Developing a Burns Service
Kristina Stiles, Burn Care Advisor, McIndoe Burns Centre, Queen Victoria Hospital NHS Foundations Trust
The birth of a service
Due to the structure of burn service provision in UK and established burn patients’ trauma pathway, patients with burns are initially treated by non-specialist clinicians (General Practitioner’s [GP’s], Practice Nurses, Paramedics and Emergency Departments) and then referred to a specialist burns service. This causes delays to definitive specialist treatment and inappropriate management of patients with burn injury.
The London and South East of England Burn Network (LSEBN), established in 2008, amalgamating four specialist burn services. Four Burn Care Advisors (BCAs) were appointed to the LSEBN in response to a national review of burn care which identified the need for formal education and training to emergency departments [1, 2].
Burn Care Advisors are experienced and knowledgeable burns nurses, who have come into post through desire to improve burn patients’ outcomes.
Dedicated to ensuring a coordinated and consistent approach to emergency burn care in London and the South East of England, Burn Care Advisors’ intention is that all patients with burn injury:
- have access to timely and specialist-guided treatment regardless of where they receive their care
- receive the same standard of care as they would at a specialist service, irrespective of where they live and whenever they suffer a burn injury
- are referred to and treated at an appropriate specialist service
- are transported safely and quickly to that service and returned closer to home as soon as is possible, whilst maintaining specialist input into their care
BCAs provide high quality, evidence based, multi-professional training and education to all pre-hospital, primary and secondary services within the catchment area of the LSEBN, in relation to the initial assessment, management and referral of patients with a burn injury.
History
The London and South East of England Burn Network (LSEBN) was established in 2008 based on recommendation of the 2001 National Burn Care Review Committee Report [1]. One of the network’s objectives is to drive change and improve burn care services for the population of London and South East of England.
The LSEBN covers four regions: London, the northern part of South Central England, East of England and South East Coast. There are four specialist burn services within the network which cover a total population of 19,181,953. These are:
- Chelsea and Westminster Hospital – London
- St Andrew’s Centre for Plastic Surgery and Burns – Chelmsford
- Stoke Mandeville Hospital – Aylesbury
- Queen Victoria Hospital – East Grinstead
Current issues affecting burn patient care in the LSEBN:
- inappropriate referrals
- late referrals
- lack of knowledge and confidence in burns management from referring clinicians
- poor communication between the referring and burns services
Delay in accessing definitive specialist treatment and support that burn patients may require, can lead to poor wound healing, causing scarring and disfigurement. Through lack of feedback, the treating emergency personnel assume their burns management is appropriate, continuing with poor and at times outdated practice. Herein lies an opportunity for both services to benefit and learn from each other’s experiences with patients who have suffered burns trauma.
All levels of pre- and in-hospital clinicians who are expected to manage and treat patients with burn injuries report burns assessment, treatment and wound care product selection as a pressing training need. There is also reluctance to refer patients to specialist services or lack of awareness that specialist support is but a phone call away. As Burn Care Advisors we are able to support the knowledge deficit and have established and encouraged two-way communication between referring and specialist services in order to guarantee most effective and appropriate treatment for each patient with burn injury.
Progress
We are working to reduce the current network issues by:
- offering burns training, education and support to any healthcare professional who may be required to care for a burn injured patient
- developing supporting documents
- offering open communication, support and feedback to all clinicians involved in the emergency aspect of the burns patients’ pathway
To date we have:
- established links with each Ambulance Trust, Emergency Department, Minor Injury Unit, Walk-In Centre and Urgent Treatment Centre within our catchment areas
- recruited burns link nurses across the network in order to have a point of contact within each team
- cascaded up-to-date LSEBN Guidelines and burn care standards to all clinicians caring for a patient with a burn injury in the pre-hospital, emergency and primary care settings, supported by in-service teaching and electronic based resources on LSEBN website
- offered opportunities for multi professional, burn specific education and training for pre-hospital care providers and emergency department personnel and taught one standard of burn care to all clinicians caring for a patient with a burn injury
- ensured provision of written feedback on well and poorly managed referrals to all referring services
- worked with Mölnlycke and other leading wound care companies to develop and present regional Burns Management Study Days, diligently evaluating our training to reflect the participant’s feedback
- worked in collaboration with BCA’s colleagues to ensure consistency across LSEBN
- promoted the development of TRIPS/Telemedicine project
- provided a link between referring services and the specialist burns services
- offered support, guidance, training and advice on all aspects of burn care to referring clinicians
Outcomes
Clinicians who have received burns training have reported improvements in their practice and confidence in burns management as a result of Burn Care Advisors’ training – from more insight into burn wound assessment to improved knowledge of burn wound care. Course feedback guides any developments and changes to our training programme with an aim to improve future courses. Currently, Burns Management Study Days are successful, sought-after, over-subscribed and positively reviewed. They deliver a balance of taught and practical content on emergency care of a burn injured patient and allow sharing of specialist knowledge and experiences with attending clinicians.
The burns services are receiving increasingly appropriate referrals as a result of improved awareness amongst the referring clinicians. For non complex burn injuries that do not meet the criteria for referral to a specialist burns service, access to BCA education and support allows the treating clinicians to feel more confident in managing patients with burns, leading to improved patient care and outcomes.
As a result of the BCA role, all Emergency Departments within the LSEBN have protocols for the triage, initial assessment, management and referral of burn patients in accordance with the LSEBN guidelines.
Conclusion
Burn Care Advisors are experienced and knowledgeable burns nurses, who have come into post through desire to improve burn patients’ outcomes. To date, we have established key relationships with many Acute NHS Trusts and Primary Care NHS Trusts, Ambulance Trusts and higher education providers, ensuring links between theory and practice are securely comprehended and implemented, and training meets the requirements of the National Burn Care Standards [3]. As lead specialists for burns education in the burns team, we have demonstrated a high level of expertise within the specialist service, providing specialist advice, education and support to all health care professionals and patients.