Merits and challenges in the development of a dedicated burn service at a regional hospital in South Africa

Allorto, Nikki; Clarke, Damian

doi:10.1016/j.burns.2014.07.021

Cited by 12 publications

(12 citation statements)

References 11 publications

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“…Traditionally, mortality has been the most frequently used burn outcome measure and even if this is still the case, especially in some age groups, the improved survival after burn injuries has shifted the focus to long-term functional and health-related outcome measures [21–23]. …”

Section: Follow-up Design and Outcome Measuresmentioning

confidence: 99%

“…The ratio of LOS over %TBSA should be approximately 1, at least in high-resource settings. It has been debated whether the ratio can be used for minor burns involving hands or other functional body areas or for patients with social problems, but the consensus still suggests that LOS/%TBSA is a useful outcome measure [23]. Other outcome measures for acute burn care that have been proposed by the American Burn Association include psychological outcomes, burn resuscitation, nutritional and functional outcomes and burn wound-healing outcomes [24].…”

Section: Follow-up Design and Outcome Measuresmentioning

confidence: 99%

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A smartphone-based consultation system for acute burns – methodological challenges related to follow-up of the system

Hasselberg

Wallis

Blessing

et al. 2017

Global Health Action

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Background: A smartphone-based consultation system for acute burns is currently being implemented in the Western Cape, South Africa. Even though studies indicate that similar systems for burns tend to support valid diagnosis and influence patient management, the evidence is still sparse. There is a need for more in-depth evaluations, not least in resource-constrained settings where mHealth projects are increasing. Objective: This article describes the consultation system and assessments in relation to its implementation with a special focus on methodological challenges. Methods: A number of evaluations and assessments have been conducted, are ongoing or planned for in relation to the implementation of the teleconsultation system. Initial assessments showed that size and depth of burns could be assessed at least as well using photographs as at bedside and that the image quality of handheld devices can be used as well as computers. Studies on system usability are currently being done with a mixed-methods approach. A historical cohort design will be applied to assess the potential health impact of the system. Patients with burn injuries where the doctor at point of care has used the app to receive diagnostic support from a burns expert will be considered as exposed and patients with burn injuries where the app has not been used will be considered as non-exposed. Conclusions: Smartphone-based consultation systems have the potential to strengthen the assessment of burn injury in many settings. However, ethically and methodologically sound evaluations are needed to find the best systems and solutions. This article identifies challenges and suggests potential assessments in relation to the implementation of such a system.

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Section: Follow-up Design and Outcome Measuresmentioning

confidence: 99%

Section: Follow-up Design and Outcome Measuresmentioning

confidence: 99%

A smartphone-based consultation system for acute burns – methodological challenges related to follow-up of the system

Hasselberg

Wallis

Blessing

et al. 2017

Global Health Action

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“…[5] Contemporary burn management principles, which include attempted early excision and grafting, are followed, and the service makes use of nanocrystalline silver and hydrofibre dressings. Limitations in theatre, and blood and intensive care unit bed availability pose logistical difficulties that limit the full application of staged excision and grafting.…”

Section: Study Design and Objectivesmentioning

confidence: 99%

“…Limitations in theatre, and blood and intensive care unit bed availability pose logistical difficulties that limit the full application of staged excision and grafting. [5] The study was conducted after receiving approval from the Biomedical Research Ethics Committee of the University of KwaZuluNatal (ref. no.…”

Section: Study Design and Objectivesmentioning

confidence: 99%

Predicting postoperative haemoglobin changes after burn surgery

et al. 2017

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Background. Burn surgery is associated with significant blood loss and fluid shifts that cause rapid haemoglobin (Hb) changes during and after surgery. Understanding the relationship between intraoperative and postoperative (day 1) Hb changes may assist in avoiding postoperative anaemia and unnecessary peri-operative blood transfusion. Objective. To describe the Hb changes into the first day after burn surgery and to identify factors predictive of Hb changes that would guide blood transfusion decisions. Methods. This was a single-institution, retrospective cohort study that included 158 patients who had undergone burn surgery. Hb was measured at the start and end of surgery, and on the first day (16 -32 hours) after surgery, and the results were analysed. Peri-operative factors (Hb at the end of surgery, total body surface area operated on (TBSA-op), fluid administration and intraoperative blood administration) were evaluated to determine their association with Hb changes on the first day after surgery. Results. The mean (standard deviation) preoperative Hb was 10.6 (2.29) g/dL, the mean postoperative Hb was 9.4 (2.01) g/dL, and the mean Hb on the first day after surgery was 9.2 (2.19) g/dL. Median total burn surface area was 7% (interquartile range 9%, min. 1%, max. 45%), with a mean body surface area operated on (debridement area plus donor area) of 9.7%. Of the 158 patients, 26 (16%) had an Hb <7 g/dL (transfusion trigger) on the first day after surgery. For patients with a high (≥9 g/dL), intermediate (≥7 -<9 g/dL), or low (<7 g/dL) Hb measurement at the end of burn surgery, those with an Hb below the transfusion trigger on the first day after burn surgery were 0%, 27%, and 75%, respectively. End-of-surgery Hb and TBSA-op strongly predicted the first day Hb level. In the intermediate group, 55% of patients with a TBSA-op ≥11% had an Hb below the transfusion trigger on the first day after surgery. Conclusion. Hb at the end of burn surgery was the best predictor of Hb on the first day after surgery. Patients with an Hb <7 g/dL remained as such on the first postoperative day. Half of the patients with an end-of-surgery Hb ≥7 -<9 g/dL and who had ≥11% TBSA-op had an Hb <7 g/dL on the first postoperative day.

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“…[22] Ongoing audit has revealed some successes and some failures. [23,24] The grid enabled contextualisation of each research project and each intervention within the overarching system, and closure of the loop between research and strategy.…”

Section: Applying the Grid To The Pietermaritzburg Metropolitan Traummentioning

confidence: 99%

Trauma quality improvement: The Pietermaritzburg Metropolitan Trauma Service experience with the development of a comprehensive structure to facilitate quality improvement in rural trauma and acute care in KwaZulu-Natal, South Africa

Clarke¹

2015

S Afr Med J

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Strategic planning is a systematic process designed to assist organi sational decision-making by taking account of the micro environment(s) within an organisation, as well as the macroenvironment in which the organisation exists. [1][2][3][4][5] Healthcare systems are complex and tightly coupled. Strategic planning within such a system, without an overarching framework to provide a structure for quality improvement programmes, risks becoming ad hoc, haphazard, ineffectual and even counterproductive. The strategic planning process must identify the organisation's vision and mission or the system's aims and objectives. The mission statement explains the reasons for the healthcare system's existence. The vision statement identifies a potential more ideal 'future state' that the system aspires to achieve. Situational analysis follows and analyses the external environment to identify threats and opportunities, then looks inwards to assess the organisation's resources and capabilities. [1][2][3][4][5][6] The stage of synthesis follows, in which the strategic plan is crafted. The plan must then be implemented, and after that outcomes must be audited. There are a number of generic strategic planning tools that are of relevance to developing a structured systemic approach to quality improvement programmes. These include the SWOT analysis, the balanced scorecard, and strategic drift and gap analysis. SWOTThis acronym stands for Strengths, Weaknesses, Opportunities and Threats (SWOT) and identifies internal strengths and weaknesses, and threats and opportunities in the external environment, that may affect the organisation. The balanced scorecardThe balanced scorecard is a forward-looking management system that views the organisation from four perspectives, namely learning and growth, process, the customer point of view, and results. Strategic drift and gap analysisThe final outcome of a strategic plan is a result of the interaction of the external environment and three internal factors, namely the plan, the leadership and the culture of the organisation. A gap analysis model helps identify reasons for the strategic gap.

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Merits and challenges in the development of a dedicated burn service at a regional hospital in South Africa

Cited by 12 publications

References 11 publications

A smartphone-based consultation system for acute burns – methodological challenges related to follow-up of the system

A smartphone-based consultation system for acute burns – methodological challenges related to follow-up of the system

Predicting postoperative haemoglobin changes after burn surgery

Trauma quality improvement: The Pietermaritzburg Metropolitan Trauma Service experience with the development of a comprehensive structure to facilitate quality improvement in rural trauma and acute care in KwaZulu-Natal, South Africa

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