groups. However, controlling for burn size, patients with small and medium burns that lived farther from the burn center had significantly longer hospital stays. There was no significant difference in length of stay for patients with large burns, mortality or disposition to home between the two distance groups.

Conclusions
At a burn center with a large catchment area, patients with burn size &lt; 50%TBSA who lived more than 100 miles from the burn center had significantly longer hospital stays than those who lived closer to the burn center. This may indicate that patients who are referred to a regional burn center for care of smaller burns may require care beyond the level of their local hospitals. It is worth noting that using burn size as an indication of complexity of care may be misleading as body site location of the burn (e.g. hand, face or feet) impacts the recovery.

Applicability of Research to Practice
For a burn center that serves patients across a vast region, this investigation might be useful in identifying opportunities to provide care for patients who live far from tertiary burn care.
562 “A Long process:” a Qualitative Analysis of Burn Survivors’ Treatment and Recovery Process
Authors: Baldwin Stephanie , Kimberly Dukes , Christel Katherine N , Hagedorn Joshua , Ruba Emily , Wibbenmeyer Lucy 
Published: March 2020

Abstract

Introduction
The treatment and recovery from a burn injury is a long process that can affect a survivor’s appearance, mobility, daily function, and emotional wellbeing. In this study, we sought to identify various factors in survivors’ treatment and recovery process.

Methods
We conducted thematic analysis on transcripts of in-depth, semi-structured interviews with 11 burn survivors who had been treated at a Midwest tertiary facility. Survivors were purposefully selected for variability in age, gender, injury size, injury mechanism and quality of life responses. All transcripts were coded by at least two authors. We managed coded results in MAXQda, a qualitative data management software program.

Results
The mean age of interviewees was 51 years (35–63 years) and time from the injury was 5.4 years (2 months to 26 years). Their burn sizes ranged from &lt; 10% in 4 people to 70–79% in one. Participants reported varied perceptions of care quality and provider relationships from the initial hospital stay. Some recalled communication issues from the hospital throughout the long recovery process. Many used graphic terms for the unfamiliar treatment methods.
Survivors reported ongoing issues with their skin and mobility that continued to impact activities of daily living even years later. Many did not have clear or realistic expectations or understanding of the recovery process. Wound care was overwhelming and provoked fear for many survivors even with formal instruction. Most participants developed different ways to treat their injuries at home. Barriers to recovery included finances, comorbidities, and environmental characteristics, including rurality.

Conclusions
Even years later, the burn injury can continue to evolve, create fears, and affect daily living for survivors. To help patients understand the realistic course of recovery, providers could focus on clear communication about the injury and recovery. Providers should recognize survivors with barriers who may need referrals for further support.

Applicability of Research to Practice
Reflecting on the subjective accounts of survivors will help identify opportunities to improve patient experiences during treatment and throughout the recovery process.
584 Maintaining Success in Patient Safety and Quality Metrics Through Teamwork and Contextual Modification
Authors: Thomas Mini , Ha Aemilio W , Joe Victor C , Chin Theresa L , Bernal Nicole O 
Published: March 2020

Abstract

Introduction
Hospitals constantly invest heavily in improving patient quality and safety metrics. Oftentimes, success is achievable for a single parameter but becomes challenging to achieve in all quality metrics. Our Burn Unit aimed for overarching principles of teamwork and contextual modification to obtain outstanding quality metrics in all six areas of patient quality. This quality improvement project aimed at reducing patient harms related to CLABSI, CAUTI, VTE, C.Diff, Falls, and HAPI.

Methods
Hospital leadership launched a dashboard of all six patient harm areas that is updated and reported daily during the leadership huddle. Apart from ensuring best practices for each quality metric, Burn Unit focused on teamwork and contextual modifications.
Team work: Utilizing engaged multidisciplinary team, apparent cause analysis of identified cases helped in detecting fallibilities. Additionally, proactive actions were implemented for high risk patients by routine audits and discussions during daily rounds. Frequent reminders, appreciations, and celebration of success were also helpful strategies.
Contextual modification: Unit and population specific interventions were actively sought for each quality metric. For HAPI, delineating existing burns or skin conditions from that of hospital acquired pressure injury helped to eliminate false positives. Identification and modification of patient care environment was vital in reducing the number of falls. Chlorhexidine gluconate bathing of burn wounds reduced the bioburden to help decrease CAUTI/CLABSIs.

Results
Burn Unit events related to CLABSI, CAUTI, VTE, C.Diff, Falls, and HAPI were compared to other ICUs, Step down, Telemetry, and Med-Surg units. The BICU was below national benchmarks for all six quality indicators and had outstanding success within the hospital. Our last patient harm was 328 days ago compared to the other 11 units which averaged 32 days. In the non-ICU units, Falls were the most frequent patient harm compared to CLABSI or CAUTIS for the ICUs. In Comparing to previous year, in 2019, BICU progressed in CAUTI, Falls, and HAPI while sustaining 2018 excellence in the other three areas.

Conclusions
Quality metrics can be simultaneously achieved by strengthening team work and contextual modifications beyond following best practices and protocols.

Applicability of Research to Practice
Quality metrics can be simultaneously achieved by strengthening team work and contextual modifications beyond following best practices and protocols.
Strong teamwork from engaged staff and contextual modifications should be intertwined with scientific evidences for obtaining quality metrics in patient care.
588 Defining Components of a Professional Practice Model (PPM) That Drives Growth and Promotes Cultural Change in a Large Regional Referral Burn Center
Authors: Echols Jane , Berry Lisa , Dowling Lynn , Gamble Ashley , Wheeler Michael , Mullins Robert F , Fagan Shawn , Hassan Zaheed , Homsombath Bounthavy 
Published: March 2020

Abstract

Introduction
As a burn center experiences growth and expansion, it is as important for nurse executives and nurse managers to understand the culture of their unit as it is to understand the financial needs of their unit. Culture and philosophy may need to change in order for growth to be realized and often, this is met with resistance. Establishing a new culture that is accepted and that results: in continued successful growth and acceptance of new philosophies begins with implementing a PPM. It is vital that there is acknowledgement of current philosophies and efforts to include input from staff. The goal of this project is to describe efforts taken to create this success.

Methods
Cultural change, along with better staff retention rates was achieved through various efforts such as specialty training/apprenticeship, fostering a nurse mentor program, bridge to nursing efforts for non-licensed staff, and shared governance committees.

Results
In the midst of tremendous growth, we have successfully maintained well below the hospital goal of 15% and in this year, we have seen sustainability of the rates in all units.
TURNOVER RATES (Hospital Goal = 15%)

Conclusions
Implementing various components of a Professional Practice Model in the midst of growth and change, fosters acceptance of cultural change and supports nurse retention efforts during these times.

Applicability of Research to Practice
Evaluating efforts of implementing a PPM validates infrastructure and contributes to overall sustainability.
597 Opioid-limiting Mandate Did Not Increase Readmissions for a Single Burn Center
Authors: Nurczyk Kamil , Sljivic Sanja , Pogson Kaylyn , Chrisco Lori , Nizamani Rabia , Jones Samuel W , Williams Felicia N 
Published: March 2020

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&lt; 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&lt; 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.
603 Fluid Considerations: Enhancing Burn Nurse Competency
Authors: Thompson Keith , Castillo Mark A , Santos Adrienne , Helms Alexandra J , Rizzo Julie A , Salinas Victor M , Reid Colleen , Abbott Monica L 
Published: March 2020

Abstract

Introduction
One of the most pivotal points for any burn patient is the initial fluid resuscitation. Nurses must maintain burn competencies and be familiar with perfusion indicators. Diverse levels of experience, unusually low census, frequent staff turnover, and changes in resuscitation strategies prompted concern regarding staff education. We developed a new resuscitation course for burn nurses, and aimed to determine whether it improves their confidence and knowledge.

Methods
Prior to training, a 7-item survey and a 10-item knowledge assessment were distributed to staff to assess baseline knowledge and confidence. In January 2019, nurses were provided a 45-min lecture about the unit’s fluid resuscitation protocol, critical indicators of end-organ perfusion, and adjunctive resuscitation tools. Teams were provided information on a real case scenario and asked to create a resuscitation plan. This was followed by a collaborative discussion. Staff then completed a follow-up survey and assessment. Nurses were provided a copy of the unit’s fluid resuscitation clinical practice guideline and a copy of a peer-reviewed journal article. In April 2019, staff members were not given a lecture, but were asked to repeat the questionnaire portion from the previous course to assess knowledge retention. In August 2019 staff received a 45-min lecture regarding blood gas interpretation as it applies to burn resuscitation, common burn resuscitation missteps, and when to call the physician. Staff received a burn resuscitation checklist to improve nurse/physician communication. The staff was given a 5-item satisfaction survey related to course content.

Results
The initial confidence survey (n=64) overall average was 8/10 with 0 being least confident and 10 extremely confident. The post-training average was 9/10. One of the largest confidence improvements was staff with less than 5 years of burn experience, which increased from 6.5/10 to 8/10. The initial baseline knowledge assessment (n=64) overall average was 80%. The post-lecture assessment average was 94%. The knowledge retention questionnaire (n=48) average score was 90%. Finally, the satisfaction survey (n=60) showed an overall score of 94%.

Conclusions
Data gathered suggest that brief lectures combined with collaborative discussion and case studies may be an effective tool for enhancing burn competencies and confidence among staff, especially for those with less than 5 years’ burn experience. Since this was a small sample size and single-center project, more research is needed to optimize the approach.

Applicability of Research to Practice
Managing burn injuries, particularly in the hours immediately following injury, requires expertise and training. This project provides one method for improving nurse competency.
605 Integrative Nursing for Burn Patients: Necessity for Bridging Gaps in Spiritual Care
Authors: Henderson Tammy L , Thomas Mini , Joe Victor C 
Published: March 2020

Abstract

Introduction
Spirituality is universal and is a major factor in the search for meaning in life. Spiritual care helps to overcome the fear of the unknown and anxiety related to distress or dying. The majority of healthcare providers do not feel competent or confident to deliver spiritual care. Currently there are gaps in spiritual care delivery, despite the availability of spiritual care services during patient’s and families’ imminent spiritual privations.

Methods
A written survey was conducted among the clinical nurses in the burn unit to identify the nurse’s perception regarding spiritual care. The survey was voluntary and anonymous. The survey contained six multiple choice questions and a comment section. (See Table 1)

Results
There was an 88% response rate (n=30) from all nurses (n=34) in the unit. While majority (90.3%) of staff felt spiritual care was an important component in the overall care, only 13.3% felt confident to provide the care. Among the survey participants, 77.4% agreed they had come across a time when they were not able to obtain spiritual care for their patient. Among the survey responders, 77.4% believed a nurse could be trained to deliver spiritual care in urgent situations to fill the gap in the absence of hospital chaplain. Finally, the nursing staff was asked if they would be interested in receiving education and 38.7% agreed they were interested in spiritual care education (Table 1).

Conclusions
Burn unit nurses reported spiritual care as an essential component for the holistic care of patients. However, nurses admit they lack confidence in providing spiritual care and agreed to the need for spiritual care education, with about a third of them being willing to obtain the education. As a result of this assessment, education will be provided to nurses in the burn unit as a pilot project. The overall goal is to educate the nurses throughout the facility who are interested in improving their spiritual care delivery.

Applicability of Research to Practice
Proper nursing education is needed to develop competency and confidence to provide spiritual care and minimize the gaps in spiritual care services during a patient’s imminent death or spiritual distress.
612 Assessing the Impact of Burns on Children Aged 5–18 Years: A Narrative Review of Health Outcomes Literature
Authors: Austen Amelia , Hou Carina , Patel Khushbu , Brady Keri , Grant Gabrielle G , Schneider Jeffrey C , Kazis Lewis , Ryan Colleen M 
Published: March 2020

Abstract

Introduction
Burn injuries can have major long-term effects on the health and quality of life for children and adolescents. This study narratively reviewed the health outcomes literature focusing on the impact of burn injury for children aged 5–18.

Methods
Literature targeting pediatric outcomes was reviewed to identify the effects of burns on children aged 5–18 (n=16). Inclusion criteria included studies that focused on the impact of burns on health and quality of life and were age-appropriate for this population. Articles were identified via PubMed, Web of Science, and manual reference checks. Data collected included the outcomes and health domains assessed in each article and the findings of the effects of the burn injury on those specific outcomes. The Preschool LIBRE Conceptual Model served as a ‘domains framework’ to guide the identification of outcomes and health domains.

Results
Long-term burn-specific outcomes and broad health domains identified were physical functioning (n=9), psychological functioning (n=12), social functioning (n=4), symptoms (n=8), and family (n=7). Some studies exclusively focused on one domain whereas others assessed two domains or more. Subdomains such as upper extremity functioning and functional independence were addressed in the physical functioning domain. Psychological functioning outcomes included subdomains such as emotional health and behavioral problems. Social functioning outcomes evaluated subdomains such as problems with peers and social participation. The symptoms domain addressed post-burn pain and itch. Family outcomes subdomains such as parental satisfaction with appearance and general family functioning were identified.

Conclusions
Burn-specific outcomes and health domains assessing the effects of burns on children aged 5–18 were identified among 16 studies. There is a need for a comprehensive assessment tool that more precisely measures the impact of burn injury across these domains. This work will inform the development of the School-Aged Life Impact Burn Recovery Evaluation (LIBRE) Computer Adaptive Test (CAT) Profile – a new outcome metric for children and adolescents with burns.

Applicability of Research to Practice
This review is relevant to researchers and clinicians assessing health outcomes and measuring burn recovery in children aged 5–18.
623 The Benefits of Burn Awareness Week in a Large Metro Area Hospital
Authors: Johnston Jennine M , Abbott Sarah B , Montelongo Sandra , Huzar Todd F 
Published: March 2020

Abstract

Introduction
According to the American Burn Association, Burn Awareness Week is an annual event that provides an “opportunity for organizations to mobilize burn, fire and life safety educators to unite in sharing a common burn awareness and prevention message in our communities.” In 2018, due to alarming data indicating that a high volume of our children’s burn admissions was a result of scald burns, we recognized the need to participate in our first Burn Awareness Week and involve our community stakeholders.

Methods
Analysis of our data from the 2017 trauma registry determined that 61% of pediatric burn admits were scald burns and most were &lt; 6 years old. Geo-mapping identified at risk areas by ethnicity and zip-codes. Our Burn Awareness Week messaging was designed based on this information. We predominantly targeted English and Spanish speaking families with the goal of increasing awareness of the prevalence and prevention of scald burns and evidence-based first aid treatment. Most materials created were bilingual and included an interactive burn awareness quiz with rewards, firefighter coloring books, bilingual first aid magnets, and t-shirts displaying the scald awareness message, “Hot Liquids Burn Like Fire.” Bilingual story board testimonials of real patients were displayed. Multimedia platforms provided public service announcements in English and Spanish.

Results
More than 1500 people attended the booth during the 5-day event. We designed and implemented our first Burn Awareness Week with participation from community stake-holders. A post-event survey identified that the interactive burn awareness quiz, first aid magnets, t-shirts, and story boards were most effective in delivering our message and well-received by the community. This event served as a catalyst to continue burn awareness and education with clinics and interdepartmental units. In addition, a community hospital requested our materials and information. During our event, one of our community stakeholders successfully secured a proclamation for Burn Awareness Week from our state Governor.

Conclusions
Burn Awareness Week enabled our institution and our community to get involved in addressing an identified pressing public health issue. We created a template for our future participation in Burn Awareness Week based on generated data that allows us to target demographic locations with specific burn related issues within our community.

Applicability of Research to Practice
Scald burns is the most common burn injury in young children admitted at our hospital. A collaborative event between our hospital and community stake-holders provided burn awareness and prevention education to our community to help reduce such injuries in the future.