Embers of Hope: A Palliative Care/Burn Unit Collaboration Story (FR400)

Abstract

•Describe Unique Clinical Features of Burn Care which impact a Palliative Care approach.•Describe key mental health aspects involved in the care of patients with burn injury.•Identify challenges and successful elements in the development of Burn/Palliative Collaboration at a Regional Burn Center. According to current statistics, approximately 30,000 people will be hospitalized at one of the 128 U.S. Burn Centers this year, with over 3000 patients succumbing to death from fire or inhalation injury. Yet there is little description in the literature of successful Palliative Care/Burn Unit integrated collaborations. Burn patients are unique, representing the most severe model of trauma for many of the disciplines involved. For example, patients with severe burn injury have 40-45% pre-burn psychiatric morbidity, including substance abuse, depression, anxiety, PTSD, and psychosis, and many develop post-burn PTSD and depression. Primary and specialty level palliative care integration in burn units can lead to improved pain and symptom management, clearer prognostic discussions, earlier establishment of goals of care, and assessment and treatment of mental health comorbidities. Since 2011, the Palliative Care Team at Bridgeport has been providing consultative services, but initial Burn Service integration was sporadic and minimal. In 2016, following a successful index case, BH developed a strong PC/Burn collaboration, resulting in an average of over 20 consults per year. Average time to consult also shows earlier consultation and consultation for those with a greater chance of survival. The Bridgeport Hospital Palliative Care/Burn Service Collaboration was recognized by ACS Surveyors as an exemplary integration of the two programs to relieve distress in patients with burn injury and their families. Through case discussions, brief didactic sections, and subsequent discussion, presenters will share the core aspects of Palliative/Burn care, including challenges, successes, and lessons learned in developing a Burn/Palliative Care Partnership. Burn Unit specific issues that will be discussed are prognostication, assessment and treatment of mental health issues, pain management, and collaborative/coaching relationships with referring clinicians. These lessons, while specific to the Burn Unit, are applicable to additional settings in the development of collaborative partnerships.