TY - JOUR
T1 - The association between out of hours burn centre admission and in-hospital outcomes in patients with severe burns
AU - Singer, Yvonne
AU - Gabbe, Belinda J.
AU - Cleland, Heather
AU - Holden, Dane
AU - Schnekenburger, Marc
AU - Tracy, Lincoln M.
N1 - Funding Information:
The BRANZ has previously received funding from the Australian and New Zealand Burns Association, the Australian Commission on Safety and Quality in Health Care (2008–2009), the Julian Burton Burns Trust (2008–2013), the Helen Macpherson Smith Trust (2010–2012), the Thyne Reid Foundation (2011–2013), the Australasian Foundation for Plastic Surgery (2013–2017), the New Zealand Accident Compensation Corporation (2013–2020), the Clipsal by Schneider Electric National Community Grants Program (2017), and the HCF Research Foundation (2018–2019). Belinda Gabbe was supported by an Australian Research Council Future Fellowship (FT170100048) during the preparation of this manuscript. Individual burns centres also contribute funding annually to the BRANZ. Nonetheless, the funding bodies listed had no role in the design of the current study; in the analysis or interpretation of data; in the preparation of the manuscript, or the decision to submit the manuscript for publication.
Funding Information:
The BRANZ has previously received funding from the Australian and New Zealand Burns Association , the Australian Commission on Safety and Quality in Health Care (2008–2009), the Julian Burton Burns Trust (2008–2013), the Helen Macpherson Smith Trust (2010–2012), the Thyne Reid Foundation (2011–2013), the Australasian Foundation for Plastic Surgery (2013–2017), the New Zealand Accident Compensation Corporation (2013–2020), the Clipsal by Schneider Electric National Community Grants Program (2017), and the HCF Research Foundation (2018–2019). Belinda Gabbe was supported by an Australian Research Council Future Fellowship ( FT170100048 ) during the preparation of this manuscript. Individual burns centres also contribute funding annually to the BRANZ. Nonetheless, the funding bodies listed had no role in the design of the current study; in the analysis or interpretation of data; in the preparation of the manuscript, or the decision to submit the manuscript for publication.
Publisher Copyright:
© 2022 International Society of Burns Injuries
PY - 2023/8
Y1 - 2023/8
N2 - Introduction: Patients with severe burns (≥20 % total body surface area [TBSA]) have specific and time sensitive needs on arrival to the burn centre. Burn care systems in Australia and New Zealand are organised differently during weekday business hours compared to overnight and weekends. The aims of this study were to compare the profile of adult patients with severe burns admitted during business hours with patients admitted out of hours and to quantify the association between time of admission and in-hospital outcomes in the Australian and New Zealand context. Methods: Data were extracted from the Burns Registry of Australia and New Zealand for adults (≥18 years) with severe burns admitted to Australian or New Zealand burn centres between July 2016 and June 2020. Differences in patient profiles, clinical management, and in-hospital outcomes were investigated. Univariable and multivariable logistic and linear regression models were used to quantify associations between time of admission and in-hospital outcomes of interest. Results: We found 623 patients eligible for inclusion. Most patients were admitted out of hours (69.2 %), their median age was 42 years, and most were male (78 %). The median size burn was 30 % TBSA and 32 % of patients had an inhalation injury. A greater proportion of patients admitted out of hours had alcohol and/or drugs involved with injury compared to patients admitted during business hours. No other differences between groups were observed. Patients in both groups had similar odds of dying in hospital (Odds Ratio [OR], 95 % Confidence Interval [95 %CI] 1.49 [0.64, 3.48]), developing acute kidney injury within 72 h (OR, 95 %CI 0.58 [0.32, 1.07]), or sepsis (OR, 95 %CI 1.04 [0.46, 2.35]). No association was found between time of admission and hospital (%, 95 %CI 1.00 [0.82, 1.23]) nor intensive care length of stay (%, 95 %CI 0.97 [0.73, 1.27]). Discussion: In this first Australian and/or New Zealand study to explore the association between time of admission and burn patient in-hospital outcomes, out of hours admission was not associated with patient outcomes of interest. Conclusion: These findings support current models of care in Australian and New Zealand burn centres, however further investigation is required. Nonetheless, given most severe burns patients arrive out of hours to burn the centre, it is plausible that out of hours availability of senior burn clinicians will improve patient care and safety resilience within burn care systems.
AB - Introduction: Patients with severe burns (≥20 % total body surface area [TBSA]) have specific and time sensitive needs on arrival to the burn centre. Burn care systems in Australia and New Zealand are organised differently during weekday business hours compared to overnight and weekends. The aims of this study were to compare the profile of adult patients with severe burns admitted during business hours with patients admitted out of hours and to quantify the association between time of admission and in-hospital outcomes in the Australian and New Zealand context. Methods: Data were extracted from the Burns Registry of Australia and New Zealand for adults (≥18 years) with severe burns admitted to Australian or New Zealand burn centres between July 2016 and June 2020. Differences in patient profiles, clinical management, and in-hospital outcomes were investigated. Univariable and multivariable logistic and linear regression models were used to quantify associations between time of admission and in-hospital outcomes of interest. Results: We found 623 patients eligible for inclusion. Most patients were admitted out of hours (69.2 %), their median age was 42 years, and most were male (78 %). The median size burn was 30 % TBSA and 32 % of patients had an inhalation injury. A greater proportion of patients admitted out of hours had alcohol and/or drugs involved with injury compared to patients admitted during business hours. No other differences between groups were observed. Patients in both groups had similar odds of dying in hospital (Odds Ratio [OR], 95 % Confidence Interval [95 %CI] 1.49 [0.64, 3.48]), developing acute kidney injury within 72 h (OR, 95 %CI 0.58 [0.32, 1.07]), or sepsis (OR, 95 %CI 1.04 [0.46, 2.35]). No association was found between time of admission and hospital (%, 95 %CI 1.00 [0.82, 1.23]) nor intensive care length of stay (%, 95 %CI 0.97 [0.73, 1.27]). Discussion: In this first Australian and/or New Zealand study to explore the association between time of admission and burn patient in-hospital outcomes, out of hours admission was not associated with patient outcomes of interest. Conclusion: These findings support current models of care in Australian and New Zealand burn centres, however further investigation is required. Nonetheless, given most severe burns patients arrive out of hours to burn the centre, it is plausible that out of hours availability of senior burn clinicians will improve patient care and safety resilience within burn care systems.
KW - Acute kidney injury
KW - Australia
KW - Mortality
KW - New Zealand
KW - Out of hours admission
KW - Outcomes
KW - Registry
KW - Severe burns
UR - http://www.scopus.com/inward/record.url?scp=85136303938&partnerID=8YFLogxK
U2 - 10.1016/j.burns.2022.08.002
DO - 10.1016/j.burns.2022.08.002
M3 - Article
C2 - 35995642
AN - SCOPUS:85136303938
SN - 0305-4179
VL - 49
SP - 1062
EP - 1072
JO - Burns
JF - Burns
IS - 5
ER -