1
|
Ross EE, Speiser N, Donohue S, Yenikomshian HA. Injury Pattern Analysis to Optimize Burn Injury Prevention in the Unhoused Community. J Burn Care Res 2024; 45:273-276. [PMID: 38437619 DOI: 10.1093/jbcr/irae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Unhoused patients are an overrepresented group in burn injury, and are a uniquely vulnerable population. Current research focuses on the consequences of homelessness on burn outcomes, with little known about the specific circumstances and behaviors leading to burn injury that may represent specific targets for injury prevention efforts. The burn registry at an urban regional burn center was queried for burn admissions in unhoused adults from 2019 to 2022. Registry data pulled included demographics, urine toxicology, mechanism of injury, and injury subjective history. Subjective injury history was reviewed to determine more specific injury circumstances and activities during which accidental burns occurred. Demographic and mechanistic trends in burn admissions were explored via descriptive statistics. Among 254 admissions for burns from the unhoused community, 58.1% of patients were positive for stimulants on admission. Among accidental injuries (69.7%), common circumstances included preparing food or beverages, cooking or using methamphetamine, smoking cannabis or tobacco, bonfires, and candles. A specific common circumstance was lighting a cigarette while handling accelerants (6.7%). Interventions for stimulant abuse, as well as outreach efforts to educate unhoused patients about situational awareness, safe handling of accelerants, safe smoking practices, and safe cooking practices, may be effective tools in reducing burn admissions in this vulnerable population.
Collapse
Affiliation(s)
- Erin E Ross
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033USA
| | - Noah Speiser
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033USA
| | - Sean Donohue
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033USA
| | - Haig A Yenikomshian
- Division of Plastic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033USA
| |
Collapse
|
2
|
Smith MB, Brownson E, Newman AK, Madison C, Fuentes M, Amtmann D, Carrougher GJ, Gibran NS, Stewart BT. Experiences of Alaska Native people living with burn injury and opportunities for health system strengthening. BMC Health Serv Res 2023; 23:1260. [PMID: 37968627 PMCID: PMC10652576 DOI: 10.1186/s12913-023-10243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Injuries are a leading cause of death and disability for Alaska Native (AN) people. Alaska Native Tribal Health Consortium (ANTHC) is supporting the development of a burn care system that includes a partnership between Alaska Native Medical Center (ANMC) in Anchorage, AK and UW Medicine Regional Burn Center at Harborview Medical Center (HMC) in Seattle, WA. We aimed to better understand the experiences of AN people with burn injuries across the care continuum to aid development of culturally appropriate care regionalization. METHODS We performed focus groups with twelve AN people with burn injury and their caregivers. A multidisciplinary team of burn care providers, qualitative research experts, AN care coordinator, and AN cultural liaison led focus groups to elicit experiences across the burn care continuum. Transcripts were analyzed using a phenomenological approach and inductive coding to understand how AN people and families navigated the medical and community systems for burn care and areas for improvement. RESULTS Three themes were identified: 1-Challenges with local burn care in remote communities including limited first aid, triage, pain management, and wound care, as well as long-distance transport to definitive care; 2-Divergence between cultural values and medical practices that generated mistrust in the medical system, isolation from their support systems, and recovery goals that were not aligned with their needs; 3-Difficulty accessing emotional health support and a survivor community that could empower their resilience. CONCLUSION Participants reported modifiable barriers to culturally competent treatment for burn injuries among AN people. The findings can inform initiatives that leverage existing resources, including expansion of the Extension for Community Healthcare Outcomes (ECHO) telementoring program, promulgation of the Phoenix Society Survivors Offering Assistance in Recovery (SOAR) to AK, coordination of regionalized care to reduce time away from AK and provide more comfortable community reintegration, and define rehabilitation goals in terms that align with personal goals and subsistence lifestyle skills. Long-distance transport times are non-modifiable, but better pre-hospital care could be achieved by harnessing existing telehealth services and adapting principles of prolonged field care to allow for triage, initial care, and resuscitation in remote environments.
Collapse
Affiliation(s)
- Mallory B Smith
- Harborview Injury Prevention & Research Center, University of Washington, 325 9th Ave, Box 359796, Seattle, WA, 98104, USA
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Elisha Brownson
- Department of Surgery, Alaska Native Medical Center, Anchorage, AK, USA
| | - Andrea K Newman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | - Molly Fuentes
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Gretchen J Carrougher
- Division of Trauma, Critical Care, and Burn, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Nicole S Gibran
- Division of Trauma, Critical Care, and Burn, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Barclay T Stewart
- Harborview Injury Prevention & Research Center, University of Washington, 325 9th Ave, Box 359796, Seattle, WA, 98104, USA.
- Division of Trauma, Critical Care, and Burn, Department of Surgery, University of Washington, Seattle, WA, USA.
| |
Collapse
|
3
|
DiPaolo N, Hulsebos IF, Yu J, Gillenwater TJ, Yenikomshian HA. Race and Ethnicity Influences Outcomes of Adult Burn Patients. J Burn Care Res 2023; 44:1223-1230. [PMID: 36881674 PMCID: PMC10480350 DOI: 10.1093/jbcr/irad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Indexed: 03/09/2023]
Abstract
Outcomes of burn survivors is a growing field of interest; however, there is little data comparing the outcomes of burn survivors by ethnicity. This study seeks to identify any inequities in burn outcomes by racial and ethnic groups. A retrospective chart review of an ABA Certified burn center at a large urban safety net hospital identified adult inpatient admissions from 2015 to 2019. A total of 1142 patients were categorized by primary ethnicity: 142 black or African American, 72 Asian, 479 Hispanic or Latino, 90 white, 215 other, and 144 patients whose race or ethnicity was unrecorded. Multivariable analyses evaluated the relationship between race and ethnicity and outcomes. Covariate confounders were controlled by adjustment of demographic, social, and prehospital clinical factors to isolate differences that might not be explained by other factors. After controlling for covariates, black patients had 29% longer hospital stays (P = .043). Hispanic patients were more likely to be discharged to home or to hospice care (P = .005). Hispanic ethnicity was associated with a 44% decrease in the odds of discharge to acute care, inpatient rehabilitation, or a ward outside the burn unit (P = .022). Black and Hispanic patients had a higher relative chance of having publicly assisted insurance, versus private insurance, than their white counterparts (P = .041, P = .011 respectively). The causes of these inequities are indeterminate. They may stem from socioeconomic status not entirely accounted for, ethnic differences in comorbidity related to stressors, or inequity in health care delivery.
Collapse
Affiliation(s)
- Nicola DiPaolo
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ian F Hulsebos
- Department of Surgery, Hospital Corporation of America Medical City North Texas Hospitals, Plano, Texas, USA
| | - Jeremy Yu
- Clinical and Translational Science Institute, University of Southern California, Los Angeles, California, USA
| | - Timothy Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
4
|
Boyd AN, Kadi BA, Rothenberger MA, Hartman BC, Spera LJ, Meadows KJ, Walroth TA. Evaluation of the Role of a Clinical Pharmacist on Medication Management in an Adult Burn Clinic via a Collaborative Drug Therapy Management Protocol. J Burn Care Res 2023; 44:1023-1030. [PMID: 37300486 DOI: 10.1093/jbcr/irad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Indexed: 06/12/2023]
Abstract
Historically, pharmacists have not been formally involved in managing burn clinic patients. Collaborative Drug Therapy Management (CDTM) protocols allow pharmacists working within a defined context to independently assume responsibility for direct patient care activities. The objective of this study was to evaluate the number and type of medication-related interventions made by a clinical pharmacist, in an adult burn clinic, via a CDTM protocol. The protocol allows pharmacists to independently manage the following disease states: pain, agitation, delirium, insomnia, venous thromboembolism, skin/soft tissue infections, and hypermetabolic complications. All pharmacist visits between 1/1/22 and 9/22/22 were included. A total of 16 patients were seen at 28 visits with a clinical pharmacist for a total of 148 interventions. Patients were mostly males (81%) with a mean ± SD age of 41 ± 15 years. The majority of patients were in-state (94%), with 9 (56%) being from an outlying county. Patients were seen for a median (IQR) of 2 (1,2) visits. Interventions were made at all visits (100%) with a median of 5 (4,6) per visit. Interventions (per visit) included medication reconciliation [28 (100%)], a median of 1 (0,2) medication ordered or adjusted, labs ordered at 7 (25%) visits, with adherence and patient education both reviewed at over 90% of visits. To the best of our knowledge, ours is the first burn center to implement a Clinical Pharmacist CDTM Protocol, with a pharmacist directly impacting transitions of care. This may serve as a framework for other sites. Future directions include continuing to track data for medication adherence and access, billing/reimbursement, and clinical outcomes.
Collapse
Affiliation(s)
- Allison N Boyd
- Department of Pharmacy, Clinical Services, Eskenazi Health, Indianapolis, IN, USA
| | - Bacil A Kadi
- Purdue University College of Pharmacy, West Lafayette, Indiana, USA
| | | | - Brett C Hartman
- Richard M. Fairbanks Burn Center, Eskenazi Health, Indianapolis, Indiana, USA
| | - Leigh J Spera
- Richard M. Fairbanks Burn Center, Eskenazi Health, Indianapolis, Indiana, USA
| | - Katherine J Meadows
- Richard M. Fairbanks Burn Center, Eskenazi Health, Indianapolis, Indiana, USA
| | - Todd A Walroth
- Department of Pharmacy, Clinical Services, Eskenazi Health, Indianapolis, IN, USA
| |
Collapse
|
5
|
Galicia KE, Mehta A, Riviello R, Nitzschke S, Bamer A, Gibran NS, Stewart BT, Wolf SE, Ryan CM, Kubasiak J, Schneider JC. The Effect of Distance to Treatment Center on Long-Term Outcomes of Burn Patients. J Burn Care Res 2023; 44:624-630. [PMID: 35939346 PMCID: PMC9905382 DOI: 10.1093/jbcr/irac112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Indexed: 11/13/2022]
Abstract
Geospatial proximity to American Burn Association (ABA)-verified burn centers or self-designated burn care facilities varies across the country. This study evaluates the effect of distance to treatment center on long-term, patient-reported outcomes. Data from the Burn Model System (BMS) National Longitudinal Database were analyzed. Demographic and clinical data were compared between three cohorts stratified by distance to BMS center (<20, 20-49.9, ≥50 miles). Distance to BMS center was calculated as driving distance between discharge and BMS center ZIP code centroids. The following patient-reported outcomes, collected at 12-months follow-up, were examined: Veterans RAND 12-Item Health Survey (VR-12), Satisfaction with Life (SWL) scale, employment status, and days to return to work. Mixed model regression analyses were used to examine the associations between distance to BMS center and each outcome, controlling for demographic and clinical variables. Of 726 patients included in this study, 26.3% and 28.1% were <20 and between 20 and 49.9 miles to a BMS center, respectively; 46.6% were ≥50 miles to a BMS center. Greater distance was associated with white/non-Hispanic race/ethnicity, preinjury employment, flame injury, and larger burn size (P < .001). Regression analyses did not identify significant associations between distance to BMS center and any patient-reported outcomes. This study suggests that patients treated at BMS centers have similar long-term, patient-reported outcomes of physical and psychosocial function, as well as employment, despite centralization of burn care and rehabilitation services. Given a steady decline in the incidence of burn injury, continued concentration of key resources is logical and safe.
Collapse
Affiliation(s)
- Kevin E Galicia
- Address correspondence to Kevin E. Galicia, MD, Department of Surgery, Loyola University Medical Center, 2160 S. First Ave, Maywood, IL 60153, USA.
| | - Anupama Mehta
- Division of Trauma, Burn, and Surgical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Robert Riviello
- Division of Trauma, Burn, and Surgical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Stephanie Nitzschke
- Division of Trauma, Burn, and Surgical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Alyssa Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Nicole S Gibran
- Department of Surgery, The University of Washington, Seattle, Washington, USA
| | - Barclay T Stewart
- Department of Surgery, The University of Washington, Seattle, Washington, USA
| | - Steven E Wolf
- Division of Burn and Trauma Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Huff ML, Blome-Eberwein S. Providencia rettgeri Infection Compromising Post-Burn Recovery: A Lesson in the Importance of Follow-Up Care. Cureus 2022; 14:e25450. [PMID: 35774678 PMCID: PMC9239292 DOI: 10.7759/cureus.25450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/27/2022] [Indexed: 11/05/2022] Open
|
7
|
Solomon EA, Phelan E, Tumbaga LG, Karashchuk IP, Greenhalgh DG, Sen S, Palmieri TL, Romanowski KS. Understanding factors in burn patient follow-up. J Burn Care Res 2021; 44:501-507. [PMID: 34525203 DOI: 10.1093/jbcr/irab168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Indexed: 11/13/2022]
Abstract
Follow-up rates (FUR) are concerningly low among burn-injured patients. This study investigates the factors associated with low FUR and missed appointments (MA). We hypothesize that patients who are homeless, use illicit substances, and have psychiatric comorbidities will have lower rates of follow-up (FU) and more MAs. Data from a discharge-planning survey of 281 burn-injured patients discharged from September 2019 - July 2020 was analyzed and matched with patients' EMR records for a retrospective chart review. Data collected included general demographics, burn characteristics, hospitalization details, FU visits, MAs, homeless status, substance use, major psychiatric illness (MPI), and survey responses. Data analysis used Chi-square, Fisher's exact test, Student t-test, Wilcox Rank Sum test, and Multivariate Regression Analysis (MVR). Overall, 37% of patients had no FU in clinic and 46% had one or more MA. On MVR, homeless patients were more likely to never follow up, OR = 0.227 (95% CI = 0.106-0.489), as were patients who anticipated transportation difficulties, OR = 0.275 (95% CI = 0.151-0.501). Homeless patients were more likely to have MA, OR= 0.231 (95% CI = 0.099-0.539). On univariate analysis, patients with one or more documented MPI had lower FUR, with 50.62% having no FU (p = 0.0020). Among patients who responded to the survey that they were current drug users, 52% had no FU as compared to 28% of patients who responded that they did not use drugs (p = 0.0007). Factors associated with lower FUR and more MAs include homeless status, substance use, MPI, and transportation difficulties.
Collapse
Affiliation(s)
- Eve A Solomon
- UC Davis School of Medicine, University of California, Davis, Sacramento, CA, Stockton Blvd, Sacramento, CA
| | - Elizabeth Phelan
- Firefighters Burn Institute Regional Burn Center, University of California, Davis, Sacramento, CA. Stockton Blvd, Sacramento, CA
| | - Lilia G Tumbaga
- Firefighters Burn Institute Regional Burn Center, University of California, Davis, Sacramento, CA. Stockton Blvd, Sacramento, CA
| | - Irina P Karashchuk
- UC Davis School of Medicine, University of California, Davis, Sacramento, CA, Stockton Blvd, Sacramento, CA
| | - David G Greenhalgh
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA,. Stockton Blvd, Sacramento, CA
| | - Soman Sen
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA,. Stockton Blvd, Sacramento, CA
| | - Tina L Palmieri
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA,. Stockton Blvd, Sacramento, CA
| | - Kathleen S Romanowski
- Department of Surgery, Division of Burn Surgery, University of California, Davis, Sacramento, CA,. Stockton Blvd, Sacramento, CA
| |
Collapse
|