As demonstrated during the BCIG Forum presentations to burn services earlier this year, the MS Power Business Intelligence (P-BI) presentation of the iBID data has been launched. Considerable care in ensuring that the data is fully anonymised and secure in accordance with NHS guidance, including small number suppression. This reporting enhancement builds on the iBID Information Service, which has been available online to over 200 burn service personnel since 2017. Specific data extracts and reports based on individual requests will continue to be available. With over 300 completed requests to date, many of which have led on to presentations and publications, this remains an important and valuable resource for the burn care community.
Services are still able to download their own raw data from within their version of the iBID (Aquila) software, but this development shows all of the analysed metrics that make up the Quality Dashboard (QD), which in this release includes the complete 2023/24 data. Although there are still a few issues to work through regarding some of the QD metrics, the direction of travel is now plain to see, and suitable for inspection and comment. You will note that the telereferral data is also presented for those services using the system, with the data extraction being matched with the iBID data. New insights from the combined datasets are planned.
The intention is to develop further pages as indicated on the site as ‘Coming Soon’. These are being worked on, but feedback on the existing presentation is invited, including suggestions of which further forms of analysis would be of benefit. We plan to make the data as near real-time as possible, rather than relying on periodic extracts, but this will take several further steps before being realised.
The long-term collection of carefully structured data from all burn services within each health economy (usually national) allows several important functions to be fulfilled when sufficient data has been accumulated. These include:
An ability to understand the demand for burn services alongside an assessment of the current use of the existing capacity to identify either economies of scale or occasional rebalancing of services.
A clear understanding of how burn services should be optimally organised to meet the demands of their catchment population.
The ability to serially assess factors which impact on mortality and length of stay amongst the burn care population.
An opportunity to develop quality assurance measures and assessment of services against standards developed by consensus to indicate whether services are behaving optimally and in some instances identify outlier services that may require additional support or guidance.
In the longer term it also allows the monitoring of the epidemiology of burn injury and the effectiveness or otherwise of prevention strategies, recognising that observations from a single service or a small group of services remain unconvincing.
The value of centralised information gathering about burn service activity in sufficient detail to inform these issues, amongst others such as performing power calculations for clinical research projects are powerful arguments for the creation and long term maintenance of such systems in all health economies globally.
No clinician in healthcare would deny that finance is an important area, but it is rarely the subject of discussion at clinical meetings or areas of research undertaken by clinicians. The value of such work is that it brings vitally important understanding to the problems and consequences associated with change. These changes can be in many areas: staffing, consumables, the introduction of new techniques, service resizing, service closure.
The work undertaken in Manchester, UK has focused on answering questions concerning the cost of burn care and on modelling change. The process initiated in 2007 was to establish a financial baseline against which changes could be evaluated. The many steps in this process will be coming to a conclusion in the near future and already allow a far more profound understanding of the consequences of changes in burn care. These developments fall into 4 key areas, each 1 of which will be presented separately:
The financial consequences of change in terms of service funding.
An understanding of the epidemiology of burn care demand and the geographical areas of high demand.
The financial consequences of service reorganisation and the requirements for resilience in such planning.
The financial consequences of introducing changes in clinical practice and evaluating its impact on service activity and funding.
The system became the source of referrals into specialised burn services in Feb 2018 across the Northern Burn Care Network apart from Newcastle, Middlesbrough and Liverpool Adult services.
The latest analysis of site specific reports have now been produced and sent out each quarter. A series of reports are produced and sent directly to Burn Services.
All reports are derived using the most recently updated iBID software, which has successfully been deployed in all English and Welsh Burn Services. The reports are based on some of the the original templates in use over recent years but have been reduced in number in line with user feedback.
The far more comprehensive set of web based reporting tools, configurable by the user, the iBID Information Service was released in early 2017.
The design of burn service reports for public use is under way as an extension to the iBID Information Service.
Any identified data problems may be of local origin and may need resolution by the Burn Service with support from the Burn Care Network Manager, whilst others may represent technical problems requiring support from the iBID team centrally.
An online burns referral system has been designed and produced by Medical Data Solutions and Services (MDSAS.com) on behalf of NHS England and the burn care Clinical Reference Group. It was piloted in Greater Manchester from May 2017 and proved highly successful. Currently, the system is being rolled out nationally. Referrals are submitted online by the referrer using an NHS Net web link, the only requirement being the need to submit an NHS e-mail address. Clinical photographs and x-ray images can be attached to the electronic referral directly or by using a secure NHS-compliant app SiD (Secure Image Data). A short video of the application is available here:
Use of the system has reduced the number of cases transferred for immediate assessment by over 60%.
The system has also been used to allow patients to upload their own wound or scar images post discharge to allow remote monitoring and management.