31 Implementation of Provincial Adult Burn Clinical Practice Guidelines and their Impact on Patient Outcomes

Abstract

In 2011, our institution implemented province clinical practice guidelines were implemented in 2011 to standardize acute burn management and resuscitation practices to optimize consistency in patient care prior to transport to a designated burn center. A retrospective review was performed to evaluate the impact of these guidelines on burn patient care since their implementation. A review of patients admitted at our burn center between 2011–2016 after the implementation of the 2011 provincial burn guidelines was performed evaluating TBSA estimation, resuscitation records and clinical outcomes. Study inclusion required patients greater than 18 years old with a TBSA burn injury larger than 15%. Patients were categorized into groups based on treatment adherence to the 2011 guidelines and if they were treated initially peripherally or directly at our quaternary burn center. Results were compared previous burn outcome data obtained prior to guideline implementation. A total of ninety-five patients met the study inclusion criteria. In the first 24 hours after acute burn injury, the patients that were initially managed peripherally and then transferred, received an average of 5.8cc/kg/%TBSA of fluids when there was no evidence of guideline adherence. If the guidelines were implemented only after transferred to our center, patients received an average of 5.0cc/kg/%TBSA. For burns patients where guidelines were utilized both peripherally and after transfer, an average 4.0cc/kg/%TBSA was used for resuscitation. Complications such as respiratory failure (17% vs. 11%), abdominal compartment syndrome (4% vs. 0%) and acute kidney injury (50% vs. 33%) more frequently developed when the guidelines were implemented only after transfer to our burn center. The implementation of new clinical practice guidelines to aid in fluid resuscitation following major burns has decreased IV fluid administration for patients initially assessed in peripheral low volume centers. Early guideline implementation may decrease burn associated systemic morbidities. This research reinforces the importance of standardizing treatment practices to improve burn patient care and discusses the obstacles associated with disseminating specialized clinical skills and knowledge.