Burns care varies across the country

Embargoed until: Publicly released:

A review of data from the Burns Registry of Australia and New Zealand has found significant variation in clinical management and outcomes in burns units. The review found that most injuries in burn units involved burns to less than 10% of the total body surface area, but that there were marked difference in skin grafting rates between units. Death rates and rates of ICU admissions also varied across sites.

Journal/conference: Medical Journal of Australia

Organisation/s: The University of Sydney, University of Otago, Monash University, Alfred Hospital, Royal Adelaide Hospital, Royal Perth Hospital, Royal Darwin Hospital, Auckland Regional Centre for Plastic Reconstructive and Hand Surgery, Middlemore Hospital, Concord Hospital, Royal Hobart Hospital, Royal North Shore Hospital, Christchurch Hospital, Hutt Hospital, Wellington Plastic Surgery Institute

Media Release

From: Medical Journal of Australia (MJA)

BURNS REGISTRY PROVIDING VITAL EVIDENCE TO UNITS

THE Burns Registry of Australia and New Zealand (BRANZ) is providing vital data to burn units across the region, improving practice and outcomes for patients, according to research published today in the Medical Journal of Australia.

BRANZ was established in 2009 to monitor and benchmark quality of care in specialist burn units in the two countries. The researchers, including the unit heads of ten of the contributing Australian and New Zealand burn units, analysed 4 years of BRANZ data from July 2010 to June 2014.


They examined four basic features of burn care in Australia and New Zealand: two management items, rates of admission to intensive care units and rates of skin grafting; and two outcome measures, length of hospital stay and mortality. The study identified considerable variation in practice, and it also provided evidence of significant variations in outcomes that are not explained by simple differences in casemix alone.


The study included 6955 adult patients (16 years and over). In most cases (78.7%), the total body surface area burned (%TBSA) was under 10%; inhalation injury was described in 7% of patients, and, 14.5% of patients were admitted to an intensive care unit. The in-hospital mortality rate was 1.3% (65 of 5074) for men and 2.0% (41 of 2101) for women.


“Nearly three-quarters (74%) of patients underwent at least one surgical procedure,” the authors found. However, there “were significant differences between units in skin grafting rates”. Surgical management impacts on long term scarring outcomes and the study indicated that the rates of grafting differ between units; this requires further investigation.


“For survivors, the hospital length of stay (LOS) increased exponentially with %TBSA. The mean adjusted hospital LOS differed by more than 2 days between the hospitals with the shortest and longest LOS. The BRANZ flags to some units the need to pay attention to variables that influence LOS, such as time to surgery and early mobilisation protocols which ensure that care is delivered efficiently.


“There were [also] differences between units in the adjusted odds of mortality, with three units reporting significantly lower estimated probabilities of death than the two units with the highest estimates.”


BRANZ assists burn units study the effects of different treatments and protocols on patient outcomes in order to identify best practices that improve care, efficiency and reduce costs. The researchers emphasised that in a field where evidence is lacking, the BRANZ was doing a crucial job.


In response to these findings, the Australian and New Zealand Burn Association launched the Burns Quality Improvement Program in 2013. This program uses BRANZ data to develop evidence-based standards of care and to provide a quality improvement framework for improving care.


“The information provided by BRANZ provides a unique opportunity for significantly improving the quality of care for burns patients in Australia and New Zealand,” the authors concluded.

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The Medical Journal of Australia is a publication of the Australian Medical Association.
The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA or the MJA unless that is so stated.

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