Systematic Reviews in Burns Care: Poor Quality and Getting Worse.

The objective of this article is to investigate adherence to reporting standards and methodological quality in systematic reviews on burns care published in peer-reviewed journals to determine their utility for guiding evidence-based burns care. PubMed, Embase, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, and the Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports were searched from 2009. Any systematic review on any question on therapeutic interventions in burns care was eligible for inclusion. Critical appraisal and data extraction were performed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist by two independent reviewers. The overall quality of the 44 included burns care systematic reviews was low, with an average methodological quality of 55% and an average compliance with reporting guidelines of 70%. Correlation analysis showed that adherence to reporting guidelines has been relatively stable, but methodological quality has deteriorated (r = -.32, P < .05). Cochrane reviews had lower citation rates than reviews published in other journals, whereas reviews that included meta-analyses had more citations. Quality did not have a significant effect on citation rate. Health professionals working in burns should be able to expect that systematic reviews published in their field are of a high standard. Unfortunately, this is not the case. To address this problem, established guidelines on the conduct and reporting of systematic reviews should be adhered to by researchers and editors.

The implementation of best practice in medication administration across a health network: a multisite evidence-based audit and feedback project.

BACKGROUND: Medication errors present a significant risk to patient safety. The "rights" of medication administration represent one approach to potentially reducing this risk. OBJECTIVES: The aim of this project was to implement an evidence-based audit and feedback project to improve compliance with best practice in this area across a health network. METHODS: A baseline audit was conducted to determine compliance with evidence-based standards by trained observers. The results of this audit were analysed and fed back to staff. An analysis of barriers to compliance was undertaken by key staff within the organization, which was followed by the implementation of targeted strategies to improve compliance. A follow-up audit was conducted and the results compared to the baseline audit. RESULTS: There were improvements in the percentage of compliance across all of the eight criteria audited, with statistically significant improvements found in six of the eight. In general, compliance with the criteria was high in both the baseline and follow-up audits. CONCLUSION: This audit and feedback implementation project was successful in increasing compliance and knowledge in this area and providing future direction for sustaining evidence-based practice change. It is now planned to use this approach for rolling out future implementation projects within this health system.

The development of an evidence based resource for burns care.

OBJECTIVE: There currently exists a need for evidence-based information and tools in burns care. It was therefore the aim of a working party of the Joanna Briggs Institute to establish an evidence based resource to assist professionals in the burns community to practice evidence based healthcare. METHODS: After receiving initial funding to create this resource, a steering committee was developed consisting of representatives of the funding agencies and Joanna Briggs Institute staff. This evolved into a tiered international reference group to provide feedback, topic suggestions, and content for the resource. Resources were developed systematically based upon an agreed taxonomy, and included evidence summaries, recommended procedures, audit criteria and information for consumers/patients. RESULTS: As of 2012, the resource is now available online. There are 63 international experts on the reference groups providing feedback on all of the resources available. There are 102 evidence summaries covering a wide range of burns topics online, 55 recommended practices, 13 audit topics and 33 consumer information pamphlets. CONCLUSION: This paper outlines the details and processes surrounding the development of the JBI Burns Node, and how it has grown from humble beginnings into a resource that can assist in the translation of evidence into practice for burns care professionals.

Physical and quality of life outcomes of patients with isolated hand burns--a prospective audit.

Hand burns can have major implications on function, appearance, and quality of life. Our clinical practice has changed over the last 10 years, with a steady increase in the proportion of hand burns receiving early and aggressive surgical management using Biobrane® sheets/gloves and a concomitant fall in the proportion requiring excision and split skin grafting. The aim of this study was to measure a comprehensive range of outcomes for patients admitted with isolated hand burns to review our outcomes and provide us with the "expected" patterns of recovery. A prospective audit was performed over a 14-month period, with outcomes measured during hospital admission and at 2 weeks, 1, 3, 6, and 12 months postinjury (depending on the method of management). Outcomes comprised pain, the Burns Specific Health Scale (abbreviated version B), return to work/leisure, total active range of motion, grip strength, the Michigan Hand Questionnaire, and scar appearance using Matching Assessment with Photographs of Scars. A total of 52 patients (35 male, mean age 39 years) with 57 burned hands participated. Patients whose burn injuries were such that they were able to be managed conservatively or with Biobrane® showed rapid recovery in all outcomes, with normal or near-normal values achieved within 2 weeks to 1 month postinjury. The patients whose burn injuries required excision and split skin grafting demonstrated more marked initial deterioration, a slower rate of improvement, but eventual good recovery. In conclusion, for this sample of patients with isolated hand burns, recovery was good and rapid for those whose burn injuries were such that they were managed conservatively or with Biobrane®.

Developing clinical quality indicators for a Bi-National Burn Registry.

BACKGROUND: Clinical quality indicators are routinely used to benchmark and drive improvements in healthcare. There is a dearth of standardised clinical quality indicators established for management of burns that allow quality of care to be monitored and benchmarked across Australia and New Zealand. METHOD: Using published quality indicator development processes and clinician experience, the Bi-National Burn Registry (Bi-NBR) working party developed quality indicators for burn care to be included as routine data items in the Bi-NBR. RESULTS: Twenty indicators covering structure, process and outcome measures were identified. Preliminary testing resulted in further revision to the quality indicators to increase validity, reliability and improve data quality. The quality indicators are routinely collected in the Bi-NBR and reported quarterly. CONCLUSION: This is the first published account of the development and testing of standardised Bi-National clinical quality indicators for burns. The Bi-NBR quality indicators project remains a work in progress and it is hoped that further refinement of the indicators, in conjunction with international collaborators will assist in driving improvements in burn care.

Social issues prolong elderly burn patient hospitalization.

A retrospective audit of length of hospital inpatient stay of all patients admitted to the Royal Adelaide Hospital Burns Unit over a 5-year period was performed. Data gathered from the Burns Unit database and records allowed patient division into two comparison groups: those younger than 70 years and those aged 70 years or older. Further comparison based on discharge destination was made in the ≥70 years group. Outcomes included length of stay, burn size, and discharge destination. A total of 1641 patients were included. The median length of stay was 5.0 days for patients younger than 70 years and 10.0 days for those aged 70 years or older (P < .0001). The mean percentage of TBSA burned was similar. A greater proportion of those aged 70 years or older were discharged to supported care facilities, such as nursing homes, and a greater proportion needed assessment for placement (P < .001) when compared with those younger than 70 years. The median length of stay of those aged 70 years or older who did not need assessment for placement was 9.0 days compared with 38.0 days for those who needed assessment (P < .0001). Elderly patients have, generally, nearly twice the length of stay of younger patients; when further subdivided according to discharge destination, the effect of placement delay (a social issue) becomes apparent and disturbing. This has significant implications, given the limited capacity and high cost of burn unit admission. A geriatrician will be appointed to the Burn Service over the next 12 months to assess whether earlier geriatric assessment can decrease the length of inpatient admission by facilitating a more efficient placement process.

Experience with biobrane: uses and caveats for success.

OBJECTIVE: To present some of our experience with Biobrane (a total of 703 patients in 7 years) in a range of uses in burn practice and to illustrate the caveats that we have found applicable in maintaining our success with this versatile material. METHODS: Retrospective analysis of theatre records, medical notes, and photography database to categorize our experience with Biobrane. Thorough assessment of our surgical and nursing protocols (both literature and experience influenced) to identify caveats for successful use. RESULTS: Pivotal steps are revealed in wound selection, wound preparation, material application, dressing, and subsequent nursing care that have led to overwhelming success in definitive management of superficial partial thickness to middermal burns (ensuring pain relief, allowing early mobilization, tolerance of dressing changes and therapy, and earlier hospital discharge). Its many uses in a broad range of common burn situations are demonstrated and tips provided to achieve best outcome. CONCLUSIONS: Biobrane is not a panacea but it is extremely versatile. The different potential uses have learning curves, and suggestions are provided to flatten these.

Organisational challenges when enabling ease of access for the elderly around a large acute hospital campus.

This paper describes one of several projects undertaken in a large acute care hospital under the banner of 'TOPIC7' The Older Person and Improving Care. It was conducted between January and November 2008. Although driven by the Royal Adelaide Hospital Nursing Service it was undertaken within a multidisciplinary framework. Large city-based tertiary hospitals, nearly without exception, are usually large sprawling campuses having evolved over time from buildings designed and constructed for lower populations and less traffic issues. Parking facilities may or may not be available on-site. In addition, drop-off points are located on the peripheries of the campus at often congested areas. These elements present a particular challenge to the elderly patient. Aims The purpose of this project was twofold: first, to investigate the challenges faced by older people when making their way from access points such as drop-off points and car parks through to hospital departments and second, to review potential solutions. Methods The multidisciplinary project team used a variety of knowledge translation tools and strategies to focus on areas of concern in relation to access for the elderly. They conducted a series of audits to guide practice improvement activities. This led to a reconsideration of currently planned strategies and planning of new initiatives to improve access for the elderly. Results The project was able to define clearly and prioritise the many challenges facing the older person trying to negotiate their way into hospital buildings and the barriers to them successfully reaching their destination in a safe and timely manner. At the beginning of the project it was apparent that a specific solution (an electric courtesy buggy) was in the process of being implemented. This intervention was reviewed in terms of consumer support and implementation feasibility. As a result of the comprehensive audit process, the 'courtesy buggy' was determined to not be the ideal solution and an alternative solution (wheelchair bank) is now being planned for implementation. Conclusions This project highlighted the challenges of working within a large and complex organisation with multiple key stakeholders and the need for clear pathways that clinician groups can follow to avoid duplication of effort and potential implementation of suboptimal strategies.