Table 3 Results PJM tool Spreadsheet One. Scientific standards and family and healthcare providers meeting standards
The injury | Emergency care | Ambulatory care | Admission | In-patient care | Discharge | Rehabilitation | |
|---|---|---|---|---|---|---|---|
Standards achieved by healthcare service and healthcare professionals | ⋅ 20 min cool running water within first 3 h ⋅ Remove jewellery and clothing ⋅ Cover with non-adherent dressing ⋅ Seek medical assistance ⋅ Keep warm ⋅ Provide access to basic online first aid training on burn injury to target the community ⋅ Ensure first aid courses contain burn first aid content | ⋅ Burns greater than 5% in children ⋅ Full Thickness burns greater than 5% ⋅ Burns of special areas ⋅ Burns in very young ⋅ Children up to their 16th birthday should be transferred to a children's burn unit ⋅ Metro clients access tertiary facilities directly, and outer regions require routine links to tertiary facilities ⋅ Access to specialist service | ⋅ Consult with a burn surgeon ⋅ Access to physiotherapy, · occupational therapy, social work, speech pathology, nutritional support, clinical psychology ⋅ Ambulatory burn clinic provides assessment and dressing of minor and non-severe burns, rehabilitation interventions, follow-up burn dressing and skin graft management for patients after discharge ⋅ long-term scar management and symptom control ⋅ patient and family teaching and support ⋅ ongoing complication risk management and treatment ⋅ advisory service to other hospitals, healthcare professionals and community | ⋅ Social worker undertakes thorough psychosocial assessment to review family history and address psychosocial issues in the acute phase ⋅ Accurate assessment undertaken in the ED in accordance with the admission guidelines for individual burn unit ⋅ Laser Doppler Imaging to assess depth ⋅ Rehabilitation starts on admission and whole patient and family are considered when addressing rehabilitation needs ⋅ Care plan is developed and documented and reviewed on a continual basis . Case management is commenced on admission ⋅ Allied health contributes to all stages of continuum of care guided by clinical practice guidelines ⋅ Nurses provide holistic care and are integral to patient care from point of admission to rehabilitation to ambulatory care ⋅ Multi-disciplinary teams coordinate individual clinical pathways ⋅ Each discipline contributes to treatment plan | ⋅ Social work and clinical psychology provide assessment and intervention ⋅ Dietician assessment for burns > 10%, < 1yo, burn to mouth/hands ⋅ Nursing staff work closely with comprehensive pain management service incorporating a range of modalities and including non-pharmacological and complementary therapies ⋅ Care plan incorporates rehabilitation throughout all stages of care starting at time of injury and family are considered when addressing rehabilitation needs ⋅ Major burn patients should be assessed within 24 h of admission by physiotherapy OR occupational therapy ⋅ Multidisciplinary plan of care · Allied health contributes to all stages of continuum of care guided by clinical practice guidelines ⋅ Multi-disciplinary teams coordinate individual clinical pathways ⋅ Receive multi-disciplinary inpatient care ⋅ Each discipline contributes to treatment plan ⋅ Burn injury team liaises with microbiology and infection control ⋅ The burn injury team works closely with the pharmacist in the management of care ⋅ State-wide e-health service supporting consultant-led on-call advisory service ⋅ Patients managed in ICU require coordination of wound care by burn care nurses ⋅ Access to pathology services ⋅ Nursing staff provide holistic care ⋅ 24 h access to operation rooms ⋅ Paediatric treatment rooms · Child protection unit involvement | ⋅ Pharmacist to provide regular information to child, family, carer on medication at admission and discharge ⋅ Allied health contributes to all stages of continuum of care guided by clinical practice guidelines ⋅ Social work and clinical psychology provide assessment and intervention ⋅ Address psychosocial issues, prior to discharge . Case management for complex cases continues throughout long-term care to facilitate periodic re-assessment and monitor changes in functionality ⋅ Patients to receive 'Nutrition for burns' pamphlet prior to discharge | |
Standards not achieved by healthcare service and healthcare professionals | ⋅ Provide 7 day/week ambulatory burn service co-located with acute inpatient burn unit ⋅ Burn injury patients have access to ‘hospital-in-the-home’ services post inpatient discharge | ⋅ Clinical psychology provides assessment and intervention at admission | ⋅ Comprehensive nursing care plan developed in consultation with patient and/or caregiver on admission to unit | ⋅ Facilitated early discharge by accessing ‘hospital-in-the-home’ services, and by using a step down to local non-tertiary hospital for transition to rehabilitation | ⋅ Use telehealth for ongoing post-acute care of burn patients ⋅ Rehabilitation team provides referral to external rehabilitation facilities for ongoing management ⋅ Be referred to OT/physio at local services where available, with support from burn unit therapists ⋅ Patients and families continue to receive psychosocial intervention and refer to other agencies where required | ||
Standards not applicable for this burn care journey | ⋅ Inhalation, electrical, circumferential and chemical burns ⋅ Burns with illness ⋅ Burns with major trauma ⋅ Any burn where the referring worker requires management or advice from the paediatric burn service ⋅ Burn injury with suspicion of non-accidental injury ⋅ Appropriate communication and management instigated for interstate transfers within 4 h ⋅ The facility who has first contact with the burn injury contacts the unit for support and advice ⋅ For minor burns, communication with unit regardless of confidence in assessment and plan of care ⋅ For moderate burn, communicate with unit early and adopt recommended guidelines ⋅ Laser Doppler technology is used to assess depth ⋅ Initial assessment in ED where staff communicate with state unit, providing 24-h turnaround service via email images for clinical advice | · accept patients referred from a hospital emergency department, general practitioners, other hospitals, community health services, or self-referred ⋅ burn injury of up to 10% of total body surface area may be managed on an ambulatory basis · Outpatient community care may include home, school, pre-school and workplace visits ⋅ Referral to dietician if deemed to be at nutritional risk; followed by nutritional assessment for social and cultural needs ⋅ Use of step-down facility to allow access to ambulatory care services for rural and remote families ⋅ patients with a burn who require surgery, with interim burn care until the day of surgery | ⋅ Emergency surgery within 24 h post-deep circumferential burn ⋅ Access to Burn Unit is dependent on post-assessment classification of the burn injury using E-health Outreach Service via non-specialist centres for regional/rural/remote | ⋅ Education teacher on daily basis ⋅ Psychosocial assessment focussing on the accident causing injury and family member’s perceptions around this, past experiences of trauma, family dynamics, cultural and socio-economic factors, barriers to coping and family strengths and supports ⋅ Long term access to psychological support | ⋅ Provide access to sub/acute/step-down facilities ⋅ Referral to community agencies for support at home if required | ||
Standards unable to be assessed | ⋅ Staff attending burn patients in outpatient setting observe standard precautions at all times, including hand hygiene and aseptic non-touch technique and relevant PPE | ⋅ Step-down facilities are linked to acute services to achieve a seamless continuum of care ⋅ Provide access to burn camps for children ⋅ Contribute to cooperation between family and school ⋅ Visit school with burn team to educate | |||||
Data from Case Notes and discussions (where able) regarding how standards were/were not applied | |||||||
Caregiver | Had completed first aid training | Accessed emergency ambulance care | Travelled in private car to appointments. From daily dressing to once every 6 weeks | Time in emergency department then transferred to ICU | Four days in ICU (and staying at home at nights) and four weeks in surgical unit (staying at home and sometimes in hospital) | Travelled home in private car. Felt hurried out and inadequately prepared to provide necessary at-home care | |
Family | N/A | Contacted by phone after accident occurred | Travelled in private care with caregiver occasionally | Arrived at hospital after admission to ICU | Visited often in private car | ||
Aboriginal Health Worker (AHW) | No AHW employed | No AHW employed | No AHW employed | No AHW employed | No AHW employed | No AHW employed | |
ACCHS | Not accessed by the family | Not utilised by the family | Not accessed by the family | Not utilised by the family | Not utilised by the family | Not utilised by the family | |
Emergency Care Provider | Not able to contact place of injury or those present at time of injury | Not able to contact Ambulance worker Case Notes: Mandatory notifications made | N/A | N/A | N/A | N/A | |
Surgeon | N/A | N/A | Consults as necessary | Surgical assessment within 4 h of admission to hospital | Surgical intervention | Discharge note made | |
Burn Nurse | N/A | N/A | Arranged care appointments and supported caregiver in minimising time spent in hospital | Support transition to ICU and then to ward. In regular contact with caregiver and giving constant information | Developed initial care plan. Led case conferences with medical staff. Involved multidisciplinary team. Reviewed at least daily | Gave information regarding required care Arranged follow-up appointments | |
A/ILO | N/A | No support provision | Not notified | On A/ILO list. Seen and offered support. Did not attend case conferences | Seen prior to discharge and support offered | ||
Traditional Healer | N/A | No traditional healer employed | No traditional healer employed | No traditional healer employed | No traditional healer employed | No traditional healer employed | |
Occupational Therapist | N/A | N/A | Consults in scar clinic | Assessed within 8 h of admission | In patient care provided. Attended case conference Input into care plan | Discharge note made | |
Physiotherapist | N/A | N/A | Consults in scar clinic | Assessed within 24 h of admission | In patient care provided. Attended case conference Input into care plan | Discharge note made | |
Psychologist | N/A | No input into care. Not able to be contacted | No input into care. Not able to be contacted | No input into care. Not able to be contacted | No input into care. Not able to be contacted | No input into care. Not able to be contacted | |
Social Worker | N/A | Attended ED. Supported, engaged and explained | No input into care | Able to provide support to caregiver and available for all level 1 trauma | Provided initial assessment of caregiver, supported, engaged and provided intervention where necessary and supported access to fuel and food vouchers. Attended case conference | Discharge note made | |