Telemedicine has been increasingly used in a host of settings for over 20 years. Burns are well suited for evaluation by either synchronous ("interactive") video or asynchronous digital ("store and forward") imagery, but little information is available about telemedicine use in burn care. The authors surveyed U.S. burn center directors to assess their current use of, and interest in, telemedicine in clinical burn treatment. With Institutional Review Board approval, a web-based survey (surveymonkey.com) was created and sent to directors of 126 burn centers in the United States. Questions measured the use of telemedicine by burn centers and burn directors' attitudes toward telemedicine. Surveys were returned from 50 centers (40%). Directors of 42 units (84%) reported using telemedicine; 37 use it routinely. Interactive video communication was used by 18 centers, store and forward by 38 centers, and remote access to patient data by home computer or personal digital assistant in 41 centers. Uses included remote evaluation of acute burns for consultation, for help in determining the need for transfer, or for remote clinic follow-up. Users identified some problems with current telemedicine usage, including Health Insurance Portability and Accountability Act/compliance, licensure, and billing/collection issues. Importantly, 40 respondents (80%) indicated that they would like programming on telemedicine to be available at American Burn Association's annual meetings. Use of telemedicine is fairly widespread among U.S. burn centers, with volume and type of usage varying widely. Significant interest in learning more about telemedicine suggests strongly that telemedicine should be included in the annual program at the American Burn Association.

The purpose of this study was to evaluate the impact on sleep quality of a nursing-driven sleep hygiene protocol (SHP) instituted in a single burn-trauma intensive care unit. Criteria for eligibility were adult patients admitted to the Burn Service who were not delirious, able to respond verbally, and had not received general anesthesia in the prior 24 hours. Patients were surveyed using the validated Richards-Campbell Sleep Questionnaire prior to implementation ("PRE"; May to December 2010) and following implementation ("POST"; January to August 2011) of a SHP that sought to minimize environmental stimuli and limit disruptions during the night. This analysis includes only initial survey responses from each patient. A total of 130 patients were surveyed, 81 PRE and 49 POST; 60% were burn admissions. There was no significant difference in responses to the questionnaire between burn and nonburn patients. All patients in the POST group were significantly older and more frequently endorsed taking sleep medication at home. Although not significant, POST patients reported falling asleep somewhat more quickly, but no other differences were identified between the two groups. Among patients who reported having sleep difficulties prior to admission, POST patients not only reported a significantly higher pain score than PRE patients, but also reported significant improvement in falling asleep and being able to go back to sleep. Frequency of complaints of sleep disruption was unchanged between PRE and POST patients. POST patients did complain significantly less than PRE patients about sleep disruptions by clinicians. Implementation of the SHP permitted acutely injured or ill patients in our intensive care unit to fall asleep more quickly and to experience fewer sleep disruptions. A sleep protocol may be helpful in improving sleep and overall well-being of burn center patients.

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Background: Although some emergency department observation units (EDOUs) may exclude patients over 65 years old, our EDOU accepts patients up to 79 years old. We assessed the utilization of our EDOU by older patients (those 65–79 years old). Methods: We prospectively enrolled emergency department (ED) patients with chest pain. We gathered baseline data at the time of ED presentation and tracked outcomes related to the ED stay, EDOU, and/or inpatient admission. Our primary outcome included EDOU placement among older patients. Our secondary outcome was the rate of major adverse cardiac events [MACE: myocardial infarction, stent, coronary artery bypass graft, and death]. Results: Over the 5-year study period, we evaluated 2242 ED patients with chest pain, of whom 19.4% (95% confidence interval, 17.8%–21.1%) were 65–79 years old. Older patients were more likely to be placed in the EDOU after the ED visit (45.8% vs. 36.6%; P = 0.001) and more likely to be admitted to an inpatient unit from the ED (31.8% vs. 17.9%;P < 0.001) than those under 65 years old. The overall MACE rate was similar between admitted older patients and those in the EDOU: 5.9% versus 4.3% (P = 0.57). Of the admitted older patients, 30.4% (95% confidence interval, 22.3%–39.9%) were low risk and there were no cases of MACE in this group. Conclusions: In an EDOU that allows older patients, we noted substantial utilization by these patients for the evaluation of chest pain. The characteristics of admitted older patients suggest the potential for even greater EDOU utilization in this group.