Burn Therapists Research Articles

Quantitative Analysis of Compassion Fatigue & Compassion Satisfaction in Burn Therapists

Abstract Date Presented 03/23/24 OTs who work with burn survivors are present with day-to-day exposures to people who are often in severe pain or distress. This study is a quantitative analysis of the presentation of compassion fatigue in therapists who treat burn survivors. Primary Author and Speaker: Miranda Yelvington Additional Authors and Speakers: Stacey Reynolds Contributing Authors: Jiale Hu

A Quantitative Review of Certified Burn Therapist’s Involvement in the JBCR Publications and ABA Leadership

Abstract The Burn Therapist Certification (BT-C) was introduced in 2018 to acknowledge occupational therapists (OT) and physical therapists (PT) with specialized knowledge, skill, and experience in the promotion of quality burn rehabilitation. Currently, BT-Cs make up 11.7% of therapists working in burn rehabilitation (n = 39/333). The purpose of this review is to report on the contributions of BT-Cs to organizational leadership of the American Burn Association (ABA) and in the generation of new knowledge through peer-reviewed publications. Despite the small percentage of burn therapists who are certified, they have a disproportionately large involvement in leadership within the ABA and burn research in the Journal of Burn Care and Rehabilitation (JBCR). From 2018 to 2023, BT-Cs have contributed to nearly one-half (n = 26/56) of therapy authored publications in the JBCR and almost one-third (n = 65/202) of accepted abstracts at the ABA annual meeting. Certified burn therapists demonstrate substantial involvement throughout the ABA, including maintaining an 85% membership rate and, on average, serve in 53% (n = 31/59) of the therapy allotted committee positions. Therapist pursuit of certification can have a profound impact on the burn community through publication, leadership, and development of care standards. Although therapists have indicated a desire to pursue certification, barriers related to a lack of association and center support have been identified. The burn community has endorsed certification as a mark of excellence for nurses and physicians. Maximizing the value of a transdisciplinary approach to burn care is also dependent on the excellence of therapies. If the burn community desires improved engagement and contribution from therapies, it should support therapist certification.

Mobilization With Femoral Catheters in the Burn ICU: A Retrospective Review Following Change in Practice Guidelines.

Femoral catheters are commonly viewed as a barrier to Burn ICU mobility progression due to anatomical location and potential risk of complications. The purpose of this review was to examine outcomes and complication rates following implementation of femoral catheter mobilization guidelines, as well as determine safety and feasibility of mobilization with femoral catheters in place within the burn population. A retrospective review was completed on 17 patients prior to and following the implementation of new femoral catheter mobility guidelines, 34 patients total. Burn therapy notes were reviewed for burn admissions with at least 1 femoral catheter in place, including arterial, central, and dialysis catheters. Demographic data, admission statistics, line placement timelines, and active mobility achieved during therapy sessions were recorded for both the nonmobilization group (NMG) and mobilization group (MG). The 34 patients reviewed had 99 total lines placed (30 NMG, 69 MG). Change in mobility protocols for the MG resulted in more therapy sessions (n = 516 vs 281) and a significant increase in active mobility sessions (n = 83 vs 5, P < .001), including 146 total mobility activities such as transitions to chairs, tilt table, sitting edge of bed, standing, active chair transfers, ambulation, and cycle ergometry. No catheter-associated adverse events occurred during active mobility sessions and no complications were associated with participation in mobility. This review supports that the presence of femoral catheters alone should not limit the progression of mobility interventions with the use of clinical judgment in specialty-trained burn therapists.

A Qualitative Descriptive Exploration of the Experiences of Burn Therapists.

Exposure to patients who have experienced major traumatic events places burn therapists at risk of developing high levels of anxiety and stress, directly impacting their quality of life. Poor professional quality of life has been associated with negative physical and emotional characteristics in healthcare professionals and may subsequently influence patient safety and satisfaction, job retention, and productivity. The purpose of this study was to understand and describe the experiences of occupational and physical therapists who provide acute therapy to people who have sustained burn injuries. Semistructured interviews were completed with 10 participants (8 females and 7 physical therapists) for this qualitative descriptive study. Conventional content analysis was used to analyze the data collected from semistructured interviews. Six themes emerged after content analysis: (1) the importance of therapeutic relationships to patient successes and therapists' retention; (2) the autonomy and flexibility of burn therapists; (3) the impact of career longevity on compassion; (4) the uniqueness of burn team relationships and camaraderie; (5) the challenges of operating within the business of a healthcare system; and (6) the physical, mental, and emotional challenges to the burn therapists' resiliency. This research brings to light the physical, mental, and emotional challenges that impact burn therapists' resiliency, and which should be considered when creating programs to increase retention and professional quality of life in this professional population.

34 The Costs of Caring: Quantifying Compassion Fatigue and Compassion Satisfaction in Burn Therapists

34 The Costs of Caring: Quantifying Compassion Fatigue and Compassion Satisfaction in Burn Therapists

30 A Qualitative Descriptive Exploration of the Experiences of Burn Therapists

30 A Qualitative Descriptive Exploration of the Experiences of Burn Therapists

779 Burn Therapists’ Perspective of Rehabilitation and Recovery Post Primary Closure of a Burn Wound

779 Burn Therapists’ Perspective of Rehabilitation and Recovery Post Primary Closure of a Burn Wound

The Costs of Caring: Quantifying Compassion Fatigue and Compassion Satisfaction in Burn Therapists.

Recovery from a severe burn injury requires early and aggressive therapy, which is often painful and distressing to the patient. Burn therapists who guide these interventions may be prone to experiencing secondary trauma and compassion fatigue through repeated exposure to difficult situations. At the same time, therapists may gain a sense of purpose and altruism from their work, fostering compassion satisfaction. Despite being well documented in other health professions, compassion fatigue and compassion satisfaction have not been sufficiently explored among burn therapists. This study aimed to quantify and characterize burn therapists' compassion fatigue and satisfaction using the Professional Quality of Life scale and to answer the question of what job-related factors may impact these outcomes. A total of 143 burn therapists participated in this study. Results revealed compassion fatigue subsale scores of burnout and secondary traumatic stress in the low or moderate range and compassion satisfaction scores in the moderate or high ranges for all participants. This study presents new knowledge for the field of burn care in its quantification of professional quality of life in burn therapists. While burn therapists experienced moderate-to-high levels of compassion satisfaction in their work, burnout and stress also approached moderate levels. Years of practice was a significant predictor of compassion. Although the reasons for this are not clear, it may be related to increased competence or confidence in practice and may suggest a need for different support strategies for practitioners at each stage of their burn therapy career.

Retrospective Review of Outcomes Related to Early Therapy Intervention Following Application of Cultured Epidermal Autografts in Severely Burned Patients.

Cultured epidermal autografts (CEA) have since become more prevalent in the treatment of burn-injured patients with limited available donor sites for adequate wound closure, resulting in decreased mortality rates and an increased number of these patients requiring burn therapy services to achieve optimal functional outcomes at discharge. However, the use and postoperative management of CEA continue to be controversial due large to the physiological fragility and expense of CEA, leading to variable postoperative treatment practices across burn centers. As such, minimal research is available regarding patient outcomes following CEA application, specifically related to burn therapy intervention. Thus, a retrospective chart review was conducted on a series of 10 patients, 18 years of age or older, admitted to a single, American Burn Association verified burn center, between April 2015 and April 2023, who required CEA and received pre- and postoperative treatment by burn therapists in accordance with center-specific burn rehabilitation guidelines. The resulting patient outcomes, in response to early implementation of therapy interventions post-CEA surgery, demonstrated optimal functional status for patients upon discharge and positive long-term implications.

A Scoping Review of Compassion Fatigue and Compassion Satisfaction in Burn Therapists.

Occupational and physical therapists who routinely provide potentially painful and distressing rehabilitation to burn survivors are at risk for developing compassion fatigue. Burn therapists may also experience compassion satisfaction based on the successes their patients accomplish. The purpose of this review was to synthesize the literature related to compassion fatigue and satisfaction in therapists who work with burn survivors, explore previously reported predictors and mediators of (and responses to) these constructs, and identify gaps in the literature. Original, peer-reviewed papers published from journal inception to May 2023 were obtained from 5 electronic bibliographic databases: CINAHL, Embase, PsycINFO, PubMed, and Web of Science. Studies were eligible if they (1) reported compassion fatigue or its related concepts and (2) focused on occupational or physical therapists who work with burn survivors directly or as a member of a multidisciplinary burn treatment team. The initial search revealed 284 articles, 2 of which met inclusion criteria and are summarized in this scoping review. Neither article focused solely on burn therapists but examined the experiences of multidisciplinary burn team members working in single burn centers in North America. Both studies used a cross-sectional survey-based design to assess concepts related to compassion fatigue and compassion satisfaction. This scoping review uncovered important gaps in the literature related to compassion fatigue or satisfaction in burn therapists. More research is needed to better understand the interplay between concepts as well as their relationship to burn therapists' outcomes.

A need for a specialized burn therapist!

A need for a specialized burn therapist!

749 Does a Dedicated Burn Therapist Add Value in an Outpatient Setting?

Abstract Introduction Caring for burn patients requires specific knowledge, skill, and a collaborative team approach from multiple disciplines including occupational therapy. In the hospital system, therapists are often under direction of rehabilitative services, not nursing administration. There are specific productivity expectations within the rehabilitation department which rely heavily on time-based billed interventions. This hospital had an occupational therapist (OT) assigned to the burn clinic as well as acute care patients to help improve the therapist’s productivity. With a growing burn clinic, some patients were missed by the OT while they were providing services elsewhere in the hospital. With support and advocacy from the nursing Director of burn services, a full-time occupational therapist was hired solely for the outpatient burn clinic to improve the care of burn patients. Prior research has focused on the importance of OT in treatment of the burn patient, however no research was found in regard to the benefit of hiring a therapist specifically for an outpatient burn setting. This information is crucial for hospital administration to determine the need of having a burn-dedicated therapist. Specialized training in wound care, splinting, measuring and assessing for custom compression garments, and burn-specific evidence-based practice is required for a therapist to be competent in a burn center. Having a specialized burn therapist available is vital for the optimal care of the burn outpatient. This study analyzes the benefits of having an OT dedicated to the burn clinic compared to an OT being staffed for both the inpatient and outpatient needs. Methods A retrospective chart review was performed for 6 months prior to hiring a full time OT in the clinic to 6 months after. Results Preliminary data taken from October 2021 to present indicate a growth in OT services provided in the burn clinic from an average of 0.64 patients and 2.44 billed productive units per day to 3.9 patients and 12.4 units per day. At over 500% increase in just 3 months of hiring a full time OT, the data indicates that adding a burn therapist in the clinic increases number of patients seen. Productive units billed by the therapist also increased over 400%. Data regarding the amount of revenue are pending. Conclusions Having a dedicated burn therapist in an outpatient clinic increases the number of patients receiving necessary OT services and subsequently improves financial reimbursement. Applicability of Research to Practice Consistent availability of the OT, increased understanding of the role, purpose, and value of OT for the burn patient, increased communication with providers, and higher efficiency due to proximity to patients and providers result in increased use of OT services. Hiring a dedicated burn therapist in an outpatient setting should be considered by burn centers to increase number of patients seen and increase productive billable units by OT within the burn clinic.

567 Outcomes of an Education Program on the Rehabilitation of Face and Neck Burns

Abstract Introduction Face and neck burns bring unique complications and often require specific training and experience for the burn physical rehabilitation professional. The COVID-19 Pandemic created a need for virtual learning during a time when in-person learning was not possible. While this format can meet some needs, it does not allow for practice and interaction with instructors. There are limited education and training opportunities for burn therapists which include such extensive practical opportunities. This unique didactic training program provided mentorship and tangible skills of a complex and specialized area of burn rehabilitation. Methods • Learning Objectives were determined using the Burn Therapist Competency Tool-Version 2 • Developed curriculum for each facial/neck regions as well as various scar management techniques throughout the continuum of care • Individual modules were developed by Occupational Therapists, Physical Therapist and Speech and Language Pathologist with experience in the field • The in-person course consisted of 4 hours of lecture and 8 hours of hands-on splinting and scar management training • Instructors provided interactive and collaborative feedback for every participant Pre &amp; Post testing completed to assess learning • Feedback from participants was assessed for quality improvement • Follow up questionnaire was provided to assess implementation into clinical practice and self-perceived level of experience related to rehabilitation of face/neck burns Results 24 Occupational, Physical and Speech Therapists participated in the 2-day course. Results of the post-test indicate increased knowledge pertaining to the learning objectives. 21 participants remained for the second day of the hands-on splinting and scar management portions and demonstrated learned knowledge of these intervention techniques. Post-course assessments attest to increased comfort with new skills. Participant follow up gaged overall effectiveness of clinical practice improvements. Conclusions Participant feedback provided valuable insight into the ongoing need for training and mentoring of burn therapists. This is vital in developing additional training resources, including step-by-step explanation and video content for repetition and learning. Ultimately, implementation of these new skills into each participant’s clinical practice was the desired outcome of this course. Applicability of Research to Practice This project highlighted the gap in knowledge for burn therapists when it came to face and neck burns.

120 A Review of Certified Burn Therapist’s Involvement in JBCR

Abstract Introduction Burn therapist certification (BT-C) was introduced in 2018 to recognize therapists with specialized skill in burn rehabilitation and promote quality burn therapy. There are currently 32 BT-Cs, representing a small fraction of therapists who rehabilitate burn patients. Barriers to certification described in a Letter to the Editor by O’Neil in 2022 included an indifference to therapy research and program development. Despite efforts to call for additional support of therapy advancement and research, therapist publications continue to be sparse. This review analyzed BT-C therapists involved in publications as one indicator of a positive impact on the field. Methods A review of therapist-authored manuscripts and abstracts published in the Journal of Burn Care and Research from 2018-2022 was performed. Therapy authored publications included any manuscript or abstract with a therapist listed as a lead or contributing author. Publications with only SLP, PTA, or OTA credentials were excluded. Therapists were only considered to be certified if they had achieved BT-C at the time of publication. Results BT-C make up not more than 15% of therapists practicing in burns, yet the percentage of therapy-authored manuscripts published from 2018-2022 with a BT-C credited author is 50%. When examining supplemental editions, 31% of accepted therapy-authored submissions from 2018-2022 included a BT-C therapist. The table compares the percentage of therapy-authored manuscripts and therapy-authored submissions from BT-C versus the percentage of BT-C using the 215 identified PT and OT members from 2008 as a conservative estimate of the floor of the number of PT and OT providing routine burn care, with the current count of BT-C at 32. Conclusions Estimations of the number of PT and OT working in burn rehabilitation are difficult to determine. It is assured that therapists providing care to burn patients routinely are larger in number than those who are active members in the American Burn Association in any given year. One publication revealed 215 active PT and OT members in 2008. Despite BT-C therapists making up a small percentage of the therapy community working in burn rehabilitation, BT-C therapists contributed to half of therapy publications and almost a third of abstract submissions in each area respectively, indicating that certified burn therapists have a profound, and disproportionately large, impact on formal investigation and research. Applicability of Research to Practice Currently there is a lack of objective information that can be presented to administrators to validate support of the burn therapist certification. Supporting certification may promote quality care through involvement in research furthering best practice.

45 A Three Year Analysis of a Multi-tiered Orthotic Protocol

Abstract Introduction A variety of factors affect the fit of custom orthoses in those with burn injuries. A resting hand orthosis (RHO) is a common device within burn care, yet fabrication and fitting of this custom orthosis requires precision and expert assessment. However, burn therapists have varying degrees of education and credentials and previously we had noted preventable complications. Our center implemented a multi-tiered protocol focused on custom RHOs and found a marked decrease in complications immediately following implementation. The purpose of this QI project was to evaluate whether these improvements had been sustained over the following three-year period. Methods This was a retrospective chart review. Per protocol an RHO could be fabricated by a single certified hand therapist (CHT) or co-fabricated by two (non-CHT) therapists. Incidence of orthosis complications, defined as erythema and/or an orthotic induced partial-thickness injury to the volar second metacarpal head (index finger) was the primary outcome measure. Other data collected were average time to fabricate &amp; modify devices and average refabrication(s) required between CHT vs non-CHT devices. Patients with missing data points was excluded. Results Eighty-five patient hands were examined from 2019-2022. Prior to implementation, total erythema occurrences were reported in 23.4% of orthoses (n=18) and total orthotic induced partial thickness injury occurred in 11.7% (n=9) of cases. Post protocol implementation erythema occurred in 5% of cases (n=5), and partial thickness injury in 0% of cases (n=0). This represents a decrease of 95% and 100%, respectively. On average CHTs fabricated RHOs in 59 minutes vs 48 minutes for non CHTs. CHTs had a complication rate of 0.0% vs 10.98% for non-CHTs. Potential complication was also limited to 0.0% for CHTS and 27% of non-CHTs. Modification rates were limited to 18.75% for CHTS vs 47.56% of non-CHTs. Conclusions Data from this QI project showed a clinically significant decrease in erythema and decrease in breakdown and number of modifications needed from utilization of either a CHT or two therapists when managing hand orthoses. Since instituting our protocol focusing on RHOs, our center has decreased complications and potential complications to improve patient outcomes. Although, most therapists receive standard education, it can be inferred that CHTs may approach orthotic fabrication through a different lens. The required studying and education required to maintain an advanced practice certification may benefit burn therapy departments. Therapists without this specialty certification can enhance skill and outcomes via co-fabrication and assessment. Applicability of Research to Practice Orthotic induced erythema may be decreased by utilizing CHTs or two non-CHTs to manage RHOs. This protocol can be expanded to include other orthoses or with other advanced certifications.

T4 Integration of PT/OT in Burn Wound Care Increases Therapist Productivity

Abstract Introduction Inpatient physical (PT) and occupational (OT) burn therapists must balance complex patient factors such as daily wound care when attempting skilled therapy sessions, while also attaining specific productivity standards. These factors often lead to inefficient work flow and loss of productivity. The purpose of this study was to assess the productivity and feasibility of therapist integration into daily burn wound care. Methods A quality improvement project was initiated by the burn therapy team at our ABA verified burn center. One full time equivalent (FTE) PT or OT was assigned to the burn wound care team five days a week, involving 6 therapists (3 PTs and 3 OTs). General duties included wound assessment, functional wound dressings, and skilled therapeutic interventions. The primary outcome measure was individual therapist productivity tracked 3 months pre and 3 months post project implementation. Productivity was calculated by taking total billable patient time divided by total workday time, with a goal of 50% productivity. Billed time units were also compared to goal units. The results were analyzed using a paired t-test to measure significance and averaged. The secondary outcome measure was program feasibility, assessed by a qualitative questionnaire taken by burn staff pre and post. Results Overall therapist productivity increased, 49% pre implementation vs 54% post (p=0.0041). The difference of billed vs goal units increased, 5 pre vs 15.9 post (p= 0.00142). Proportion of therapists meeting target productivity increased, 57.1% pre vs 90.5% post (p=0.0052). Prior to program implementation, survey results found that 77% of burn staff (n=23 respondents) were favorable of project implementation, whereas 23% were either hesitant or indifferent. After 3 months post implementation, 95% of burn staff were favorable of therapist participation, 95% indicated ease of staffing burden, and 100% reported improved multidisciplinary communication. Furthermore, 100% of burn staff felt that the unit’s workflow had improved. Conclusions Full time therapy participation in wound care increases therapist productivity and increases the likelihood of meeting target productivity in the future. The majority of burn staff actively supported this pilot program and felt that it eased staffing demands, improved unit workflow, and improved multidisciplinary communication. Future efforts should focus on measuring specific patient outcomes and cost as a result of therapist participation in daily wound care practice. Applicability of Research to Practice All burn units should consider implementing a skilled burn therapist in wound care practice.

511 Mobilization with Femoral Catheters in the Burn Intensive Care Unit: A Case Series

Abstract Introduction Femoral catheters are a known barrier for ICU therapy sessions and mobility progression due to the anatomical location and potential risk of complications. Safety and feasibility of mobilization has been studied in ICU populations but has not been explored specifically within the burn population. Burn survivors in the ICU have challenges in terms of line access and are at high risk of complications concerning thrombosis A previous retrospective study found that 21% of mobility sessions within the burn ICU on vented patients were limited due to line limitations. This case review was completed following implementation of new mobility guidelines allowing the mobilization of patients with femoral catheters within the burn ICU. Methods This retrospective case series was completed in the first year following implementation of new femoral catheter mobility guidelines within a 15-bed adult burn unit. Burn therapy notes were reviewed for burn admissions with at least one femoral catheter in place, including arterial and central lines. Mobility was recorded based on achieved activity levels achieved during each session. Passive interventions (stretching, ROM, and positioning) were excluded. Results 13 patients were admitted with a total of 55 femoral catheters (8 arterial, 46 central venous) treated. Patients were seen by PT and OT for a combined 417 sessions with lines in place. A total of 65 active therapy sessions occurred with 112 mobility activities including bed exercises/cycle ergometry (11), chair mode (13), cardiac chair transfer (28), tilt table (1), sitting on the side of the bed (32), standing (15), active chair transfers (8), and ambulation (4). No catheter related complications including catheter malfunctions, removal, bleeding, or thrombosis occurred during any therapy sessions. Conclusions Active therapy sessions including out of bed activities are safe and feasible in burn ICU patients with femoral catheters. Early mobilization within ICU settings is necessary in preventing complications, combating muscle wasting, and improving long term outcomes for survivors. This study supports that the presence of femoral catheters alone should not limit the progression of mobility interventions. Applicability of Research to Practice Using clinical judgement and specialty training, burn therapists can safely mobilize burn ICU patients with femoral catheters in place.

566 Posterior Spinal Cord Syndrome after High Voltage Electrical Injury

Abstract Introduction High voltage electrical injuries have been called “the grand masquerader”, and significant neurological sequalae have been described. Here, we report the case of a 73-year-old man who sustained a 14.5% total body surface area (TBSA) full thickness electrical burns, most significantly to his scalp (Figure 1). On initial evaluation, there was concern for loss of proprioception resulting in gait instability. A magnetic resonance image (MRI) of the cervical spine performed on post injury day 9 showed no evidence of cervical spinal cord injury. Methods A novel descriptive case report of a high-voltage electrical injury with incomplete spinal cord injury Results The patient underwent several operative interventions for wound coverage and preservation of function with the known challenges experienced with high voltage burn wounds. Despite lack of imaging confirmation, suspicion for an occult neurological injury remained high. Neurological consultation confirmed limited proprioception and loss of 2-point discrimination. Due to these specific findings that resulted in an inability to make significant rehabilitation gains, a subsequent MRI of his cervical spine performed on post-injury day 30 demonstrated T2 hyperintensity in the dorsal column in the cervical spine at the C2-3 and C5-6 levels, suggestive of myelopathy (Figure 2). Conclusions To our knowledge, this is the first reported case of an incomplete spinal cord injury (posterior spinal cord syndrome in this case) due to an electrical injury without bony abnormality the association of paralysis. With the knowledge of this injury, our burn therapists have been able to develop a rehabilitation plan with reasonable expectation and goals. While discussing prognosis with the patient and his family, we noted the absence of data regarding outcomes after injuries of this nature and sought to contribute to the literature with this case. Applicability of Research to Practice A novel case of delayed imaging confirmation of posterior cord syndrome contributes to the body of evidence for neurological sequelae due to electrical injuries.

117 Allocation of Therapist Time: Mobilization of CFU’s in Hand w/Burn Injury

Abstract Introduction Movement of the hands and digits are used to perform communication and activities for IADL’s and competitive employment. Following a second or third degree to the hand(s), there is a potential for the development of burn scar contracture(s) (BSC), which decreases hand skills creating the potential for decreased quality of life. The ABA data base identifies that 70% of burns are sustained to the upper torso, UE, hands. One ABA verified burn center created a study to identify the time required for the burn therapist to elongate hand CFU’s to pre-burn movement. Methods The one-year retrospective study included unilateral and bilateral hand burns with LOS of 2 days or greater or had an outpatient OT session within one week of the burn. Co-author created the Passive Motion Scoring Grid (PMSG), using a number score with higher number indicating greater passive movement. Education was provided to the OT’s to complete the PMSG at the beginning and end of each hand CFU elongation session. Otherwise, there was no change in the OT burn hand therapy treatment. The study included (5) OT’s with mean of 6 years of experience (3-46). Results There were 50 patients, average age was 48.91 years with majority male and African American. All burns were secondary to thermal with burns of 2nd and 3rd degree. There were 33 unilateral hand burns with an average TBSA of 7.02% and 17 patients sustained bilateral hand burns with an average TBSA of 21.3%. Unilateral hand burns had an average number of CFU’s of 39.4 (11-68) and hand CFU’s accounted for 87.1% of the CFU’s. Average number of CFU’s in bilateral hand burns was 90.3 (8-196) with hand CFU’s accounting of 83.4% of the CFU’s. A total of 539 OT sessions were provided to those with unilateral hand burns with an average of 18 OT sessions (3-36). Bilateral hand burns received a total of 487 OT sessions with average of 24.4 OT sessions (4-67) Therapist time for hand CFU elongation to pre-burn status: unilateral hand burns, 43.5 minutes (SD=24.7) and bilateral hand burns was 53.5 minutes (SD=32.2). The minutes only reflect CFU elongation not the entire therapy time. Conclusions Hand burns result in a small number for TBSA, however it results in a greater number of CFU’s than other body locati8ons. The greater number of CFU’s involved, indicates greater potential for development of BSC. At the completion of the burn OT therapy, no patient exhibited BSC. Providing education and information to funding sources regarding CFU’s in hand burns, equating that to potential BSC development and time required for therapist direct hands-on techniques to obtain pre-burn movement can positively influence authorization for therapy. Applicability of Research to Practice Can assist with allocating therapist time with hand burns. Can positively influence funding authorization for therapy.

565 Rehabilitation Time to Evaluation Report: A Quality Improvement Study

Abstract Introduction Successful rehabilitation of patients with burn injuries requires an in-depth occupational therapy (OT) and physical therapy (PT) evaluation early in the acute phase of a patient’s injury to develop a detailed therapy plan of care. In addition, it is a standard of the American Burn Association for verified burn centers to have a comprehensive rehabilitation program designed for burn patients within 24 hours of admission. However, there is no standardized report for tracking timeliness of issuing PT/OT orders or completion of therapy evaluations by PT/OT after a patient is admitted to a burn unit. This quality improvement study details the creation of a “Time to PT/OT Order Placement and Evaluation Completion Report” and results of a quality improvement process used to improve these metrics. Methods A multi-disciplinary workgroup was created and included a burn surgeon, PT and program nurse coordinator and an electronic report was created in collaboration with the hospital’s business intelligence team. The report included the following metrics: average time from admission to PT/OT order placement, average time from PT/OT order placement to therapist acknowledgement, and average time from PT/OT order placement to therapist completion of initial evaluation. A baseline report was run (3-months) and results were analyzed. A quality improvement process was then put into place including education of burn attending physicians, fellows, and rotating residents on timeliness of therapy order placement, therapy staff education on findings and a new process for morning coordination of burn therapist caseloads to prioritize new evaluations, and initiation of monthly reporting at the burn joint practice committee meetings. The report was then run for an additional 3-months and results were analyzed. Results Baseline and post-quality improvement process results (3-month averages) were as follows: Average time from admission to PT/OT order placement increased from 3.4 to 8.3 hrs, average time from PT/OT order placement to therapist acknowledgement decreased from 43.2 to 31.5 hrs, and average time from PT/OT order placement to therapist completion of evaluation decreased from 43.6 to 35.1 hrs. Conclusions After development of this report findings showed that the quality improvement process used to improve timeliness of inpatient PT/OT initial evaluation completion was effective. In addition, this report has been useful for metric reporting during burn joint practice committee meetings, the ABA verification process and burn therapy staffing/daily caseload management. Applicability of Research to Practice This report could be used by other burn centers to help track and improve timeliness of initial PT/OT evaluations for acute burns. In addition, metrics created from this report could be used for the ABA verification process and help justify burn unit therapy staffing needs.