The Evolution of Burn Care Facilities in the United States

Abstract

This historical review documents the establishment and current status of specialized burn care facilities opened in the United States since 1947, describes trends in their physical configuration and burn bed availability and discusses the terms used to classify those facilities. Lists of active burn care facilities were reviewed, including primarily the Burn Care Resource directories of the American Burn Association, which date back to 1976, along with the results of special surveys carried out by the authors in 1992 and 2006. Of the burn facilities at 175 US hospitals which had reported the presence of specialized burn beds since 1947, 25 had closed before 1992, 153 have been active as recently as 1992, and 125 were active as of early 2007. Between 1979 and 2007, total burn beds listed as available in annual surveys of hospitals reporting specialized burn care facilities ranged between about 1700 and 1800 beds. Average burn beds in those facilities increased from approximately 11.2 to 14.4. Specialized burn care facilities provide burn care in various configurations of units dedicated primarily to burns and those shared with other patients. Despite the closing of 50 such facilities in recent decades, total reported burn beds in the United States have remained essentially stable during the past 30 years. Issues related to concentrating burn beds in a smaller number of facilities and external factors affecting their past and future operations merit additional review.

Trends in the epidemiology of major burn injury among hospitalized patients: A population-based analysis

“…However, there were significant changes in the distribution of patients across income quintiles over the interval of study; the proportion of patients in the lowest income quintile decreased from 35% to 16%, while the proportion of patients in the middle two quintiles (2–3) increased from 29% to 55%. The proportion of patients in the highest two quintiles (4–5) did not change significantly, representing approximately 25–30% of all patients each year.…”

“…These improvements have been attributed, in part, to a dedicated, multidisciplinary approach to the care of burn injury, prompting efforts to develop regional systems for the care of burn-injured patients(3,4). While there is evidence in other areas of surgery and medicine that regionalization or concentration of care improves outcomes, there are limited data available relevant to the patient with major burn injury(5–9).…”

“…Efforts to characterize trends in regionalization, and its effect on the outcomes of burn injured patients, have been hindered by the lack of a consensus definition for what constitutes a burn center and a lack of data regarding care at non-burn centers(4,10). The only recognized mechanism for assessing and confirming the quality of care provided in a burn center is verification by the American Burn Association (ABA)(11).…”

Verified Centers, Nonverified Centers, or Other Facilities: A National Analysis of Burn Patient Treatment Location

“…In fact, several studies have demonstrated that patients who receive optimal burn care at verified centers may have a better functional outcome after discharge. (5, 15) This may provide an opportunity for the burn community to educate and reinforce transfer criteria to non-burn hospitals, as well as for CMS to consider whether payment for treatment of large burns outside of burns centers is appropriate.…”

Pain and itch outcome trajectories differ among European American and African American survivors of major thermal burn injury

“…Second, our study was limited to only patients who presented to major burn centers. However, the great majority of MThBI survivors receiving tissue autograft are treated at such centers [4]. Another potential limitation is the influence of peri-assessment activities (occupational therapy, dressing changes, etc.)…”