The UCHealth Burn Center — Anschutz Medical Campus recently received a plaque from the Chicago-based American Burn Association (ABA). The token recognizes the Burn Center’s reverification by the ABA, a 2,000-member, worldwide organization dedicated to improving care for individuals and families whose lives have been blighted by burns. Receiving the plaque is now something of a ritual for the Burn Center, but for the providers and staff who work on the unit, it’s far more than a piece of hardware and receiving it is hardly routine.
The Burn Center remains the only ABA-verified adult facility in Colorado and the Rocky Mountain Region, a distinction it has held for 20 years. Earning the three-year reverification required an on-site visit and report by two ABA surveyors whose job was not to hand out plaudits but to critically assess the Burn Center’s capacity to deliver the best possible care to its patients, all of whom require a complex array of clinical and support services.
Over the past three years, the Burn Center has continued to build a team specifically trained to treat and care for these patients – not only those with burns, but also others with a variety of skin injuries and diseases. The “core” team encompasses:
- Advanced practice providers
- Nurses with multiple skills and responsibilities
- Physical, occupational, and speech therapists
- Social worker/case manager
Many other services around the hospital assist the Burn Center, as evidenced by the more than a dozen representatives, from Trauma to Emergency Services to Spiritual Care Services, who attended a breakfast meeting with the ABA surveyors Dec. 15. Nursing, physician and administration leaders were also on hand to express their support.
No match for these services
The breadth of coverage is what distinguishes an ABA-verified center from other facilities that care for burn patients, said Anne Wagner, MD, medical director for the Burn Center.
“It’s more and more being recognized that centers of excellence, like ours, that treat high volumes of patients have better outcomes,” Wagner said. “We’re always teaching and always reading.”
Wagner also noted that ABA-verified centers can’t simply cherry-pick successful cases as evidence of their skills. They are required to report their mortality and morbidity rates and quality measures, such as preventing central line-associated bloodstream infections and deep vein thromboses. The Burn Center also reviews every case, looking for potential areas for improvement.
“If there are any concerns, we work on action plans to show how we as a system are going to improve patient care,” said Linda Staubli, RN, CCRN, the Burn Center’s clinical coordinator.
Outreach and expansion
Many of the changes that occurred after the last reverification, late in 2014, centered on strengthening the continuity of patient care. For example, shortly after the 2014 visit, the Burn Center completed a long-term project that added beds to its inpatient unit and adjoined it with the outpatient clinic, which had been in the hospital’s outpatient pavilion. The result: a comprehensive care center that improved efficiency and service to patients.
In addition, the Burn Center added four advanced practice providers – two nurse practitioners and two physician assistants, with plans to add a fifth – ensuring that burn patients receive continuous care from specialists. The coverage is especially important because new patient admissions increased nearly 30 percent between fiscal year 2016 (which ended June 30, 2016) and fiscal year 2017, Staubli said.
The volume growth is just one reason why the Burn Center continues to concentrate on building relationships with clinicians, EMS workers and community members throughout the state and region. “It’s a requirement that we work on burn prevention and outreach,” said Laura Madsen, RN, outreach coordinator for the Burn Center.
To that end, Madsen, Wagner and associate medical director Arek Wiktor, MD, travel extensively around Colorado and the Rocky Mountain region throughout the year. They work as a regional team to help provide optimal care and outcomes for patients, starting with first responders and carrying through to outpatient clinics.
“We’re trying to reduce burn risk and make sure that communities have the resources they need,” Madsen said. “Not all of them are as aware of the risks of burns as they are of strokes, cancer and heart attacks.”
Madsen said an important goal of outreach is to help community providers recognize the difference between burns and other trauma that require the specialized care that UCHealth provides and those that can be safely treated in local hospitals.
“We want to make sure we’re admitting patients who truly need to be admitted,” Madsen said. “Some patients can be treated as outpatients and not incur that cost.”
To help community providers make that call, in 2016 the Burn Center rolled out UCHealth Burn Center Consult, a free downloadable smartphone app that providers in the field can use to transmit HIPAA-protected photos of patients’ burns. The Burn Center evaluates the injury, saving time if it requires the patient to come to UCH, but allowing those with less serious problems to get care closer to home.
“The ABA wants to see that patients get the proper care,” Wagner said. “That’s why we’re required to teach at every stage: EMS, fire, nursing, emergency departments. Many get no training in burn.”
More than burn care
The outreach is also important to helping communities understand that the Burn Center treats many conditions, Wagner said.
“There is a misconception that we only treat burns,” she said. For example, the Burn Center is a leader in frostbite treatment, which includes administering clot-busting tissue plasminogen activator (tPA) under the right circumstances.
“There are many in the world who still think that frostbite has no treatment,” she added. “We’re a frostbite center.”
The mobile app is a valuable tool in frostbite cases because it can save precious time, Wagner said, noting that every hour delayed in rewarming frigid tissue decreases the salvage rate 30 percent. By contrast, a patient who gets clot-busters to frozen fingers or toes has 40 to 70 percent less risk of amputation, Wagner said.
She went on to tick off a host of conditions of non-burn conditions the Burn Center treats, including road rash, degloving (large sections of skin torn from their blood supply), necrotizing fasciitis (tissue-killing skin infection), and Stevens-Johnson syndrome (a skin reaction that can cause severe blistering and peeling). She pointed to a recent case of a patient discharged from another hospital who was admitted to UCH and diagnosed with exfoliative disorder, a primarily autoimmune condition that causes the body to shed skin. It took two months, but a Burn Center team effort that included considerable contributions from wound care, nutrition, and pharmacy, got the patient’s condition under control.
Outcomes like that one, repeated many times over the past three years, led to the ABA presenting the plaque that now hangs in the Burn Center. But the push is on to meet ever higher standards. For example, the surveyors asked the team for more published research.
“With the growth we’ve had, we’ve been buckling down to focus on patient care,” Madsen said. “The surveyors encouraged us to get the great things we’ve done out to other burn centers and to share the hard work we’ve done.” One big assist in that effort: Wagner assumes the presidency of the ABA’s Research Committee in April.
Another goal recommended by the reviewers is to train more residents in burn surgery and to install a fellow position. “The Burn Attending reviewers noted that they want future surgeons coming through the hospital to see how burn surgery should be done,” Staubli said. A third surgeon fellowship-trained in burn surgery and critical care is slated to join the team this year.
The Burn Center also aims to extend its commitment to improving the quality of care to the outpatient setting, Madsen said. That means consistently evaluating processes, as the team does now for inpatient care. It’s not yet a requirement of reverification, but signs point in that direction, she noted.
“We want to create a more robust program for the future,” Madsen said. “We’re staying ahead of the curve with outpatient care.”