History of the International Burn Injury Database
Presentation by Mr Peter Davenport to the British Burn Association (BBA) calling for the creation of a burns database to match that created in the USA in 1976 by Dr Feller.
Presentation to the European Burns Association (EBA) by Andrew Burd of the first survey of UK burn services activity and mortality statistics. This data was collected from the admission books of each burn service visited by Mr Burd during his travelling fellowship, funded by the British Burn Association. The presentation included a call for the creation of national databases across Europe with which to compare and contrast workload and outcomes.
Presentation to the British Burn Association by Ken Dunn outlining how a UK burn injury database could be created in association with the only other injury registry operating in the UK at the time, the Major Trauma Outcome Study (MTOS), based in Salford, now called the Trauma Audit and Research Network (TARN) database.
The burn injury section of MTOS was created and released in July. Ten burn services were asked to contribute data on hardcopy proforma which were then centralised to the MTOS office and placed on the database alongside, but as a specific subset of, the existing collection of general injury data coming from accident and emergency departments. In 1993 this initiative was judged too complex and bureaucratic and deemed to have failed to create a usable understanding of burn injury epidemiology.
The then Chair of the British Burn Association, Dr John Settle, published a short monograph on the future of burn services in the British Isles. In it he called for the creation of a national database to better understand the nature and demand for burn care on which to base plans for the centralisation of the care of major injuries.
A specific workshop at the Nottingham annual meeting of the British Burn Association discussed the creation of a national database and an agreement was reached that the Association would fund the development of software to allow data collection to begin. It was agreed that Ken Dunn should chair a committee made up of interested and motivated BBA members to design the database.
A plan was developed to create a National Burn Care Review Committee. Funding was attracted from 3 sources: DoH, BBA, BAPS.
A separate Expert Working Group (EWG) was created by the National Casemix Office to cover the design of HRG codes for burn injury. The first chairman was Dr Keith Judkins.
The first analysis of Hospital Episode Statistics (HES) data done by Ken Dunn using a burn injury subset of data from the National Casemix Office (NCMO) covering 1994-96.
The first version of the British Burn Association funded software package was completed and circulated to services free of charge. Data collection commenced in a number of areas but no funding was available for centralisation and the analysis of data. Additionally, the work of the National Burn Care Review (NBCR), which commenced in 1997, was felt by some in the BBA to have superseded the burn injury database as a priority and the data collection ceased.
As part of the NBCR process, a snapshot of one calendar year of data was collected using a very simple dataset. This was an attempt to understand the overall spectrum of complexity and severity being treated in British Isles Burn Services at that time.
Burn care services were recognised and accepted as an NHS specialised service, the definition of which was revised in 2009 and 2012.
In November 2003 the first meeting of the National Burn Care Group (NBCG) was held to take forward the recommendations of the NBCR.
A study of HES data from England, Wales and Scotland was commissioned by the National Burn Care Group (NBCG) from Dr Rory O'Conor to decide if this was sufficiently sensitive for use in service design and reconfiguration. After detailed analysis it was concluded the HES data was inadequate for the task.
Nationally accepted burn care standards were developed which included the requirement that burn services contribute to the national burn injury database.
Funding for iBID was made available by the NBCG towards the end of 2004. To rapidly develop and circulate bespoke software meant adopting, without change, the BBA dataset created in 1997. As a result the software was ready by April 2005 but many ideas and innovations had to be shelved until such time as a revision was practicable.
Data collection started in April from all substantial burn services in England and Wales (19), with a call from commissioners to all the specialised services for data concerning all admissions be retrospectively added back to Jan 2003.
The NBCG stipulated that being assessed against the burn care standards and contributing to the national burn injury database was a primary requirement for burn services prior to them being considered for burn service designation as a centre, unit or facility.
Support given by the NBCG for the creation of a new version of collection and analysis software as well as agreeing the need to find a long-term partner to support future development and enhanced
Funding provided by the NBCG to develop a tele-referral system for burn injury based on learning from a series of Modernisation Agency projects from 2003/04.
First formal report published from the iBID. General feedback agreed that smaller more frequent reports using the iBID website were more practical and useful.
Design team for the next version of the iBID completed the dataset necessary to incorporate user suggestions and NNBC requirements.
Creation of the new NNBC (National Network for Burn Care) in February to replace the NBCG and the establishment of a formal Informatics sub-group to administer iBID with a membership drawn from stakeholders.
The Healthcare Quality and Improvement Partnership (HQIP) was asked to review the structure and function of the iBID to advise the NNBC as to optimal future arrangements, especially sustainability.
Confirmation of ongoing funding for iBID as a national registry, as part of the national review of specialised services commissioning arrangements.
NNBC considered the HQIP report in Feb and agreed a formal NHS procurement should be undertaken with the responsibility to enact the HQIP recommendations being part of the agreement.
Creation by the NNBC national project manager of the first Quality Dashboard set of measures. Initial data collection planned to be partially by iBID and the remainder from Burn Services. Until changes could be made to the iBID software to allow complete data capture.
NNBC disbanded in preparation for the new Commissioning arrangements in the English NHS from April 2013.
The requirements to be measured against burn care standards and contribute to the iBID were reiterated in the creation of a burn service specification by NHS England as the basis of future contracts.
Release of a new version of the iBID software, with significant enhancement of the detail and scope of the dataset to allow complete collection of the QD requirements plus specific attention to burn care cost-driver information and levels of care dependency.
A further review of the nature, purpose and funding of the database by the National Specialised Commissioning Group in December.
The NHS IT procurement process failed in January to produce a third-party supplier.
Formal adoption in July by the Burn Care Clinical Reference Group (bcCRG) of the Burn Care Informatics Group incorporating the iBID and associated projects as part of its commissioning design function. This was associated with a re-design of the management and governance structure of the iBID as well as the launch of a completely redesigned software package and an extended work programme for 2013/14.
Agreement by Keith Willett and Chris Moran as past and current National Clinical Directors for Trauma that injury prevention is part of the CRG function.
Full coverage in January of data collection achieved for all 2013 designated burn services in England.
Production of the first full set of validated dashboard reports for English burn services in February.
Stakeholder study day including iBID users to direct the BCIG work programme.
A further review in March of the nature, purpose and funding of databases done by each CRG on behalf of NHS England as part of a wider review of national databases. A report was produced by a
subgroup for the bcCRG.
Stakeholder survey of iBID users to influence the BCIG work programme.
Agreement to incorporate the data from the only Burn Service not using the iBID software, thus allowing near real-time data centralisation, a precursor to real-time reporting. Achieved in early 2016.
Development by the BCRG of a revised set of Quality Dashboard (QD) results derived entirely from the iBID dataset, alongside the first version of a description of how each database field is used to create the QD results.
Incorporation in November of iBID into the work programme of the Fire / Health Initiative intended to prevention injuries and to reduce NHS admissions.
Release of the first version of a NHS net (N3) based Information Service to allow the creation of user defined reports.
A further review in March of the nature, purpose and funding of the database by NHS England as part of a wider review of national databases supporting the commissioning of Specialised Services.
Release of the NHS national Burns Telereferral system to allow the secure transfer of patient information from Emergency Departments to Burn Services.
Initial work on the design of a national tariff for burn care based on the patient level costing programme became the basis of a further PhD.
A further PhD looking at nursing dependency data from the iBID started with the intention of relating workload with nursing staffing levels.
Review of the NHS England burn care Quality Dashboard was concluded in December including the planned introduction of burn care PROMS and Rehabilitation prescription.
The planned introduction of the revised Quality Dashboard was delayed by the Covid-19 pandemic with a new introduction date of April 2021.
Expansion of the updated Burns Tele-Referral system into further areas of England and Wales.