🤔 Question: A question came up about the new co-management of care definition. Would this be appropriate for use when the Burn Service team is consulted and managing a frostbite injury while the hospital medicine team is managing the rest of the patient's medical needs?
🌱 Answer: Co-management means that the burn team is doing the actual care, writing orders for the patient related to the wound care, and writing notes related to the care. They may also be doing operative wound procedures on the patient if that is required. If they are only consulting, they may be advising on the wound care but are not actually doing the care or writing the orders for the patient.
🤔 Question: There was a 30yo who presented to a burn center emergency department. They were involved in a motor vehicle crash/car fire. They sustained 35% TBSA burns and were treated at another burn center. They had multiple surgeries at that center and were supposed to be discharged to rehab in about a week. Unfortunately, they were unhappy with their care at that facility and left. They presented to our emergency department. Should this patient be included in our Registry?
🌱 Answer: The decision about whether to enter this patient in your registry is dependent on if they still have open acute burn injury wounds. If yes and you admit them to your inpatient unit, then enter them. If no, then they are no longer an acute patient and should not be entered. It doesn't matter if they were treated at another burn center before they arrived at your facility.
🤔 Question: I have a current patient that’s being seen by our Burn Service since 2011 and has Hidradenitis. They are not in our registry prior to ABA full Live Registry. I was wondering since I will be adding him into the registry starting today, should I be entering everything this patient has encountered such as OR trips, etc. into his registry from the very start?
🌱 Answer: The patient with Hidradenitis that has been seen since 2011 but only entered into the registry now - It is up to your center how far back you would like to go in entering data on this patient. The Data Dictionary states that "Additionally, some facilities treat patients with acute dermatologic conditions or other injuries that affect the integrity of the skin. Data on these patients may be included in the ABA registry."
🤔 Question: A Burn Center is currently seeing skin rash/infection cases that are input into the registry (example: SJS, Calciphylaxis, etc.) If a Wound team takes over seeing these patients and not the Burn team, is the Burn Service still required to input these patients into the registry?
🌱 Answer: For patients now cared for by the Wound Service and not the Burn Service, you should not continue to enter these patients in the registry. The Data Dictionary states "The Burn Service should be responsible for or co-managing the care of the patient for the case to be included in the registry."
🤔 Question: Can you clarify why are we not required to collect some specific data fields on all patients. Ex. Co-morbids and complications. Complications for example are essential for all patients and centers should be tracking and reviewing their complications regardless of the overall TBSA. If we are only "required to collect" them on >10% TBSA injured patients, there will be some centers that choose to capture on all patients as this gives a true representation of complications for their entire service line/program. When it comes to reports and comparisons center to center the data is skewed as some centers that choose to capture on all patients will be "over reporting.
🌱 Answer: It was decided by the Quality and Burn Registry Committee that certain fields like complications would not be required to be collected on some of the patients to decreases the volume of data collection for the burn centers. For example, minor burn populations have few complications and the amount of time to collect this data has a low return on the investment to collect the data. This is, for example, patients with <10% TBSA burn injuries who do not have an inhalation injury, do not go to surgery or do not die. Burn centers may, of course, decide to collect this data for their own purposes.
🤔 Question: Our facility has patients who come into Emergency Department, get admitted with an order for OBS, ICU, progressive care, or med/surg however, they never leave the ED because of bed issues. In these instances, for burns, is this considered admitted? By the way, they sometimes stay longer than 24hrs but other times its less than 24hrs. We are trying to define on how to enter for initial admission or related admission for these patients.
🌱 Answer: This is addressed in the 2024 Data Dictionary under Registry Inclusion Criteria (page 5). If the patient is under the care of the burn service, regardless of where in the hospital they are, then they should be included in the registry if they meet one of the 3 criteria listed in the Data Dictionary/Registry Inclusion Criteria. You may also include observation patients admitted for less than 24 hours if they are under the care of the burn service. All these patients should be admitted as initial admits. - Registry Inclusion Criteria (Page 5 Data Dictionary 2024)
🤔 Question: What data specifically is required for a facility to become ABA verified?
🌱 Answer: Please check with the Verification Committee or ABA representative for this information. You can also find some of this in the Verification Guidelines on the American Burn Association website. (https://ameriburn.org/quality-care/verification/)
🤔 Question: If a trauma patient comes in with multiple injuries and is comanaged by several other services but the Burn Service is consulted for a laceration and repairs the laceration. Should this patient be added to the registry?
🌱 Answer: If the burn service co-manages the care of the patient, then yes, this patient should be included in the registry. The dates the patient should be included are from the time the burn service begins co-managing care until the time they sign off and are no longer co-managing care, which may be before the patient is actually discharged from the hospital. In this particular case, if the Burn Service is only consulting and perhaps doing a minor laceration repair and then does not see the patient again for continued follow-up, they should not be included in the Registry.
🤔 Question: Have the inclusion criteria been reviewed/approved by the Verification Committee? I recall prior email threads within our community Doctors wanted burn patients who died in the ED before burn service could be consulted or manage care to be included in the registry for PI purposes.
🌱 Answer: Yes, patients that are alive at any point while they are in the ER and then die in the ER should be included in the registry and this has been approved by both. Patients that arrive to the ER dead and never reacquire any cardiac function should not be included in the registry. - Burn Center Admission – Inclusion Criteria (page 19 Data Dictionary 2023)
🤔 Question: If the readmission surgeries are done solely by another service, are these included in the related admissions in the registry?
🌱 Answer: No, enter only surgeries done by the Burn Service in Related Admissions. You should enter all burn-related surgeries in the Surgical Procedures section of the new Long-Term Outcomes which will begin with new patients admitted beginning in January 2024 regardless of who does them (e.g., other hospitals or services).
🤔 Question: Should cases admitted to other services, such as Internal Medicine for inhalation injury be included in the Registry?
🌱 Answer: The only cases that should be included in the Registry are those where the Burn Service is managing or co-managing the care of the patient. If this patient was solely under the Internal Medicine Service and the Burn Service was not involved in co-managing the care, then no, the patient should not be included. Consults are not considered co-managing.
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