805 A Retrospective Review of Factors Influencing Post-hospital Discharge Follow-up in Patients with Burn Injuries and Necrotizing Soft Tissue Infections

Abstract

Abstract Introduction Approximately 486,000 burn injuries requiring medical treatment occur each year. Medical treatments for burns vary and are dependent on the extent of the injury. Several physical and psychosocial problems may develop after discharge, including pain, itching, scarring, anxiety and depression, making it important and necessary for burn care treatment to continue even after discharge. Often, patients do not continue outpatient care due to unknown circumstances. The purpose of this study is to help identify factors that affect outpatient burn clinic visits after hospital discharge. Methods A retrospective chart review of patients admitted to the burn center who had an outpatient follow up visit in 2018 was performed. Patients were grouped by lost to follow up versus completed patients. Completed patients were categorized as those who were discharged from clinic as PRN follow up visits. Results A total of 211 patients were scheduled for outpatient visits in 2018, mean age was 36.4 years and 74% were male. Population consisted mainly of Caucasian (41%) and Hispanic (31%). The most common payor source was Medicaid (58%) and Medicare (17%). The mean TBSA was 5.8 % with the most common mechanisms were Flame/Flash and Scald (30% each). The mean length of stay was 10.3 days, mean number of surgeries was 1.5. Majority of patients were discharged Home (71%) and SNF (20%). The mean number of outpatient visits was 3.57. A total of 165 (78%) were lost to follow-up. Lost to follow up (LTF) patients had a smaller TBSA (4.69%) compared to those who completed follow-up (9.62%). Comparison between LTF and completed patients, showed no significant difference in age, race, distance from clinic, or disposition. However, larger TBSA (p=0.0009), longer length of stay (p=0.01), more surgeries (p=0.0105), patients with ongoing scar management (p=< 0.00001), and patients with Workman’s Comp (p=0.048) were more likely to complete outpatient follow up. Patients with closed wounds (p< 0.0001), substance abuse (p=0.0168), mental illness (p=0.0403), smokers (p=0.0192) were less likely to complete outpatient follow up as directed. The number of complications was also higher (p=0.0433) in the LTF group. Conclusions There were a large percentage of patients who discharged themselves from clinic care. Factors that were associated with self-discharge include healed wounds, no scarring issues noted, and patients with complications, smokers, substance abuse and mental illness. Self-discharge / LTF may be related to resolution of ongoing issues prior to last scheduled appointment. Applicability of Research to Practice Additional research is needed to determine additional factors affecting lost to follow up in our outpatient burn clinic.