Further to advice from the Informatics Group, the NNBC has decided to ask HQIP (www.hqip.org.uk/) to carry out a review of the organisation and function of iBID, with a view to making recommendations concerning its future. This is in order to provide a stable and sustainable registry of burn injury into the future and to meet the needs of specialised commissioning and of the health service in general.
The review is intended to conclude by the summer of 2011 after which consideration will be given to the procurement of a long-term partner to provide the stability of sustainability required. It is accepted that the infrastructure costs of the database will therefore increase. Explicit reassurance has been given that the clinical nature and ownership of the registry will not be lost or weakened.
In January an application was made by the National Network for Burn Care to be the host for a Payment by Results (PbR) Development Site project. The intention the project is to develop an alternative currency for the remuneration of burn care within the NHS.
In March we heard that we have been successful, and that development and expansion of the patient level costing pilot scheme under way in South Manchester is to be supported by the PbR team.
The first meeting was held of the newly created Informatics Group, which is a formal subcommittee of the National Network for Burn Care (NNBC). The terms of reference in this group are to coordinate and advice on all aspects of data collection and analysis pertaining to burn injury and to develop a means of communicating the nature of burn injury to health care professionals and the general public.
Information pertaining to the Informatics Group is available from the downloads section.
A new collaboration has been initiated to learn lessons from the patient level costing pilot being run at the specialised rehabilitation service at Northwick Park Hospital under the leadership of Professor Lynn Turner-Warwick. The intention of the work is to utilise some of the models and methods developed there and translate their usage into the burn care arena. Of specific interest is the rehabilitation dependency scoring system specifically developed to reflect the wide ranging medical and non-medical interventions required for the rehabilitation of patients following complex injury.
The Study Day was held on the 10th of December 2009 at University Hospital of South Manchester and proved to be a useful opportunity to share ideas and aspirations concerning improvements in the current data collection software as well as some of the reports being sent back to burn services. It also proved a useful discussion group for design features going into the next version of the database software. Participants had an opportunity to consider these before the meeting and to discussed them in some detail.
There was broad agreement and consensus that the planned way forward made sense for both the burn services and for the aims and intended uses of the burn database information. Valuable additions and design features were offered and accepted with an indication that areas of further work when necessary, particularly in relation to the recording of surgical activity and aspects of physical therapy outcome measurement.
Other areas covered included the design of the recently reconfigured error and validation report (report E) with an acceptance that the new version of the software should make this report redundant as real-time validation and error checking is to be written into the software. The innovation of updating menu lists automatically from the central server was accepted as a major improvement and a way of keeping the database design contemporary and clinically valid.
A recently produced report was introduced, which is renewed each month and is an indication of the volume of data being transferred by each burn service into the database server. It was emphasised that this is now available to any registered user of the database and gives an indication of the volume of successfully uploaded data. The database currently contains approximately 66,000 records.
Throughout the discussions it was accepted that one of the major drivers for the database design has been the wish to incorporate patient level costing methodology. This will undoubtedly increase the volume of data collection but in doing so make the record a more clinically relevant indication of the care provided.
It was discussed and appreciated that acceptance of the database as a commissioning tool will be a complex matter and based on successful negotiations with a number of groups, including the NHS Payment by Results team and the data team at the NHS Information Centre.
Additionally agreement needs to be reached with Specialised Commissioning Groups (SCG) within the NHS who need to accept the information from iBID as valid commissioning currency. This is expected to be discussed at the next national group meeting in Feb 2010 and subsequently at the SCGs Directors meetings.
Burn service attendees were reminded that all of the reports produced about their services remain available using the service specific username and password previously circulated to clinical leads and available from burn network managers. If any member of staff requiring access to these reports is unable to access them, then contact their network manager for the necessary access rights.
A presentation on the Patient Level Costing (PLC) pilot results from The Manchester Burn Service was well received at the European Burns Association (EBA) meeting in Lusanne in early September 2009. The paper received and outstanding abstract award and will be published in a supplement of the BURNS journal [Cost of Burn Care in the British Isles & Service Remuneration Options. Rob Duncan and Ken Dunn]. The intention has been to model the consequences of adopting PLC as the commissioning and remuneration methodology for burns care under the Payment by Results (PbR) development within the NHS. The results from the pilot are being used to guide the design of the next version of the iBID software, due for release in early 2010.
The next version of the iBID software was considered in a meeting in Birmingham in early June with representatives from clinical teams, service commissioners and IT designers. The intention is to build on the experience from using the current version and the points made in the Study Days to build a system with greater data entry support. In addition greater flexibility is needed to reflect out-patient workload and greater detail concerning cost driving activities such as critical care and operative activity. This may lead to the database being used as the prime commissioning tool for burn care that fall within the specialised services definition agreement (see the general download section). The hope is to have the next version available for testing in early 2010.
A presentation of research results from a study combining data from the iBID and the UK TARN (UK Trauma Audit and Research Network) at the 2009 British Burn Association meeting in Belfast estimated the contribution of severe burn injury to the trauma workload of England and Wales. The results demonstrated differing rates in geographical areas but with an overall contribution between 5 and 10% in most areas [Estimating the contribution of burn-injury to the overall trauma workload. Nick Kalson, Fiona Lecky, Ken Dunn]. The paper was voted the best paper of the meeting.
Another paper was presented looking at the first 5 years of national burn injury data collection [Modelling Outcomes from the National Burn Injury Database (NBID). Steve Sutch, L Dent, Ken Dunn]. The paper looked at the factors recorded in the national database that were statistically associated with mortality or an extended length of stay (LOS) in hospital for the survivors of injury. The findings are also being used to guide the development of the next version of the iBID software.
The first International Burn Injury Database (iBID) report for 1986 – 2007 incl. was released on the 22nd May 2008 and is now available for download.
An update of the iBID development was provided for the European Burns Association in Estoril, Portugal.