int. Burn Injury Database (iBID)

int. Burn Injury Database (iBID)

In common with many areas of medicine, there is an acceptance by clinical burn care teams that the collection and analysis of accumulative data about clinical cases is necessary to allow progress in several areas of service development and delivery. This is particularly important for injury prevention and the improvement of patient outcomes. Collection of such data must be standardised, as much as possible, if the results of any analysis are to be useful, rather than misleading.

The list of the historically available data sources and a brief indication of their respective limitations were considered in the National Burn Care Review (NBCR, March 2001 - available from the downloads page), which concluded that a full picture could not be achieved without creating a specific registry to collect detailed information about burn injury.

In 2004 the UK National Burn Care Group (NBCG) funded the creation of the UK.NBID, which included the creation of the iBID data collection system and the infrastructure to support it. In April 2005, the data collection and analysis began. The design of the iBID software was based on recording what happens clinically following burn injury and to extract from that service management information that can be used for many purposes.

Aims of iBID

To make available a large volume of detailed data about burn injuries severe enough to require treatment by specialised services, which will allow advances to be made in a number of areas:
  • Prevention
  • Service provision monitoring
  • Quality Assurance
  • Planning and modelling changes in service provision
  • Service accreditation
  • Audit and support of Clinical Governance
  • Outcome assessment
  • Epidemiological research
  • Design of multi-centred clinical research

Design

One of the major concerns of the database design was to ensure that sufficient information was requested to provide data for the intended uses, but to ensure that undue detail was not requested. This might reduce the risk of incomplete and inaccurate data collection.

It has been emphasised at all stages of development that the Burn Injury Database was not intended to be an electronic patient record (EPR), although clearly it could form the basis of such a development in the future. The database was intended to be a record of the injury and some aspects of the process of inpatient care, so as to give an indication of the quality and costs of care but also an indication of clinical outcome and in addition measure some process of care outcomes.

The guiding principles of the database design were to ensure that the data remained:

  • Acceptable: as a dataset to all working in burn care
  • Available: from records covering the whole care period
  • Measurable: for every case presenting and being admitted
  • Collectable: without undue effort
  • Meaningful: with a minimum of confounding factors
  • Stable: so as to be useful as a long term measure of care and to monitor prevention efforts

Overarching Principles

  • clinical tool from which service data is derived - designed for use to record the clinical process and not as a pure management tool, unlike many packages offered to health care.
  • define a minimum data set (MDS) to allow basic analysis - intended to place the patient in time and space with sufficient patient and injury definition information.
  • no absolute data requirements - no instances of data entry being frozen because a data item is not available and cannot be entered.
  • design process driven by users - both clinical and managerial users of the information have valid ideas and suggestions
  • add tools to versions as suggested by users - but do not expect them all to be used by everyone all the time. This makes the software larger but more versatile.
  • allow the whole care period to be followed- from injury to final discharge from a service.
  • include process and clinical outcome measures - and encourage the development of key performance indicators (KPI) that are clinically and organisationally meaningful.
  • iterative improvements in software and analysis should be as simple to enact as possible - minimal 'hard coding' of processes to maintain maximum flexibility.
  • minimise the cost of collection - usually by minimising the need for staff time and hardware requirements.
  • meet the information needs of the funders/commissioners of care services - otherwise collection will not be supported in the long term.
  • data provision linked to service designation and funding - helps ensure funding support and ensure data contribution.
  • verification process designed in parallel - in the UK NHS we have the HES system against which to compare the iBID data
  • design for multi language implementation - in iBID this was initially intended for the Welsh language but the design feature would allow any language to be accommodated.
  • modular design allows expansion - the incorporation of such features as telemedicine, injury mapping and image library, up to full EPR is therefore possible.

Software Principles

  • minimal infrastructure requirements - minimal OS, RAM and Internet connection requirements.
  • use existing global computer system design and data standards.
  • no licences or costs over the basic OS.
  • free software to user.
  • downloadable or delivery via USB stick as a single application - one package for all types of user.
  • use as a stand-alone or as a network application - maintain versatility.
  • does not require computer administration rights to load for use as a stand-alone database.
  • does not require firewall permissions to use the Internet connection.
  • multi platform front end - a principle that has, as yet, not been achieved for iBID.
  • multi platform from server point of view - tiered design allows multiple server types and software to be used by host organisations.
  • centrally update-able menus and calculations invisibly implemented via the Internet connection.
  • allow ODBC linkage locally - for additional data collection as required.
  • APP-able for smart phones or tablets - can be done but profound problems with data security and maintenance of confidentiality.

Data Collection Principles

  • use simple methods to collect/enter data mostly drop down menus and tick boxes, which allows multiple staff to input data, as training is minimal.
  • avoid free text entry - as this adversely affects the time needed for input, data accuracy and meaningful analysis.
  • on screen help - updated via Internet, but also available offline by local storage and updating.
  • on screen error checking and data quality support - with the ability to override items that are not correctable or available.
  • maintain local service data control and ad hoc data exporting with local analysis using provided tools.
  • automatic, secure, near real time centralisation of data - maintaining confidentiality but allowing record identification for audit and data validation.
  • keep centralised data packages as small as possible - avoids problems with unstable Internet connections.

Reporting & Analysis Principles

  • maintain patient confidentiality throughout.
  • maintain service anonymity in reporting - until such time as this is not required.
  • reporting allows peer group comparison at various levels - regional, national, service designation level etc.
  • hands free analysis process to minimise staff time use centrally - makes the capacity of the system scale-able and expandable with little resource difference needed to analyse 30 services or 3000.
  • near real time data provision to dedicated website(s).
  • website(s) maintain standard reports updated daily - including data provision, quality (errors) and record completion.
  • linkage of reporting to iBCS requirements - in terms of service activity / injury severity spectrum / outcomes.
  • linkage of capacity usage to NBBB - providing near real-time information about bed availability routinely and for a Major Incident response.
  • website(s) allow mapping, searching and export of data - within the limits of the requirements to maintain confidentiality.
  • ad hoc data access controlled by a governance process - for complex or sensitive requests or those requiring significant resources to perform.

Process

Multiple reports are generated for participating burn services and health care commissioners. A few of these reports are made available to the public.

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