Aim We aimed to measure the effect of a specialist nurse-led clinic and referral pathway on admission rate, patient length of stay (LOS), and total bed days. We hypothesised that this intervention would contribute to the optimisation of the patient pathway in a regional burn's unit. Method Retrospective analysis of inpatient records in a six-month period over three years at a regional burn's unit (June-November 2018,2019,2020). Analysis of demographics, TBSA, admissions, and length of stay before and after clinic introduction. Statistical analysis included one-way ANOVA. Results A reduction in admissions was observed in 2020 compared to 2019 and 2018 (7.3% and 6.7%) for a patient group with equivalent median TBSA (2%) and comparable median age (41 vs. 43.5 and 42.5). Median LOS was significantly shortened compared to 2019 (42.9%, F=4.07, p=0.046) and 2018 (42.9%, F=6.59, p=0.011). Minor burns showed reduced admission rates compared to 2019 (8.5%), and reduced median LOS (42.9% and 33.3%), and reduced total bed days (29.4% and 27.1%) compared to 2019 and 2018 respectively. Referrals to the regional burn's unit as a percentage total of regional A&E burns presentations increased in 2020 compared to 2019 and 2018 (16% vs. 14.4% and 12.1%). Conclusions The results suggest that the introduction of a specialist clinic has shortened in-patient stay with a significant effect on minor burns, against a backdrop of increased referrals. We suggest that continuity between clinic and inpatient care by a specialist nursing team has helped to optimise the regional burns unit.
Aim Models of the wrist allow for complex anatomy to be visualised and explained, aiding clinician to patient discussion. This pilot study aimed to investigate in impact on patient understanding of their diagnosis and treatment using a 3D-printed model hand in consultation. Method 3D-printed model wrists based on dissection specimens done in Anatomy, University of Edinburgh, were created to demonstrate a variety of pathologies, including triangular fibrocartilage tears and scapholunate ligament injuries. Patients participated by questionnaire at hand clinic appointment with responses recorded on a visual analogue scale (VAS) for criteria including confidence explaining their condition to others, and satisfaction before and after use of the models. Results 48 patients participated in the study with 38 questionnaires fully completed. Median age was 44 years old; the right hand was affected more than the left (17 vs. 15) and bilateral in 6 patients. Use of the models saw a significant improvement in patient confidence to explain their condition to a family member (mean change 2.46, range -3 to 8.5; p<0.001), although a wide range of responses were recorded demonstrating individual differences and preferences. Patient satisfaction was excellent (mean 9.25) when the models were used, and a positive net promoter score (mean 9.29) showing patients would recommend the consultation style. Conclusions This pilot study suggests that 3D-printed wrist models aid in patient education at consultation, building patient confidence and maintaining satisfaction. Given the range of responses and individual nature of learning it is likely these models will complement radiological images in this setting.
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