Abstract
Abstract
Introduction
Most burn injuries can be managed at home, however appropriate follow up care is vital to prevent complications. Our center developed an outpatient dressing and care algorithm aimed at improving patient outcomes and optimizing the use of healthcare providers. The algorithm consisted of scheduling patients discharged home from the burn emergency department with a nurse visit (NV) within 3 days of discharge and a provider visit (PV) 1 week later. All NV could be converted to PV prn. The purpose of this study was to evaluate the effectiveness and safety of our nurse clinic visits.
Methods
This was a retrospective study of outpatients managed using the new care algorithm over a 1-year period. Patients whose NV was converted (CV) to a PV were compared to those who were not converted (NCV). Basic descriptive statistics were calculated.
Results
The charts of 259 patients scheduled for NVs were reviewed, mean age was 24.3 years and 51% were male. The population consisted primarily of Caucasians (47%) and Hispanics (35%). Most patients had a payor source with private insurance (40%) and Medicaid (31%) being the most common. Initial presentation to the burn ED was 1.56 days post injury, mean TBSA was 1.58% and most injuries involved the hands (36%) and arms (28%). The most common mechanism was scald (56%) followed by contact (28%). The most common dressing was petroleum gauze (41%) followed by silver impregnated foam (39%). NVs were converted to PV for 16% of the population. The most common reason for conversion was discharge from clinic (33%), followed by worsening (24%), therapy needs (24%) and change in dressing (19%). When CV patients were compared to NCV there were no significant difference in age, gender, past medical history, burn history (time to presentation, TBSA, mechanism, area of injury) or dressing type with the exception of enzymatic debriders (p=.0226). Native Americans (p=0.0257) and patients with Workman’s Compensation (p=0.026) were more likely to be converted to a PV. Hispanic patients were less likely to be converted to PV (p=.0357). The charges for NV ranged from $120-$185/visit with an average reimbursement of $60.88.
Conclusions
Overall compliance with the scheduling of nurse visits was poor. However, when scheduled per the algorithm, nurse visits were safe and effective, decreasing provider workload while still allowing for patients to be seen in a timely manner.
Applicability of Research to Practice
Ongoing education and monitoring of compliance is needed to further evaluate the safety and utility of nurse visits.