63 Risk Factors Associated with Lack of Patient Outpatient Follow Up at a Regional Burn Center

Abstract

Abstract Introduction Burn patients are a vulnerable population at risk for poor follow up after injury. With few burn centers throughout the country, there is often limited access to specialized care. We investigated barriers to patient compliance with recommended outpatient burn care at a single ABA-verified burn center after presentation at referring Emergency Departments (ED). Methods A retrospective review was performed on patients who presented at two EDs located 60–75 miles from our burn center over a two-year period. Recommendation for follow up was made by a burn surgeon at our regional burn center after telephone consultation. Medical record review was performed to determine what specific follow up occurred. Data on patient demographics, burn size/location/etiology were also recorded. Results Out of 135 consults from the two EDs, a total of 60 patients were recommended for outpatient follow up (vs. transfer, local management, or no follow up). Median age was 35 years [IQR 27–38] and most patients were male (n=40, 66%). Most patients had burns measuring < 1% total body surface area (TBSA) (n=43, 72%). Half scheduled a follow up appointment (n=31, 52%) and fewer came to that appointment (n=26, 43%). Median time from initial presentation to burn clinic follow up was 2 days (range 1–8 days). Of patients who did not attend recommended follow up, 24% (n=8/34) presented for additional visits to the ED or another local provider. Patients who did not follow up were more likely to be male (79% vs. 50%, p=0.03), lack insurance (27% vs. 4%, p=0.05), be homeless/institutionalized (18% vs. 0%, p=0.03) and have facial burns as compared to other body regions (32% vs. 8%, p=0.05). Patients who followed up were more likely to have scald burns versus flash/flame/contact burns (69% vs. 18%, p< 0.001) and were more likely to have been injured at home/work as opposed to outdoors/other location (100% vs. 38% p< 0.001). Age, marital status, race/ethnicity, having a primary care physician, %TBSA, and other comorbidities were not associated with follow up. Although reasons for not following up were rarely noted in the medical record, anecdotal reasons included lack of transportation (n=4), incarceration (n=3), and feeling that burns were healing (n=1). Conclusions Less than half of patients followed up at the regional burn center as recommended, while nearly a quarter followed up at local EDs/clinics. Barriers to follow up include patient gender, insurance, and resources (transportation).