Outpatient workload in the NHS: A new challenge for the burn services?

The aim of this study was to evaluate the impact of outpatient care on activities at the Adults' Regional Burns Centre and the Children's Regional Burns Unit, Mid Yorkshire Hospitals NHS Trust UK, where outpatient and inpatient responsibilities are shared between the nursing staff. Data for all inpatient and outpatient interactions (all care related activities with the presence of a Registered Nurse (RN)) was collected prospectively by the attending RN for two consecutive months (October and November 2014). We also retrospectively collected data related to daily RN staffing levels, and Centre/Unit admissions and discharges. We compared our results with the staffing standard recommended by the National Burn Care Review 2001 and the National Burn Care Standards 2013. In the two months analysed we recorded a total number of 1232 interactions: 240 for the adult inpatient service, 385 for the adult outpatient service, 155 for the paediatric inpatient service, 452 for the paediatric outpatient service. Considering this burden and collating it with daily RN staffing levels, we highlighted an understaffing in 42.6% (26/61) of the days for the Adult Regional Burn Centre and in 100% (61/61) of the days and nights for the Children Regional Burn Unit. The impact of outpatients on the activities of a Burns Centre/Unit is a factor that should be taken into account when evaluating staffing needs and planning services. This is a variable not currently considered in any guideline for safe staffing.

Osteophyte-induced rupture of a scalp tissue expander.

Tissue expansion is in widespread use for the reconstruction of congenital and acquired defects. Complications of tissue expansion are well documented, the most common being infection or extrusion of the expander. Although the complications associated with scalp tissue expansion are similar to those experienced elsewhere in the body, site-specific complications can occur. These include bone thinning and erosion of the cranial vault. In this study, we report an unusual case of multiple osteophyte formation beneath a scalp tissue expander, resulting in its rupture and necessitating removal.

Review of community-referred hand infections.

PURPOSE: A retrospective review is presented of 76 patients with infections of the hand, referred from the community and admitted to our plastic surgery unit for treatment over a 30 month period. METHODS: Retrospective chart review and review of the pertinent English-language literature. RESULTS: The majority of the patients (82%) were male. Most incidents leading to infection happened at home (47%). All except two patients presented with cellulitis, and 55% had abscess formation. The most common site of infection was the digits followed by the dorsum of the hand. The average time to operative drainage was 6 h. Only seven patients (9%) were managed non-operatively. The mean duration of follow up was 51 days. Age and positive cultures were good predictors of the hospital stay and the number of operative procedures, respectively. CONCLUSIONS: Hand infections are surgical emergencies; correct and prompt management thus is essential. A quick and effective regimen for treatment yielded good results.