Burn Rehabilitation Research Articles

Programmable Artificial Skins Accomplish Antiscar Healing with Multiple Appendage Regeneration.

Functional appendage regeneration is essential for skin rehabilitation, but it has always failed by current existing healing approaches, owing to their inefficacy in preventing disfiguring scars. In this study, a novel regeneration-directing artificial skin (RDAS) system is presented, which is based on the rational design of multi-layered hydrogels that closely mimic natural skin matrices. By leveraging the programmability and architectural rigidity of DNA components, without the need for exogenous cell transplantation, such RDAS effectively minimizes tissue fibrosis by accurately guiding the regenerative process in wound fibroblasts, enabling rapid scarless wound repair, restoration of dermal function, and successful in situ regeneration of multiple appendages, such as hair follicles (HFs), sebaceous glands (SGs), and sweat glands (SwGs). Therefore, the RDAS offers a cell-free antiscarring therapeutic strategy for regenerative wound healing, resulting in improved outcomes. This innovative approach holds great potential for future clinical applications and burn rehabilitation.

Efficacy of Hydrogen Sulfide Baths in Complex Burn Rehabilitation: a Single-Center Observational Study

INTRODUCTION. The healing of burn wounds often leads to pathological scars and scar contractures, significantly deteriorating the quality of life for patients who have experienced burn trauma. In comprehensive anti-scar therapy, balneotherapy with sulfide (hydrogen sulfide) waters can be applied alongside primary methods. However, due to a lack of modern information on its effectiveness, this method is not frequently included in rehabilitation programs. AIM. To determine the significance of hydrogen sulfide baths in comprehensive rehabilitation and improve treatment outcomes for patients with hypertrophic post-burn scars. MATERIALS AND METHODS. In the years 2021–2022, 110 patients, including adults and children, participated in an observational study at the Matsesta Balneological Resort (Sochi, Russia) titled “Evaluation of the Effectiveness of Balneotherapy for Post-Burn Scars in Adults and Children”. All patients received a course of 10 hydrogen sulfide irrigations or baths at the Matsesta Balneological Resort. Before the start of the procedure and after completion, scar tissue assessment using the Vancouver Scar Scale and patient surveys were conducted by a physiotherapist. RESULTS AND DISCUSSION. Among the patients, there were 40 adults and 60 children. The age of patients ranged from 2 to 61 years, with an average of 19.8 years; 49 were male, and 51 were female. The burn area in patients ranged from 5 to 90 % (average 33.1 %) of the body surface. After the first course of sulfide irrigations, the scar tissue assessment on the Vancouver Scar Scale decreased by 2.1 points in children and 2.2 points in adults. After a repeat course of sulfide irrigations, scar tissue assessment decreased by 1.3 points in children and 1.8 points in adults. According to surveys based on the Dermatology Life Quality Index, before treatment, patients subjectively rated their condition on average at 3.45 points, and after treatment, at an average of 2.76 points. The decrease in scores was mainly due to the reduction or disappearance of symptoms such as dryness, burning, pain, and paresthesia in the scar. CONCLUSION. Balneotherapy with sulfide waters for patients with hypertrophic post-burn scars within the first 24 months after burn trauma is effective for both children and adults.

An Occupation-Based Review of Outcome Measures used to Assess Hand Function after Burn Injury.

While occupation began as the central concept of occupational therapy at the dawn of the profession, the use of occupation throughout the therapy process, including assessment, has wavered in recent decades. Occupation is defined as meaningful and purposeful activities that individuals do to occupy their time and attention. The use of occupation-based assessments is vital to establishing care with an occupational focus. The purpose of this paper is to review the outcome assessment tools commonly used in the burn literature to evaluate hand function and critique the presence of occupation in each assessment using the Occupation-Based Practice Assessment (OBPA). Knowledge of the occupational nature of assessments is important to the delivery of an occupational therapy evaluation comprised of a battery of assessments inclusive of discrete measures of movement as well as performance-based tools to represent the person from an occupational perspective. Many outcome measures used in upper extremity burn rehabilitation are discrete in nature and do not measure occupations of clients. The Suitcase Packing Activity (SPA) may be a viable addition to an assessment battery to address this essential need.

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.

Inspiratory muscle training impact on respiratory muscle strength, pulmonary function, and quality of life in children with chest burn: A randomized controlled trial

PurposeRespiratory muscle function is compromised in children recovering from chest wall burns, which potentially leads to more impact on exercise capacity and quality of life. This study investigates the effects of an inspiratory muscle training intervention accompanied with a pulmonary rehabilitation program on respiratory muscle strength, lung function, functional capacity, and quality of life in chest burned children. MethodsForty children with burns, aged from 10 to 18 years old and total body surface area of 30% to 50%, were randomly allocated to the inspiratory muscle training group (IMT- G: n = 20) or control group (CG: n = 20). They received IMT plus pulmonary rehabilitation or pulmonary rehabilitation with sham IMT, respectively for eight weeks. The outcomes were the respiratory muscle strength measured by maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP); lung functions (FEV1, FVC and FEV1/FVC ratio); functional capacity as well as Pediatric Quality of Life to measure physical and psychosocial functioning. outcome measures were assessed at before and after intervention (after eight weeks). ResultsBased on the pre-intervention assessments, we found no significant difference between both groups (p > 0.05). Significant post-intervention differences were reported between both groups in MIP (P = .003), MEP (P = .017), FVC (P = .001), FEV1 (P = .007), FEV1/FVC ratio (P = .028), functional capacity (P = .003), physical domain of QoL (P = .006) and psychological domain of QoL (P = .002) in favor of the IMT group. ConclusionsEight weeks of inspiratory muscle training combined with pulmonary rehabilitation program improved children with chest burns' respiratory muscles strength, lung functions, functional capacity, and quality of life. Inspiratory muscle training may be employed in burn rehabilitation programs. It is a safe and effective therapy in chest burned children.

117 QuickDASH Quantifies Perceived Upper Extremity Function in Acute Burn Rehabilitation: A Quality Improvement Project

117 QuickDASH Quantifies Perceived Upper Extremity Function in Acute Burn Rehabilitation: A Quality Improvement Project

588 Early Physical Therapy Improves Burn Rehabilitation: Nationwide Study of Patients ≤30% Total Burn Surface Area

588 Early Physical Therapy Improves Burn Rehabilitation: Nationwide Study of Patients ≤30% Total Burn Surface Area

522 Testosterone Supplementation in Patients with Burn Hypermetabolism

Abstract Introduction After major burn injuries, patients experience a hypermetabolic response that leads to hyperdynamic circulatory, physiologic, catabolic, and immune system responses. Many transdisciplinary approaches have been tested to mitigate this postburn hypermetabolic syndrome such as comprehensive burn rehabilitation, nutritional support, monitoring, and pharmacological interventions. Oxandrolone, a synthetic analog of testosterone, has been shown to have higher anabolic properties and minimal androgenic effects and studied intensely in burn care. In 2023, the FDA asked all manufacturers of oxandrolone to cease production and subsequently removed the drug from market on June 28, 2023. Our study examines the cost and operationalization of an intramuscular (IM) testosterone protocol as an alternative in male burn patients with ≥20% total body surface area (TBSA). Methods A cost analysis was conducted using the National Drug Codes (NDC) and commercially available benchmarking data. The cost of oxandrolone and testosterone were included in our analysis. Following a thorough literature review, a protocol was developed for adult male patients with >20% TBSA burn injuries. Patients undergoing gender affirming hormone therapy, untreated obstructive sleep apnea, or hormonal blockers for cancer were excluded from the protocol. Results The protocol begins with total serum testosterone levels at the time of admission and weekly thereafter for male patients with ≥20% TBSA injury. Once a testosterone level < 150 ng/dL is detected, supplementation of testosterone with 200 mg IM once weekly for two weeks is started. Weekly evaluations include total body weight, metabolic panels, and nutritional panels. Cost comparison between oxandrolone and testosterone show an equivalent unit cost of $8.62 versus $8.38, respectively. Conclusions Drug shortages and supply chain challenges are becoming more common in burn care. We hypothesize testosterone to be both a clinically effective and cost-effective alternative to oxandrolone in the setting of burn hypermetabolism in male patients with major burns. Currently, burn experts are working with endocrinologists to assess pharmacologic alternatives for female patients and have obtained IRB-approval to evaluate both safety and efficacy of testosterone supplementation in the setting of burn hypermetabolism. Applicability of Research to Practice This study evaluates the safety and efficacy of testosterone supplementation as an alternative to oxandrolone in the setting of burn hypermetabolism. This study helps provide guidance to other burn centers in filling the gap in therapy that now exists in the pharmacologic management of hypermetabolic syndrome in patients with severe burns.

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.

Effect of a Nurse-Led Rehabilitation Program: A Quasi-Experimental Study Examining Functional Outcomes in Patients With Hand Burns.

The model of early rehabilitation for people with burns is still relatively novel in developing countries such as Egypt. The study examined the effect of a nurse-led rehabilitation program on functional outcomes in patients with severe hand burns. A quasi-experimental design was used in this study. The study was completed in the burn unit of a teaching university hospital in Alexandria, Egypt, with a convenience sample of 80 patients with severe hand burns. Participants were consecutively assigned to one of two groups: control ( n = 40), which received only routine hospital care and clinical interventions, or intervention ( n = 40), which received routine hospital care and clinical interventions and a 4-week nurse-led rehabilitation program (health education including audiovisual aids and burn rehabilitation education booklet, social support, and hand rehabilitation exercises). To assess functional outcomes, both groups were given pre- and posttests of the Disabilities of the Arm, Shoulder and Hand outcome and the Hand Motor Function Observational Checklist questionnaires. Descriptive and inferential statistics were conducted. Functional outcomes were significantly improved in the intervention participants compared to the control participants ( t = 5.710, p < .001). The differences in index scores between the two groups were statistically significant ( p < .001). The study provides information for burn rehabilitation nurses in developing countries to develop and test early interventions that improve functional outcomes in this population. A 4-week nurse-led program may be a beneficial intervention for improving functional outcomes in adult patients with severe hand burns who are undergoing rehabilitation.

Effects of early exercise training following severe burn injury: a randomized controlled trial.

Despite being a stable component of burn rehabilitation at later stages of recovery, exercise training is not commonly provided during the acute phase of burns. A lack of evidence surrounding its efficacy and safety in severely burned adults has hampered its implementation in acute burn care. The aim of this study was to investigate the capacity of early exercise training to modulate parameters of postburn muscle wasting and quality of life. Adults <65years of age with burns ≥40% total burn surface area (TBSA) were randomly allocated to either receive early exercise (n = 29) in addition to standard care or standard care alone (n = 29). Early exercise involved resistance and aerobic training, which commenced as early as possible and lasted for a duration of 6 to 12 weeks, in line with burn center length of stay. Ultrasound-derived quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA), lower limb muscle force, Eurocol Quality of Life-5 Dimensions and Burn Specific Health Scale Brief (BSHS-B) were assessed 6 and 12 weeks after baseline. Mixed models were fitted to compare between-group changes over time. A total of 58 adults [42 (95% confidence interval 40-45) years old; 40-94% TBSA range, 86% previously mechanically ventilated] participated in this study. Exercise commenced 7 days [IQR (interquartile range) 5-9] after burn center admission with an attendance rate of 93%. Allocation to the exercise group had a protective effect on the loss of muscle size from baseline to 6 weeks of follow-up (QMLT: β-coefficient: 0.05cm, p = 0.010; RF-CSA: β-coefficient: 0.05 cm2, p = 0.045), and resulted in an improved recovery from 6 to 12 weeks (QMLT: β-coefficient: 0.04cm, p = 0.01; RF-CSA: β-coefficient: 0.06 cm2, p < 0.001). Muscle force increased significantly more in the exercise group than in the control group (β-coefficient: 3.102N, p < 0.001) between 6 and 12 weeks. Besides a marginally significant effect for the BSHS-B domains 'affect' and 'interpersonal relationships' between 6 and 12 weeks, no benefits were observed in the other assessed quality-of-life measures. No serious adverse events were reported in the exercise group. The results of this study support the use of early exercise training as a feasible and efficacious therapeutic strategy to manage burn-related changes in muscle size and strength in adults with acute severe burn injury.

Construction of the burn rehabilitation system

Burn rehabilitation is an important part of burn discipline. As the goal of burn treatment has changed from saving lives and wound elimination to high-quality recovery of body function, burn rehabilitation has been integrated into all levels of burn treatment. In clinical practice, with the establishment of the concept of early preventive rehabilitation, the remodeling of the concept of functional reconstruction in wound repair, and the clarity of the concept of overall rehabilitation, the concept of burn rehabilitation has changed fundamentally. Burn rehabilitation system is not a simple accumulation of directional medical technologies, but an additive expression of multiple medical technologies, covering multi-disciplinary content, including the introduction and application of interdisciplinary new technologies, and involvement of subspecialties. Burn rehabilitation runs throughout the whole process of burn treatment, including early body positioning, later targeted physical and chemical treatments, and even the neurocognitive treatment, which is accompanied by the evaluation of rehabilitation quality throughout the entire process of rehabilitation.

Pay attention to burn rehabilitation assessment

With the vigorous development of burn rehabilitation, many burn units in China are paying more and more attention to the application of burn rehabilitation treatment methods in burn patients. However, the development of burn rehabilitation assessment cannot be ignored in the process of burn rehabilitation treatment. Burn rehabilitation assessment is characterized with a long assessment time span and a large and complex assessment contents, resulting in the inability to develop a standardized assessment form that is suitable for all burn patients. In addition, factors including the shortage of professionals in burn rehabilitation assessment in some domestic burn units, relatively small number of objective assessment instruments and various institutional limitations, have also led to insufficient motivation and low quality of burn rehabilitation assessment. Based on those, this article analyzes the characteristics and main contents of burn rehabilitation assessment in China, and puts forward some suggestions in view of the shortcomings of burn rehabilitation assessment, in order to provide a reference for burn rehabilitation practitioners.

Utilizing a Quality Improvement Approach to Improve Positioning of Acute Burn Patients.

Patient positioning, using "anti-deformity positioning," is a standard practice in burn rehabilitation to assist with edema management, scar contracture prevention, and wound healing. Consistently providing proper positioning requires the combined effort of the multidisciplinary burn team. Our primary goal was to increase the frequency that patients were correctly positioned to over 90%. At a medium-sized, academic burn unit, random audits were conducted by burn lead therapists on the compliance of proper patient positioning over 6 months. Using this data as a trigger, a quality improvement project was designed using the Plan-Do-Study-Act (PDSA) cycle. Surveys were distributed to therapy and nursing staff to identify barriers to proper positioning. Effects on positioning compliance postintervention were monitored. In the 6 months prior to intervention, the average correct positioning was 76%. Surveys identified the following barriers to care: nursing needed more education and the approach was too heavily reliant on nursing efforts alone. To address this, therapists provided education to all nurses, communicated daily about positioning expectations, shifted the project to a multidisciplinary approach, and made changes in therapy workflow. The median compliance improved from 79% to 91% (P < .05). Coordinating efforts of the entire burn team improve consistency for positioning in burn patients. Utilizing the PDSA cycle allowed us to identify areas for improvement and develop appropriate interventions to increase education for nursing staff and workflow improvements for therapists. Following the completion of our interventions, we were able to obtain an immediate improvement in our patient positioning compliance.

Exploration of functional reconstruction and rehabilitation strategies for patients with destructive electric burns

Electric burn is a kind of three-dimensional destructive damage. It is necessary to attach great importance to the functional reconstruction and rehabilitation of patients with destructive electric burns. Wound repair and limb salvage are not the end of the treatment of destructive electric burns, but functional rehabilitation and reintegration into society of patients are the goals of treatment. This paper systematically discusses the early wound repair, late functional reconstruction and rehabilitation, limb salvage and amputation, minimized damage of donor area, psychological rehabilitation, and multi-disciplinary cooperation of destructive electric burns. Only by attaching great importance to the functional reconstruction and rehabilitation, and embedding these concepts in people's brains, perfect repair and rehabilitation of destructive electric burns can be realized.

303 Burn Rehabilitation Training for the Pediatric Burn Critical Care RN

Abstract Introduction New registered nurses (RNs) in the burn pediatric intensive care unit (PICU) need extensive pediatric, critical care, and wound care training. Each of these specialties present a challenging learning curve to the new RN and can overshadow the RN’s focus on burn rehabilitation. Our goal was to improve the RN’s understanding of the importance of early rehabilitative care and their role in the provision of burn rehabilitation in the burn PICU setting. Methods We developed an interdisciplinary program which allowed the RN to work alongside burn physical and occupational therapists. The aim of the program was to teach the participants the importance of early and consistent splinting, positioning, mobilization, and other therapeutic interventions and to learn how to incorporate these techniques into their nursing plan of care. Over two years, nine RNs participated in a four-hour shadow program with a senior physical and occupational therapist. The therapists provided direct hands-on training with patients across the care continuum focusing on competencies aligned with the American Burn Association’s Burn Nurse Competencies. The RNs completed a self-assessment tool to score their self-perceived knowledge related to burn rehabilitation. The self-assessment included a 10-question Likert-scale survey, based on Benner’s Novice to Expert Model. Scoring aligned with the Benner Stages of Clinical Competence: 10 = Novice, 20 = Advanced Beginner, 30 = Competent, 40 = Proficient, and 50 = Expert. The survey was completed pre-intervention, immediately post-intervention, and 3-6 months post-intervention. Results Nine RNs completed the serial surveys. The median years of nursing experience was 2.5 (2-3.5) years. The training was provided at a median time of 4 (3.1-4.6) months after orientation completion. The median score for the pre-intervention assessment was 19 (16-25). The immediate post-intervention score significantly increased to a median of 30 (25-31) (p=0.006) and was maintained at 3-6 months post-intervention (32 (29-37) p=0.0002). There was no significant difference in assessment scores between the immediate post intervention and the 3-6 month post intervention assessment (p=0.25). All median values are median (interquartile range) and significance level was set at a p&amp;lt; 0.05. Conclusions New RNs in the burn pediatric critical care unit have a tremendous learning curve. Our training model demonstrates that there may be improved competency when learning is introduced in staged approaches. Additionally, burn rehabilitation in the PICU requires a transdisciplinary understanding of the patient’s needs. Our training program demonstrates that collaboration across professional disciplines to provide nursing education can improve the clinical competency of new RNs. Applicability of Research to Practice Identifying more efficient and effective methods of new RN training can improve the delivery of nursing care and improve patient outcomes.

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.

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.

534 If You Build It, They Will Come: Everyday Burn Clinic Enhanced Access to Care

Abstract Introduction Prior to 2020, our small burn center had 1x/wk adult burn clinic and 1x/wk pediatric burn clinic. This schedule did not allow for optimal access to care for the geographic area our burn center serves. Also, our inpatient daily census was steadily increasing, and we identified many barriers to discharge for our acute burn survivors that would help to justify to hospital administration the need for increasing the frequency of our burn clinic to daily. These barriers to discharge included decreased availability of visiting nurse agencies for dressing changes, poor quality of rehabilitation services through visiting nurse agencies, and comfort and/or competence with family and/or caregivers being able to provide quality needed burn care. Methods Our burn leadership team developed a business plan for an everyday burn clinic to provide to hospital administration. This daily burn clinic would allow for both adult and pediatric burn survivors to be seen Monday-Friday, provide rehabilitative services a space within our burn clinic, and availability of daily dressing changes in burn clinic. The business plan was reviewed by hospital administration, meetings were held with hospital administration, rehabilitation department leadership and ancillary services leadership to help validate the need for the daily burn clinic. Results Hospital administration approved our daily burn clinic in July of 2020 allowing for improved outpatient dressing and wound management, easy access to quality burn rehabilitation, translating to decreased length of stay. Communication was sent to all area emergency rooms, urgent cares, pediatrician offices and primary care offices to inform them of the increased availability of the burn clinic. This communication included the American Burn Association transfer criteria, a referral form to facilitate access to our burn clinic, and a simple algorithm for assistance with triaging burn care. Prior to the everyday burn clinic in 2019, we were seeing 1,155 outpatient visits annually and in 2021 we saw 1,728 visits in our burn clinic. This is a 150% increase in outpatient burn clinic visits in two years. Conclusions Increasing accessibility to outpatient care for the burn survivor can benefit many aspects in their journey to recovery as well as support the surrounding community in quick access to quality burn care. Burn survivors benefit from shorter hospital stays with the availability of a daily burn clinic for ongoing dressing management while maintaining quality rehabilitation services to maximize their functional outcomes. Applicability of Research to Practice Data could be collected to evaluate the true impact the creation of the daily burn clinic had on burn survivors’ length of stay. Also, data can be collected regarding the number of burn survivors treated at other local emergency rooms and/or urgent care facilities prior to the creation of the daily burn clinic to evaluate the efficacy of the communication provided to the community.

562 Therapy Resources for Management of Large TBSA Burns: A Case Study

Abstract Introduction Therapy studies involving large percent TBSA burns ( &amp;gt;50% TBSA) are not well described. Studies show the highest predictor of preventing burn scar contracture is the amount of burn rehabilitation time received per cutaneous functional units involved, but what does “more therapy time” mean for larger burns in terms of therapy resources for burn centers? Methods A case study was completed on a 20-year-old male admitted after sustaining 85% TBSA full thickness flame burns to his face, neck, arms, legs, and trunk, along with an inhalation injury. He was admitted to the inpatient burn ICU for 113 days, undergoing 16 surgeries to achieve skin coverage prior to discharge to acute rehab. Therapy was initiated &amp;lt; 24 hours after admission to the Burn ICU. Direct therapy contact minutes were tracked during all session and divided into therapy treatment domains. (resource). If co-treating occurred, a single unit of time was used for the time of the session to avoid doubling the units provided. Results Therapy occurred on 106/113 days of admission, receiving 238 therapy sessions (113 PT, 125 OT). He received 21,027 minutes of direct therapy, averaging 196.5 min/rehab days. The highest number of therapy minutes were spent on ROM (9,032 min). Other domains of care included Mobilization (3,171 min), Positioning (2,298 min), Orthotic management (1,326 min), etc. (Table 1). Despite focus on ROM and positioning, he discharged with 7 moderate (left wrist extension, bilateral hip abduction, bilateral ankle dorsiflexion, left neck rotation, and left forearm supination) and 4 severe contractures (right wrist extension, bilateral hip extension, neck extension). He was able to transfer with moderate assistance and walk 150 ft with a platform walker at discharge. Conclusions Therapy interventions in the literature are often described in isolated “domains” of practice, however guidelines on a global approach to management of those with catastrophic injuries does not exist. Prioritization between domains with limited therapy resources when facing patients with extensive deficits is challenging. A dedicated burn therapy staff with availability to secure additional resources was required to ensure optimal outcomes in the management of this patient Applicability of Research to Practice This case study demonstrates the comprehensive burden of care and need for additional therapy resources in the management large TBSA burns.