Abstract | December 20, 2021

Statewide Prehospital Routing of Burn Injuries Reduces Patient Length of Stay

Presenting Author: Randy D. Kearns, DHA, MSA, FACHE, FRSPH, University of New Orleans|New Orleans|Louisiana

Co-Authors: Jeffrey E. Carter, MD|Burn Center Director/Associate Professor,|Louisiana State University Health Sciences Center, New Orleans, LA, University Medical Center, New Orleans, Children’s Hospital of New Orleans, New Orleans, Louisiana Nicole M. Kopari, MD||Louisiana State University Health Sciences Center, New Orleans, LA, University Medical Center, New Orleans, Children’s Hospital of New Orleans, New Orleans, Louisiana Chris Hector, NRP|Administrative Director|Louisiana Emergency Response Network, Baton Rouge, LA Paige Hargrove, BSN, RN|Executive Director|Louisiana Emergency Response Network, Baton Rouge, LA Joseph Barrios, III MD|Burn Center Director|Our Lady of Lourdes, Lafayette, LA John P. Hunt, MD|Professor|Louisiana State University Health Sciences Center, New Orleans, LA, University Medical Center, New Orleans, New Orleans, Louisiana Tracee Short, MD|Burn Center Director|Baton Rouge General Medical Center, Baton Rouge, LA Kevin Sittig, MD|Professor/Burn Center Director|Ochsner LSU Health Shreveport Academic Medical Center, Shreveport, LA Herbert A. Phelan, MD|Professor|Louisiana State University Health Sciences Center, New Orleans, LA, University Medical Center, New Orleans, Children’s Hospital of New Orleans, New Orleans, Louisiana

Learning Objectives

  1. Recognize and discuss the value and importance of a transfer center in routing patients with burn injuries to burn centers.
  2. Discuss the value and importance of the role first responders play in routing burn patients to burn centers.

Introduction:
In the U.S., traumatic injuries are the leading cause of death before age 45 and have significantly lower mortality if routed to a verified trauma center. Burn injuries are included in trauma statistics and represent 1.1 million injured people annually seeking medical assistance. Routing of burn injuries to ABA-recognized burn centers has yet to be assessed as it has in trauma injury. Our goal was to examine the impact of prehospital routing of burn injuries on hospital length of stay, mortality, and potential costs of care through a statewide care coordination center, the Louisiana Emergency Response Network.

Methods:
Our study is a retrospective statewide analysis of burn injuries from 01/01/2017 thru 12/31/2019 using the Louisiana Hospital Inpatient Discharge Database. Routing of burn patients was implemented in 2018 using the ABA burn referral criteria. Data included: total admissions with primary burn diagnosis, region, discharge status, length of stay, and raw mortality by region and state. Descriptive and comparative statistics were performed to assess the impact of routing of burn-injured patients. Cost analysis was performed using Louisiana Medicaid per diem rates from 2021 at $1,907.92/day.

Results:
1,288 patients were treated in Louisiana during the study period with 855 post-routing and 433 pre-routing. The mean length of stay was reduced from 11.84 days in 2017 to 8.82 days in 2018 (p value=0.0988) with a potential savings of 761 inpatient care days or $2.17 million. Overall mortality across the state was unchanged except in the highest volume region where it dropped from 7.9% in 2017 to 3.6% in 2019 (54%).

Conclusions:
Burn injuries meeting ABA referral criteria are a form of time-sensitive trauma. This study marks the first analysis pre and post-implementation of routing for burn injuries by a statewide care coordination center. Our study demonstrates improvement in length of stay and mortality but a continued need to examine other contributing factors such as the severity of the injury and concomitant trauma. Additionally, education and exercise are likely to improve first responder and referral center compliance and are currently in development.

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Posted in: Burn Medicine101
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