Category: IBID News

Burn Injury Telereferral system

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: https://www.youtube.com/watch?v=vNbi52ZXVPA

Use of the system has reduced the number of cases transferred for 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.

iBID Information Service

From a survey of all burn services and contributors to the iBID in 2015 it was clear that there was a desire to have access to the national dataset to allow flexible queries to be applied to national data.  It was felt the current series of reports provided were too restrictive.

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Site Specific Reports

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 a far more comprehensive set of web based reporting tools, configurable by the user, the iBID Information Service was released in early 2017.

Some general reports are accessible to non-registered / public users. 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 local 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.

EBA conference – Helsinki, September 2019

Lecture by Mr Ken Dunn

Opportunities with Big Data analysis in burn care

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.

EBA Educational meeting – Rotterdam

Lecture by Mr Ken Dunn

Cost analysis in burn care

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.

Burns Study Day – Nigeria, September 2018

Lecture by Mr Ken Dunn

Burn Injury Registries: What’s the Point?

A introduction to burn registries; their history, reach and function. Including an introduction to the WHO Global Burn Registry introduced in 2013.

Lecture by Mr Ken Dunn on behalf of the Royal College of Surgeons, London

Options for a Burn Injury Registry in Sri Lanka

A introduction to burn registries; their history, reach and function. Including an introduction to the WHO Global Burn Registry introduced in 2013.

Telereferral System in Burn Care, June 2015

A presentation was made to the British Association of Plastic and Reconstructive Surgeons meeting in London concerning the development of a Tele-referral system for burn injuries.

Pilot of an online burns referral system – by: Dr VE Ormston, Mrs C Reade, Mr R Hollingsworth, Mr KW Dunn

Introduction: An online burns referral system has been designed and produced on behalf of NHS England and the burn care Clinical Reference Group. It is being piloted in Greater Manchester with the intention of 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.
Material and Methods: The online burns referral system was developed with the software consultancy MDSAS (Medical Data Solutions and Services). It is being piloted within the Greater Manchester region to replace the current system of faxed referrals.

Key results: The benefits of the new referral system include: no requirement for pre-registration of the referrer, it avoids losing faxed referrals thus improving patient safety, confidentiality and security of information. There is improved referral information provided which is clear and typed and imaging sent with the referral will facilitate decision making particularly the need to transfer out of area. Login to the system can occur from any NHS computer and an auditable trail of the referral process is retained.

Conclusion: An online system for the referral of burns patients is being piloted. The system allows electronic referrals with clinical images to be sent by the referrer, without requiring registration of the referrer. The technique is applicable to other specialties where the review of imaging would be of benefit during the referral process.

Panhellenic Congress – Athens, October 2013

Keynote lecture: Costs of burns and plastic surgery: The UK experience

Abstract: The growing cost of healthcare is of concern to every society globally.  Its importance has been brought into stark relief by the economic crisis seen in many parts of the world and Europe in particular.  A great many pieces of work have looked at healthcare costs and claimed to represent the cost of therapeutic interventions but a review of the global literature on this subject has revealed systematic errors of methodology in the majority. A common feature in the literature is confusion between charges made by a hospital and the true cost of the care provided if calculated by other methodologies.

A long-term programme of work in England has been focused particularly on burns and plastic surgery in an attempt to establish the true cost of care provided on a patient by patient basis. The findings of this work have indicated that some of the conclusions commonly held are indeed correct:  Staff time and input to a particular patient is the single largest cost driver to the cost of the care that patient receives by that a surprisingly small contribution to the overall cost is made by disposables, be they implants, injectables, dressing materials etc.

By understanding the details behind departmental income and by breaking down burns and plastic surgery workloads into different clinical silos it is possible to identify those areas of work which are profitable to a department and a hospital while identifying some surprisingly important areas of work make a loss but may be acting as effective loss leaders.  It can be concluded that clinician perceptions of cost are frequently inaccurate.

It is hoped this work will form the basis of a more rational and accurate understanding of the costs of surgical care in burn and plastic surgery and might hopefully lead in certain health economies to a more rational and accurate approach to surgical care remuneration and even service organisation and capacity.

European Burns Assoc – Vienna, August 2013

Introduction: In the UK, burn injuries are estimated to cause around 13K admissions every year and they have a mortality of approximately 1.2%. But these are just estimates since no study has been made that can demonstrate the true incidence and prevalence of burn injuries. The aim of this study is to describe the clinical epidemiology of burn injuries for the years 2003-2011

Methods: Data form international Burn Injury Database, which is the database for specialised services, were analysed for all admissions (2003-11) in England and Wales. Data was broken down according to age, sex and Primary Care Trusts. Admission rates were adjusted for world population according to World Health Organization population tables.

Results: Admissions for males accounted for 63% and the remaining 37% to females. The mean burn surface area was 3.98 (95% 3.92-4.04). The most frequent reason for burn injury admission was scald (38%). The median age group was 10-<20 for all years with the exception of 2011 which was 1-<10yrs.   Mortality was overall 1.25. Admissions based on sex and age were highest for the age groups 1-<10yrs for both genders.   Conclusion: Mortality from burn injuries is decreasing, a finding that follows the western world trends. There is an increase in admissions in burn services but that could be an artefact of the database being used from all services over the passage of time. These results will be vital for service development and planning as well as prevention strategies and commissioning.

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