bluuebunny/crossref_metadata_2025_split huggingface dataset:
533 Medical Photo Application–Delivering Expert Burn Care in the Intermountain West
Authors: Mark Elizabeth , Rizzi Zach , Lewis Giavonni 
Published: May 2023

Abstract

Introduction
As the only verified Burn Center in the Intermountain West, we are faced with the challenge of providing care and support to a referral area spanning five states. In an effort to make consulting with our Burn Center more efficient and direct, we provide TeleHealth services. We typically provide real-time facility-to-facility consultation, facility-to-patient consultation, phone consultation, and photo consultation. Prior to development of our medical photo application (MedPic app), photo consults were completed via encrypted email. The consult process was inefficient resulting in multiple phone calls for one consult. As a result, we received requests to improve the process, making it more user friendly and HIPPA compliant.
Initially, our Burn Center created a photo consultation website that enabled referring providers to go to a webpage and upload photos. The consult began with a phone call from the referring provider. The Burn Center staff would inform the referring provider of the photo website and the referring provider would upload the photos. This improved the photo consult process, however it was still inefficient.
Based on these requests from our referring providers, staff, and patients, we developed the MedPic app. With the new MedPic app, we provide an easy to access and efficient process to consult with our Burn center; thus improving efficiency, reducing unnecessary hospital admissions, and associated medical transport costs.

Methods
The photo app was created and made available in March of 2020. The app streamlined the consult process by creating a direct link from referring providers to Burn providers. Burn providers receive images as soon as they are uploaded through the app.
The MedPic app is a photo consultation tool and requires three steps: 1. Take photos of the wounds; 2. Enter patient information; and 3. Enter a return call back number. A plan of care is communicated back to the referring provider within 30 minutes. Photos taken within the app are not saved to any device. The images are encrypted to protect patient information making the app HIPPA compliant.
We collected encounter data generated by photo consultation to our burn center prior to and after the MedPic app development (January 2016- September 2022).

Results
Since the MedPic app was released in March of 2020 we have noted 2,071 app downloads and have seen a steady increase in photo consultations. Figure 1 shows the total number of photo consultations to our Burn Center from January 2016 through September 2022.

Conclusions
Our Burn Center created the MedPic app resulting in over 2,000 downloads. The app is integrated into our Burn Center Telehealth consultation workflow. By providing a direct approach to acute burn injury consultations, we are able to efficiently assess patient wounds and ensure the patient receives the level of care they need in a timely manner.

Applicability of Research to Practice
This directly impacts triage and management of outpatient acute burn injuries.
534 If You Build It, They Will Come: Everyday Burn Clinic Enhanced Access to Care
Authors: O'Rourke Casey , Gernt Megan , Burton-Williams Kristen 
Published: May 2023

Abstract

Introduction
Prior to 2020, our small burn center had 1x/wk adult burn clinic and 1x/wk pediatric burn clinic. This schedule did not allow for optimal access to care for the geographic area our burn center serves. Also, our inpatient daily census was steadily increasing, and we identified many barriers to discharge for our acute burn survivors that would help to justify to hospital administration the need for increasing the frequency of our burn clinic to daily. These barriers to discharge included decreased availability of visiting nurse agencies for dressing changes, poor quality of rehabilitation services through visiting nurse agencies, and comfort and/or competence with family and/or caregivers being able to provide quality needed burn care.

Methods
Our burn leadership team developed a business plan for an everyday burn clinic to provide to hospital administration. This daily burn clinic would allow for both adult and pediatric burn survivors to be seen Monday-Friday, provide rehabilitative services a space within our burn clinic, and availability of daily dressing changes in burn clinic. The business plan was reviewed by hospital administration, meetings were held with hospital administration, rehabilitation department leadership and ancillary services leadership to help validate the need for the daily burn clinic.

Results
Hospital administration approved our daily burn clinic in July of 2020 allowing for improved outpatient dressing and wound management, easy access to quality burn rehabilitation, translating to decreased length of stay. Communication was sent to all area emergency rooms, urgent cares, pediatrician offices and primary care offices to inform them of the increased availability of the burn clinic. This communication included the American Burn Association transfer criteria, a referral form to facilitate access to our burn clinic, and a simple algorithm for assistance with triaging burn care. Prior to the everyday burn clinic in 2019, we were seeing 1,155 outpatient visits annually and in 2021 we saw 1,728 visits in our burn clinic. This is a 150% increase in outpatient burn clinic visits in two years.

Conclusions
Increasing accessibility to outpatient care for the burn survivor can benefit many aspects in their journey to recovery as well as support the surrounding community in quick access to quality burn care. Burn survivors benefit from shorter hospital stays with the availability of a daily burn clinic for ongoing dressing management while maintaining quality rehabilitation services to maximize their functional outcomes.

Applicability of Research to Practice
Data could be collected to evaluate the true impact the creation of the daily burn clinic had on burn survivors’ length of stay. Also, data can be collected regarding the number of burn survivors treated at other local emergency rooms and/or urgent care facilities prior to the creation of the daily burn clinic to evaluate the efficacy of the communication provided to the community.
560 Utilization of Alternate Hinge for Static Progressive Shoulder Orthosis: A Case Study
Authors: Martinez Andria , Warthman Renee , Foster Kevin , Murray Derek , Richey Karen 
Published: May 2023

Abstract

Introduction
Management of shoulder burn injuries creates unique challenges as the shoulder girdle is comprised of four joints and has the largest degree of motion in the body. The complexity of arthrokinematics and cutaneokinematics requires creative positioning devices to achieve the desired effect. Shoulder positioning devices for pediatric patients are limited, and devices that allow positioning at end range can be bulky, heavy, and costly. Available hinges for upper extremity devices offer limited utility and do not withstand the tensile forces of burn scar contracture in conjuncture with and prolonged use. This is a report of a single patient for which a locking knee hinge was used to fabricate a custom static progressive shoulder flexion device.

Methods
This case study analyzes the impact of bilateral custom static shoulder flexion orthoses and static progressive orthoses on range of motion in a pediatric patient. Static shoulder flexion orthotics were implemented, and then transitioned to static progressive orthotics. Goniometric measurements were obtained through out hospitalization. Average variance in of range of motion at the glenohumeral joint (GH), and standard deviation of goniometric measurements comparing static and static progressive orthoses were collected.

Results
There was a total of 33 bilateral sets of goniometric measurements. Sixteen sets were collected utilizing static shoulder flexion orthoses. Mean flexion was 149.6⁰ and 154.6⁰ abduction of the left shoulder. Right shoulder flexion and abduction means were 149.3⁰ and 152.8⁰ degrees. There was a standard deviation (STD) of 22⁰ for the left shoulder mean goniometric measurements and STD of 23.2⁰ for the right shoulder. Seventeen sets were collected utilizing static progressive shoulder flexion orthoses. Results revealed a mean of 166.1⁰ and 166.7⁰ for flexion and abduction of the left shoulder. Right shoulder flexion and abduction averages were 169.3⁰ and 170.6⁰ respectively. There was an STD of 8.9⁰ for mean goniometric measurements of the left shoulder and STD of 4⁰ of the right shoulder. Introduction of a locking hinged shoulder flexion orthosis resulted in an increase of 80⁰ left and 90⁰ right shoulder flexion in 24 hours. The patient was able to achieve and maintain an average of 165⁰ of shoulder flexion throughout hospitalization (47 days).

Conclusions
Use of a locking hinged shoulder orthosis allowed for progressive increase in shoulder flexion without neurological symptoms and decreased pain and anxiety related to therapy and orthotic application. Compliance with wearing schedule was increased due to ease of application.

Applicability of Research to Practice
Utilization of locking hinges to create custom static progressive shoulder flexion orthoses may allow therapists to increase and maintain shoulder range of motion in pediatric patients following burn injury.
562 Therapy Resources for Management of Large TBSA Burns: A Case Study
Authors: O'Neil Audrey , Rush Cassandra , Roggy David , Hartman Brett 
Published: May 2023

Abstract

Introduction
Therapy studies involving large percent TBSA burns ( &gt;50% TBSA) are not well described. Studies show the highest predictor of preventing burn scar contracture is the amount of burn rehabilitation time received per cutaneous functional units involved, but what does “more therapy time” mean for larger burns in terms of therapy resources for burn centers?

Methods
A case study was completed on a 20-year-old male admitted after sustaining 85% TBSA full thickness flame burns to his face, neck, arms, legs, and trunk, along with an inhalation injury. He was admitted to the inpatient burn ICU for 113 days, undergoing 16 surgeries to achieve skin coverage prior to discharge to acute rehab. Therapy was initiated &lt; 24 hours after admission to the Burn ICU. Direct therapy contact minutes were tracked during all session and divided into therapy treatment domains. (resource). If co-treating occurred, a single unit of time was used for the time of the session to avoid doubling the units provided.

Results
Therapy occurred on 106/113 days of admission, receiving 238 therapy sessions (113 PT, 125 OT). He received 21,027 minutes of direct therapy, averaging 196.5 min/rehab days. The highest number of therapy minutes were spent on ROM (9,032 min). Other domains of care included Mobilization (3,171 min), Positioning (2,298 min), Orthotic management (1,326 min), etc. (Table 1). Despite focus on ROM and positioning, he discharged with 7 moderate (left wrist extension, bilateral hip abduction, bilateral ankle dorsiflexion, left neck rotation, and left forearm supination) and 4 severe contractures (right wrist extension, bilateral hip extension, neck extension). He was able to transfer with moderate assistance and walk 150 ft with a platform walker at discharge.

Conclusions
Therapy interventions in the literature are often described in isolated “domains” of practice, however guidelines on a global approach to management of those with catastrophic injuries does not exist. Prioritization between domains with limited therapy resources when facing patients with extensive deficits is challenging. A dedicated burn therapy staff with availability to secure additional resources was required to ensure optimal outcomes in the management of this patient

Applicability of Research to Practice
This case study demonstrates the comprehensive burden of care and need for additional therapy resources in the management large TBSA burns.
565 Rehabilitation Time to Evaluation Report: A Quality Improvement Study
Authors: Vocke Scott , Werthman Emily , Caffrey Julie , Dean Brooke , Rodriguez Joshua , Andre Gregory 
Published: May 2023

Abstract

Introduction
Successful rehabilitation of patients with burn injuries requires an in-depth occupational therapy (OT) and physical therapy (PT) evaluation early in the acute phase of a patient’s injury to develop a detailed therapy plan of care. In addition, it is a standard of the American Burn Association for verified burn centers to have a comprehensive rehabilitation program designed for burn patients within 24 hours of admission. However, there is no standardized report for tracking timeliness of issuing PT/OT orders or completion of therapy evaluations by PT/OT after a patient is admitted to a burn unit. This quality improvement study details the creation of a “Time to PT/OT Order Placement and Evaluation Completion Report” and results of a quality improvement process used to improve these metrics.

Methods
A multi-disciplinary workgroup was created and included a burn surgeon, PT and program nurse coordinator and an electronic report was created in collaboration with the hospital’s business intelligence team. The report included the following metrics: average time from admission to PT/OT order placement, average time from PT/OT order placement to therapist acknowledgement, and average time from PT/OT order placement to therapist completion of initial evaluation. A baseline report was run (3-months) and results were analyzed. A quality improvement process was then put into place including education of burn attending physicians, fellows, and rotating residents on timeliness of therapy order placement, therapy staff education on findings and a new process for morning coordination of burn therapist caseloads to prioritize new evaluations, and initiation of monthly reporting at the burn joint practice committee meetings. The report was then run for an additional 3-months and results were analyzed.

Results
Baseline and post-quality improvement process results (3-month averages) were as follows: Average time from admission to PT/OT order placement increased from 3.4 to 8.3 hrs, average time from PT/OT order placement to therapist acknowledgement decreased from 43.2 to 31.5 hrs, and average time from PT/OT order placement to therapist completion of evaluation decreased from 43.6 to 35.1 hrs.

Conclusions
After development of this report findings showed that the quality improvement process used to improve timeliness of inpatient PT/OT initial evaluation completion was effective. In addition, this report has been useful for metric reporting during burn joint practice committee meetings, the ABA verification process and burn therapy staffing/daily caseload management.

Applicability of Research to Practice
This report could be used by other burn centers to help track and improve timeliness of initial PT/OT evaluations for acute burns. In addition, metrics created from this report could be used for the ABA verification process and help justify burn unit therapy staffing needs.
568 Mobilization, Splinting & Positioning: Increasing Nursing Participation in the Rehabilitation Plan of Care
Authors: Knight Deborah , Dowling Lynn , Berry Lisa 
Published: May 2023

Abstract

Introduction
The foundation for long-term functional outcomes of the burn patient is laid in the Burn ICU. Nursing plays a vital role in the Rehabilitation Plan of Care for patients with burn injuries. As the member of the critical care team who is most present with the patient around the clock, the burn nurse is essential for carrying over and following through with interventions initiated by Occupational Therapy, Physiotherapy and Speech & Language Pathology. Without cohesion and partnership on the interdisciplinary burn team, the Rehabilitation Plan Care cannot succeed. In the midst of the COVID-19 pandemic, burn nursing turnover rates are higher than pre-pandemic rates. Burn Centers are relying on travel nursing contracts or novice nurses fresh out of school to provide specialized burn care. Our center developed a didactic and “hands on” learning initiative to improve collaboration between the Burn Nursing and Burn Physical Medicine departments in order to equip the critical care burn nurses to actively participate in the Rehabilitation Plan of Care.

Methods
• Collaboration between Burn Nursing leadership and Burn Physical Medicine leadership to examine ABA nursing competencies pertaining to the Rehabilitation Plan of Care
• Team of PTs/OTs identified to develop curriculum based off these competencies
• Learning objectives set
• Hands on training program developed
• 8 small group training sessions completed
• Competency assessments completed
• 7 question pre- & post-testing completed to assess learning
• Opportunity for input from participants for quality improvement

Results
104 Burn ICU nurses participated in the classes. 99% passed competency assessment.
Improvements between Pre- and Post- Test scores demonstrate learning of desired knowledge and skills.
Feedback assessment from RNs regarding value of course participation & ongoing need for collaborative training (most common was related to positioning & compression)

Conclusions
104 burn ICU nurses participated in hands-on, didactic training related to nursing competencies related to the Rehabilitation Plan of Care. Data is now being collected regarding follow through of knowledge and skills implementation.

Applicability of Research to Practice
This project showed the improvement that can be made in regards to the cooperation of burn ICU nurses with the rehabilitation plan of care.
570 Effectiveness of Hand Edema Management Strategies in the Acute Burn Patient
Authors: Warthman Renee , Mehta Ari , Martinez Andria , Islas Claudia , Murray Derek , Foster Kevin , Williams Sierra , Richey Karen 
Published: May 2023

Abstract

Introduction
Hand edema is a common sequalae of burn injuries involving the upper extremity (UE) and larger total body surface area (TBSA) burns requiring fluid resuscitation. Hand edema can be challenging to manage depending on the severity of the injury and, if not adequately addressed, can have long-term functional implications. Multiple edema management techniques are available for therapists treating burn injuries, but little is known about their efficacy. A quality improvement project examined the efficacy of 4 strategies used at our burn center.

Methods
Edema management strategies evaluated included: elevation using a pre-cut foam wedge and pillow, elevation and self-adhesive wrap, elevation and cotton-elastic wrap, and elevation with a chip-bag. Figure-of-8 measurements were taken pre and post intervention. Outcomes included length of time intervention was in place, reason intervention selection, time required to apply intervention, and if intervention was intact prior to removal. Training was completed with staff to ensure consistent application of intervention. Only adult patients were included.

Results
A total of 23 interventions were measured. At follow up, 61% of the interventions were not intact. In each instance this was due to displacement of either the wedge or pillow. Self-adhesive wrap (3.25 cm) followed by cotton-elastic wrap (2.57 cm) in conjunction with elevation achieved the greatest reduction in edema. Elevation of the UE with a wedge and pillow are less effective in managing hand edema alone, with a mean difference of .26 centimeters (cm) decrease in edema. On average, it took therapists less time to apply cotton-elastic wrap (6.4 minutes) vs self-adhesive wrap (14.25 minutes).

Conclusions
In this limited sample, elevation with a pre-cut foam wedge or a pillow was least effective in reducing edema in the hand. Including a secondary edema management technique in conjunction with elevation is more effective in managing hand edema. A larger sample size may benefit increased understanding of edema management techniques within a burn center.

Applicability of Research to Practice
Interdisciplinary training on maintaining edema management strategies is important to promote maintenance of positioning. Further research is warranted to examine the efficacy of hand edema intervention strategies in the acute burn patient.
577 Impact of the Bismuth Tribromophenate Stick-down Method on Pediatric Burns
Authors: Joshi Nikita , Grauberger Jennifer , Joo Alex , Lalikos Janice 
Published: May 2023

Abstract

Introduction
Burn injuries are a leading cause of morbidity and mortality in the pediatric population. Patients require frequent dressing changes to minimize infection risk and promote wound healing via re-epithelialization. Bismuth Tribromophenate, an affordable petrolatum-based dressing, has been shown to have rapid re-epithelization of skin grafts and low infection rates in clean wound environments. A stick-down (SD) protocol has been developed to minimize the frequency of dressing changes. This SD protocol involves daily assessment and changing of the dressing until it begins to adhere to the underlying wound bed, where the dressing is then left in place as a protective layer as re-epithelialization occurs. The objective of this study is to characterize baseline features and compare outcomes associated with the SD dressing compared to non-stick-down (NSD) Bismuth Tribromophenate dressing.

Methods
Patients under 18 years treated at our institution for partial thickness burn injuries were retrospectively identified using our medical records. Demographic data, injury characteristics, dressing type, length of hospitalization, and outpatient outcomes were collected from these records. Statistical analysis between dressing types was achieved using Fisher’s exact test and Mann-Whitney U test, with statistical significance defined as p &lt; 0.05.

Results
A total of 106 individuals receiving Bismuth Tribromophenate were identified. 36 patients received the Bismuth Tribromophenate SD dressing and 70 patients received NSD dressing. SD patients had a higher hospital admission rate compared to NSD patients (52.8% versus 33.3%, p = 0.088), though not statistically significant. 47.3% of admitted SD patients were admitted for burn severity compared to 25% in NSD patients. SD patients also had higher PICU admission rates compared to NSD patients (36.8% versus 4.8%, p = 0.017). SD patients also required initial debridement sedation more often (63.6% versus 36.7%, p = 0.017). SD and NSD patients had re-epithelialization rates of 66.7% and 65.6% (p = 1), respectively. Median time to re-epithelialization was 13 (10.8-17.2) days in SD patients compared to 12 (10-20) days in NSD patients (p = 1).

Conclusions
SD-receiving patients were more likely to be admitted to the hospital and admitted for burn severity. In contrast, patients receiving NSD were less likely to be admitted, but more commonly admitted for pain. SD-receiving patients were also more likely to be admitted to the PICU and require sedation for debridement. Despite this difference in baseline characteristics, re-epithelialization rates and time to re-epithelialization between SD and NSD patients were not statistically distinct, with comparable rates and days to healing.

Applicability of Research to Practice
Identifying cost-effective, efficacious, and convenient dressing protocols for the treatment of pediatric burns.