Article

Critical Issues in Burn Care

Authors: James H. Holmes, IV, MD

Abstract

Burn care, especially for serious burn injuries, represents a considerable challenge for the healthcare system. The American Burn Association has established a number of strategies for the management of burn patients and dedicates its efforts and resources to promoting and supporting burn-related research, education, care, rehabilitation, and prevention, often in collaboration with other organizations. The American Burn Association has recommended that patients with serious burns be referred to a designated burn center, ie, a hospital outfitted with specialized personnel and equipment dedicated to burn care. Burn centers have been operational for over 50 years, but the complexity and costs of providing specialized burn care have given rise to a number of critical administrative and political issues. These include logistical limitations imposed by the uneven national distribution of burn centers and a potential shortage of burn beds, both during everyday conditions and in the event of a mass disaster. Burn surgeon shortages have also been identified, stemming, in part, from a lack of specialized burn care training opportunities. There is currently a lack of quality outcome data to support evidence-based recommendations for burn care, and burn care centers are compromised by problems obtaining reimbursement for the care of uninsured and publicly insured out-of-state burn patients. Initiatives are underway to maintain efficient burn care facilities that are fully funded, easily accessible, and most importantly, provide optimal, evidence-based care on a daily basis, and are well-equipped to handle a surge of patients during a disaster situation.


Key Points


* The complexity and costs of providing specialized burn care have contributed to the emergence of a number of critical administrative and political issues that must be adequately addressed in order to ensure future effective operation of burn care systems, under circumstances ranging from normal operating conditions to regional and national emergencies.


* The most pressing administrative and political burn care issues include burn bed availability and surgeon shortages, disaster preparedness, the need for quality burn outcome data, and reimbursement issues.


* Federal funding for burn care research and disaster preparedness, provision and promotion of burn center fellowships, changes to the Diagnosis-Related Group coding system, as well as proposed legislative changes, represent steps in the right direction toward sustaining everyday burn care and preparing for the possible occurrence of mass burn casualties.

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