iBID & Outcomes

Process outcomes in the Quality Dashboard (QD)

The burn care QD published by NHS England is entirely based on data analysis by the iBID. The identified measures were originally agreed by the burn care CRG in 2012 and revised in 2015/16 for use from April 2016. A number of suggested measures were also agreed for future consideration. Cases identified with the QD are identified for burn services so they can audit each case at local, regional or national level. However there is currently no assurance process in place that confirms this has happened.

Injury stratification

Having an agreed means of stratifying burn injuries allows the use of a common language between all burn services and commissioners concerning the case-mix being cared for. Additionally the resource
requirements for each level of burn injury with regard to critical care bed and theatre time utilisation allows consistently applicable modelling to be undertaken. It also allows commissioners to identify those cases being inappropriately admitted to services not designated at the required level.

Mortality stratification for inpatients

In a similar way, mortality risk stratification allows outlier cases and services to be identified and the overall performance of a burn service monitored over time.

Variable Life Adjusted Display (VLAD) charting and mortality reporting

Producing mortality and survival reports using the VLAD ethodology produces a standardised means of reviewing burn care quality in relation to mortality with reports that can be developed at national, regional or burn service level and produced to look at different subsets including age groups injury severity is and the results of injuries from specific causes.

The VLAD methodology can also be used to display the results for any variable which has a range of values applicable to subgroups which can be based on a binary differentiation.

Inhalation Project

The inhalation project is a multicentre effort to quantify cases of inhalation injury cared for by the NHS specialised burn services. The intention being to develop a quantification scale for inhalation injury as none currently exist and to consider intubated and ventilated burn injury cases where there is some question as to suitability of this intervention.

Functional outcomes

A variety of functional outcome measures identified by the BBA outcomes having incorporated in the iBID software. Many of these are used spasmodically by burn services based on local interest. These measures have not been stipulated by the CRG or commissions, possibly in recognition that their completion requires significant input by burn service personnel.

Tele-referral

The added value of a telereferral system for burns is recognised internationally, but for the various technical and information governance obstructions to its generalised use in the NHS have only recently been overcome by system developed with one of our industry partners. Full documentation of the system is available for the system currently being rolled out nationally.

PROMS (*)

An NIHR funded programme has been developed by the University of the West of England with the hope that this burn specific set of PROMS will be supported by NHS England for rollout nationally. Plans have
been made for its incorporation within the iBID software for release in the autumn of 2017.

Post discharge mortality (*)

Work undertaken in Western Australia concerning the long-term mortality consequences of having suffered a significant burn injury suggest the need for the iBID data to be linked with the Office of National Statistics (ONS) mortality database. The presence of important variables within the data allows this to be technically simple but politically complex.

Verified national audit process (*)

Recent concerns identified by the BCIG have been circulated for comment as the lack of an assured audit process for burn care is an issue of concern. The lack of ongoing debate on this issue is unsupportable.

International comparative audit (*)

The fact that the iBID collection is now one of only three comprehensive burn service data collection systems in the world and the only one with complete national collection in any country puts it in a position
to drive the international agenda concerning the use of comparable international burn injury data.

Contribute to the Global Burn Injury Depository (GBID) (*)

The experience and knowledge of the iBID team also allows a definitive role to be developed in working with the World Health Organisation (WHO) and the International Society for Burn injuries (ISBI) in developing a globally applicable minimum dataset designed for use in low and middle income countries, as well as being the starting point for any data collection in high-income countries.

(*) developments planned for the future

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