bluuebunny/crossref_metadata_2025_split huggingface dataset:
580 Factors Affecting Research Productivity of Burn Surgeons: Results from a Survey of American Burn Association Members
Authors: Elkbuli Adel , Narvel Raed , Zajd Sarah , Hai Shaikh A , McKenney Mark , Bonvea Dessy 
Published: March 2020

Abstract

Introduction
While previous studies have examined factors that impact research productivity for surgeons in general, few studies address research productivity specifically of Burn specialists. This study aimed to identify factors that promote and impede research participation and productivity of Burn surgeons, and help elucidate what changes can be made by Departments/Divisions to improve the research productivity.

Methods
A 44-question anonymous research survey tool was administered to Burn surgeons that are members of the American Burn Association (ABA). The questions analyzed factors such as demographics, career accomplishments, current institution type, educational background, research background, barriers to conducting research, and current research productivity. Chi-square tests were used to analyze significance at p&lt; 0.05.

Results
Most respondents reported not having any protected research time (71.4%) or resources provided by their institution (84.5%). A majority believed increasing regulatory policies/IRB restrictions have negatively impacted productivity (65.1%). Factors associated with positive impact on research productivity included having a mentor, conducting research prior to completing residency, and provision of research resources from institution such as statistical support, start-up funds, grant writing support, and laboratory space. Age and gender had no statistically impact on research productivity.

Conclusions
Burn surgeons are more likely to publish research and to receive grants when they have mentors, a history of research prior to completion of residency, and research resources from their institution. Barriers to research productivity include lack of institutional support, lack of protected research time, and increased regulatory policy.

Applicability of Research to Practice
This study provides a starting point for analyzing factors that contribute to research success amongst burn surgeons. Individually, burn surgeons must take better advantage of the resources available to them through organizations such as the American Burn Association and seek mentorship where available. Surgical departments should aim to increase research resources for burn surgeons, honor protected research time, and strive to create a culture of research activity if research productivity is the goal.
583 Impacting the Length of Stay of Burn Patients in the Emergency Department
Authors: Kopari Nicole M 
Published: March 2020

Abstract

Introduction
Burn patients represent a challenging patient population and require early interventions. Advance Burn Life Support classes have been developed to guide first responders with assessing and treating burn patients in the pre-hospital setting. In the emergency department (ED) patients may experience hypothermia, delayed resuscitation, inadequate pain control, and delayed wound cares.

Methods
ED length of stay (LOS) was retrospectively reviewed for burn patient who met trauma activation criteria from 2013–2018. Patients were categorized based on ED disposition to burn stepdown, burn unit intensive care (BICU), or directly to the burn operating room (OR). Patients who died in the ED or were discharged home were excluded. In 2019, guidelines for burn activations, responses, and consults were developed to mirror the activation criteria for a Level 1 trauma institution. ED nurses and physicians were educated on burn assessment, wound care, and the new triage guidelines with emphasis on the importance of early transfer out of the ED.

Results
Prior to the change in burn activation guidelines, rapid transfer of burn patients out of the ED had not been emphasized. Of the 144 patients examined, ED LOS was 5.4 hours for those going to burn stepdown, 4.3 hours for BICU, and 3.7 hours for those who went directly to the burn OR. Several barriers to early transfer out of the ED were identified including lack of bed availability, lack of cleaning staff on nights and weekends, difficult lateral transfers of non-burn patients out of the Burn Unit, and a lack of education on the importance of early interventions by nursing staff. Since the implementation of the guidelines, there has been an improvement in LOS for BICU patients, but the goal of less than one hour in the ED has not yet been achieved.

Conclusions
Unacceptable ED LOS for burn patients were identified, triage guidelines were developed, and education was provided to staff. Guidelines and education, in conjunction with emphasizing the importance of having available beds in the Burn Unit, have led to a decrease in ED length of stay. Ongoing education and process improvement are key for rapid transfer of burn patients out of the ED.

Applicability of Research to Practice
Burn Centers can improve patient accounts by identifying areas that put burn patients at risk. Implementation of protocols can lead to process improvement and lead to better patient outcomes.
592 Prevention of CAUTIs in a Burn ICU
Authors: Vargas Vina , Rivera Emiko , Sidhu Teresa , Zaballero Lea Lyn , Karanas Yvonne L 
Published: March 2020

Abstract

Introduction
Catheter-associated urinary tract infections (CAUTIs) are the most common hospital-associated infection (HAI). Urinary catheter use is associated with urinary tract infections (UTIs) that can lead to complications such as cystitis, pyelonephritis, bacteremia, septic shock, and death. CAUTIs are associated with an excess length of stay of 2–4 days, increase costs of $0.4–0.5 billion per year nationally, and lead to unnecessary antimicrobial use. Through numerous implementations, a Burn ICU was able to drastically decrease their incidence of CAUTIs.

Methods
A Burn ICU implemented several interventions to reduce CAUTI rates. These interventions included:

Results
When this project was initiated in September of 2017, there were 9 CAUTIs identified in a Burn ICU, per the hospital’s Infection Prevention Department. By the end of 2017, there were 11, which equated to a rate of 14.67 per 1000 urinary catheter days. In 2018, the Burn ICU had 1 CAUTI, with a rate of 1.92 per 1000 urinary catheter days. In 2019 (through quarter 2), the Burn ICU has not had a CAUTI per the Infection Prevention Department. We believe the interventions made have drastically decreased the incidence of CAUTIs.

Conclusions
A Burn ICU implemented many new practices in 2017 when the CAUTI rate and SIR were above the hospital’s overall SIR. The Burn ICU staff now practice proper care and maintenance of urinary catheters and continue to provide excellent care. Although we have decreased our incidence of CAUTIs for 2018 and 2019, it is equally important we sustain this improvement. Therefore, we will continue to provide an open forum for discussion with staff so we can all do our part in keeping patients safe.

Applicability of Research to Practice
A Burn ICU decreased the incidence of CAUTIs by educating staff on proper care and maintenance of urinary catheters, removing catheters as soon as possible, and testing for UTIs upon admission to determine the patient’s baseline. By doing so, CAUTI rates went from 14.67 to 0 per 1000 urinary catheter days.
606 Establishing a Deep Sedation Program: Challenges and Successes from a Nursing Management Perspective
Authors: Lane Christine , Doherty Kathleen , Poteet Mark 
Published: March 2020

Abstract

Introduction
A burn center with a high volume of burn admissions was looking for ways to decrease the pain and anxiety experienced by patients during wound care. Patients requiring surgical dressing removal or demonstrating difficulty in coping during wound care were of particular concern. Discussions between anesthesia providers and the burn team led to the concept of anesthesia safely providing deep sedation in the inpatient wound care center for select dressing changes. Nursing management began to work through the challenges of implementing the Burn Center Deep Sedation Program.

Methods
Processes for identifying, scheduling, and recovering patients were established. All Burn Acute Care Unit (BACU) patients requiring a surgical dressing removal or demonstrating poor coping during wound care would qualify for deep sedation. Nursing management worked to create an online scheduling system, and designated a room which was set up with anesthesia equipment and supplies. Candidates were reviewed for deep sedation and a schedule created for the following day. All patients required a Burn Intensive Care Unit (BICU) nurse during the recovery period. A BICU room adjacent to the wound care center became the deep sedation recovery room, and was staffed by the BICU charge nurse. BICU nurses received additional training in post anesthesia care prior to the program implementation. Once all educational needs and logistical changes were addressed, the deep sedation program began operating seven days per week.

Results
Starting in January 2016 deep sedation has been provided to approximately 400 cases per year. No additional staff was required, only shifting responsibilities of existing nursing personnel. Designating a specific room for deep sedation has ensured that anesthesia providers have access to the appropriate equipment and has minimized disruptions to the flow of other dressing changes occurring throughout the day. The impact of the program on pain and anxiety is currently under evaluation. Informal feedback from patients and staff members has been very positive.

Conclusions
The challenge in developing this program was the amount of education and planning required prior to implementation. Once the program was active, the challenges that occurred involved the scheduling system. An additional benefit of the program was the teamwork required between BICU and BACU nurses to safely handoff patients. The deep sedation program has also strengthened the burn team’s relationship with the anesthesia providers, whose commitment to the project was appreciated by all involved. A team approach and a collective mission to improve care for burn patients have driven this project to its current success.

Applicability of Research to Practice
The collaboration between the burn team and anesthesia has resulted in an improved wound care experience for the patient.
607 Reducing Burnout Related to Night Shift Calls to Physicians – a Process Improvement Project
Authors: Hemingway Kristy D , Cabrera Victor 
Published: March 2020

Abstract

Introduction
Call volume is directly linked to resident and physician burnout according to the literature. Nurse education and experience effect their ability to prioritize events that require a call to a physician, which can lead to increased calls for non-emergent issues. This is particularly challenging at night when resources are limited and physician workload is increased. Our burn team was experiencing high call volumes at night and the attending and resident physicians collaborated with nursing to initiate a process improvement that would address this issue so that burnout could be prevented from both nursing and physician teams. The overall goal was to reduce the call volume at night while still maintaining safe, quality care for our patients.

Methods
A call log was developed to track calls made to MD’s at night for a one-week period in September 2018 and then again in February 2019. The log included the time, the reason, the physician team, method of contact, response and the number of attempts to call. Based on the results of the September 2018 tracking log, 3 interventions were created and implemented before tracking again in February 2019. The 3 interventions implemented included:

Results
Reduction in calls was achieved. Calls to the burn team were reduced by 71% from period in September 2018 to the time period in February 2019. Concerns were reduced from 17 to 5 indicating improved knowledge on ability to prioritize routine versus urgent calls.

Conclusions
Collaboration amongst nursing and physicians to reduce calls at night can be achieved when a true understanding of the nature of the calls are identified. Having data logs of the calls allowed the team to break down urgent, emergent and important needs so that education could be provided to the nursing team, which then helped them analyze appropriate reasons to call physicians at night. Proactive calls or rounding also developed from this project have contributed to improved relationships between nurses and physicians as well as decreased calls.

Applicability of Research to Practice
The generational change in the work force requires considerable forethought in regards to education and orientation of new nurses working in the acute care setting. This process improvement project provides a template for others working in burn centers to implement methods to educate nurses and physicians on the importance of collaborating to define urgent, emergent and routine needs of our patients so that both benefit from being able to provide excellent patient care by minimizing unnecessary calls at night.
609 Development and Implementation of the Burn Nurse Mentor Role
Authors: Hemingway Kristy D , Fernandez Megan 
Published: March 2020

Abstract

Introduction
Training and preparation of nurses in the burn unit is a long and costly process. Attrition of seasoned staff and a shortage of qualified preceptors places added pressure on experienced preceptors. Additionally, attrition of established preceptors leaves the crucial job of preparing new nurses to novice preceptors who are less experienced or inadequately prepared. High rates of burnout and turnover have been shown to negatively affect patient care outcomes and can lead to further increased staff turnover. Quality of environment and adequate job preparation are evidence-based strategies to increase new nurse retention. Our Burn Center’s Step Down unit was averaging a staff turnover rate of 14%, and 60% of the nursing team had less than one year of experience. We determined the need to create a mentorship role in order to increase staff retention and satisfaction, with the potential to improve patient outcomes.

Methods
The goals of the Burn Nurse Mentor role are to encourage and develop the competency of the nursing staff on the Burn Step Down unit. In planning for the role, an additional full time position was drafted and justified prior to creation. The job requirements included having a BSN, a minimum of 2 years ICU experience with the burn population, classified as a clinical nurse III or higher on the clinical ladder, and functioning as a preceptor. The role was designed to be at the elbow support for new nurses who are either being precepted or newly off of orientation. This support for the nursing staff would help offload preceptor burden and encourage development of critical thinking skills. Additionally, the Burn Nurse Mentor would assess and intervene when educational, practice, or process gaps arise on the unit. The goals of the position are to encourage and develop the competency of the nursing staff on the Burn Step Down unit.

Results
The anecdotal response to the Burn Nurse Mentor role from nursing staff has been generally positive. As this was an entirely new role for the Burn Center, periodic clarification of scope and responsibilities was needed to ensure staff comfort and familiarity with the role. Initial qualitative and quantitative data regarding quality outcomes and staff retention have trended upward as well.

Conclusions
The Burn Nurse Mentor is a newly designed and implemented role for our Burn Center. As such, there is a limited amount of data and research available. Future analysis of the impact of this role will include formal staff feedback at the one year mark and nursing-sensitive and patient quality indicators.

Applicability of Research to Practice
Using the information presented in this project, other Burn Centers can analyze the need for a mentor on their unit and use it to develop a mentor on their own unit.
611 Screening Adults for Depression and Suicidality in an Outpatient Burn Center
Authors: Rose Amanda , Gilbertson Alan D , Belacic Heather , Crow John 
Published: March 2020

Abstract

Introduction
In response to NIH recommendations and ABA verification standards, a protocol was initiated to screen adult burn patients in an outpatient verified burn center for depression and suicidality. It utilized the Patient Health Questionnaire (PHQ-9), a widely recognized depression screening tool. The protocol dictated patients scoring 10 or greater, or endorsing the suicide risk question would require further assessment. This project was part of a quality improvement initiative to assess initiating the protocol, identifying at-risk patients, and making appropriate referrals.

Methods
The initial visit of adults (ages 19 and over) seen over a one year period were retrospectively reviewed. For adults screening positive in the EMR, a Data Collection Form was completed gathering information on PHQ-9 scores, mental health treatment and diagnosis, and burn injuries.

Results
There were 748 adults seen for an initial visit at the burn center, ages 19–85, 61% men and 39% women. Of those patients, 572 had a PHQ-9 score documented in the EMR, demonstrating a 76% compliance rate with administration. Of those screened, 52 met criteria for inclusion by scoring 10 or greater or endorsing the suicide risk question on the PHQ-9. Scoring ranges on the PHQ-9 were as follows (N=52): 15.4% mild; 50% moderate; 19.2% moderate-severe; and 15.4% severe. Sixty percent of patients endorsed some suicidal ideation. Fifty two percent of patients were documented clearly as being on psychotropic medication or in specialized mental health services. Results were reviewed or discussed with patients in 81% of the initial visit notes. Nineteen of the 52 patients were offered a referral for mental health services.

Conclusions
Initiating this protocol creates an opportunity to begin conversations about mental health and offer additional support to patients. Approximately 9% of the outpatients screened at the burn center endorsed significant symptoms of depression and or suicidal ideation. Nearly half of these patients were not actively receiving treatment for these symptoms and could potentially benefit from mental health services. This project highlighted that compliance with administering and documenting the PHQ-9 and referral for follow-up services could be improved at this institution.

Applicability of Research to Practice
This protocol supports the need for continued evaluation and screening for depression and suicide risk in adult burn patients. Consideration should be given for monitoring other mental health conditions that could create barriers to care or compliance with treatment, such as anxiety, PTSD, psychosis, etc.
616 Quantification of Nutritional Intakes in Burn Outpatients
Authors: Rousseau Anne-Françoise , Lengelé Laetitia , Fadeur Marjorie , Martin François , Hans Nadine , Bruyère Olivier , Misset Benoit 
Published: March 2020

Abstract

Introduction
Adequate nutrition is essential for wound healing, especially burns. Data on nutritional intakes of burn outpatients (BO) are rare, as well as dedicated guidelines. Objectives of this observational study were to quantify actual nutritional intakes in BO and to search for risk factors of inadequate intakes.

Methods
The study was conducted during 35 weeks in a university burn outpatient clinic. Adults treated exclusively on an outpatient basis were enrolled. Their average daily food intakes were evaluated by a dietician using a ten-point visual assessment of consumed portions during the last meal (SEFI tool) and a food anamnesis. Intakes (calories (Cal), proteins (P), omega-3 and-6 fatty acids (FA), selenium, copper (Cu), zinc (Zn), calcium (Ca), magnesium (Mg), iron, vitamins (vit) A, C, D and E) were compared to national recommended dietary allowances (RDA) for healthy subjects. Actual, ideal or adjusted weight was used as required according to body mass index (BMI). Micronutrients intakes were also calculated in a simulated situation where patients would have received a daily commercial tablet containing multiple vitamins and minerals. Data are expressed as median (P25-P75).

Results
Forty two patients (57% male, age 45 (34–56)y, BMI 25.9 (23.5–28.9)kg/m2, burn surface area (BSA) 2 (1–3)%) were included. Daily Cal and P intakes were 23.6 (19.6 – 29.9) kcal/kg and 1.08 (0.76 – 1.45) g/kg respectively. Inadequate intakes (defined as &lt; 66% RDA) of Cal and P were observed in 36% and 14% of BO, respectively. More than half of BO had inadequate intakes of omega-3 and -6 FA, Ca, Mg, Cu, and vit A, C, D and E. A SEFI &lt; 7 was associated with insufficient intakes in both Cal and P. Probability for patients to have insufficient intakes in both Cal and P was about 6 times more per 1% BSA. No risk factors were detected for insufficient micronutrients intakes. Inadequate intakes were not associated with prolonged healing. Seven BO already took vit C or D, or multiple micronutrients. With daily micronutrients supplements, the others (35/42) would have reached micronutrients RDA, excepting for Ca, Mg, Cu and vit D. Inadequate Ca and vit D intakes would have persisted in 57% and 37% of the supplemented patients, respectively.

Conclusions
Adequacy of Cal and P intakes should be assessed in BO patients with SEFI &lt; 7 or with substantial BSA. Micronutrients intakes, particularly vitamins, were frequently lower than RDA but could be efficiently increased through oral multiple supplementation. With regards to its pleiotropic effects, vit D should probably be supplemented separately in all BO.

Applicability of Research to Practice
Raising awareness about insufficient micronutrients intakes in a number of BO.