HARC ScholarshipBurn Injury- Post acute

care: filling the gaps

Anne Darton

Manager

ACI Statewide Burn Injury Service NetworkApril 2015

“Achieving international best practice in post acute care and inpatient rehabilitation for severe burn injured people; what are the gaps in care for NSW burn injured people?”

Opportunity identified

Gap in current Burn services identified

International conference

Application

▲ Identify potential people/places to visit

▲ Brief literature review

▲ Work plan

“Achieving international best practice in post acute care and inpatient rehabilitation for severe burn injured people; what are the gaps in care for NSW burn injured people?”

Burn rehab and post acute community

reintegration identified

ISBI conference in Edinburgh (hosting same in

Sydney 2 years later)

UK reviewed their burn services

Similarity to NSW/Australian system

Conference Edinburgh

Visited 3 Burn Care Networks (many sites):

▲ Newcastle on Tyne Royal Victoria Infirmary Burn Unit

▲ Whiston Hospital burn unit Liverpool

▲ Pinderfields Hospital burns unit, Wakefield

Northern Burn Care Network Manager, Sheffield

▲ Sheffield Children’s Hospital Burns Unit

Midland Burn Care Network Manager, Nottingham

▲ University Hospitals Leicester Burn Facility

▲ Birmingham Children’s Hospital Burn Centre

▲ University Hospital Birmingham Burn Centre

Midland Burn Care Network Board Meeting, Nottingham

▲ St Andrew’s Burn Centre, Chelmsford

▲ Chelsea and Westminster Hospital London burns unit

▲ Queen Victoria Hospital East Grinstead

▲ Defence Medical Rehabilitation Centre, Headley Court

Findings

Gaps in our service (or what they do that we don’t)

Post acute care

▲ Outreach services/clinics/home visits – variety of set ups● Home based

● Clinics in peripheral centres

● Nurse only

● MDT

▲ Reintegration programs -● adult program in partnership with a charity

● paediatric formalised reintegration school program

▲ Scar review clinics inclusive of MDT

▲ Scar Management● All scar management products e.g. silicone gel sheets, custom made garments etc.

prescribed by GP on recommendation of the burn therapist and paid for by the NHS

system.

● In-house pressure garment production instead of private company production at one site

● Camouflage make-up - routine part of rehabilitation

Gaps in our service (or what they do that we don’t)

System

▲ Online care pathways as per Northern Burn Care Network

▲ Tiered designation system for burn care services with standardised assessment

and validation

Technology

▲ Laser treatment for scars

▲ Burns assessment app for smart phone and other devices

▲ Telehealth clinical psychology follow up

Other

▲ Extensive use of clinical psychologists

▲ Burns Link nurses

▲ Burn case management

▲ Printed handout materials for patient information all aspects of burn care acute and

rehab, scar management etc.

▲ ‘Step-down’ flats for ongoing independence training with support of the burn

specialty MDT

▲ Ventilated beds on Burn Unit

Filling the Gaps (or what could we do in NSW/Australia?)

Establishing multidisciplinary outreach teams combined with Telehealth

options

Focused reintegration of back to work, community and school programs

including psychosocial supports

Case management positions/roles to coordinate discharge and ongoing

services and care.

Agreed standards of burn care service validated/accredited and be applicable

for the burn services across Australia and New Zealand through ANZBA

(Australian & New Zealand Burn Association)

Adopting camouflage make- up as an adjunct to therapy for patients with

potential to improve self-esteem and psychological well being

Exploring the use of Laser treatment for scars in the public health setting

What we have done so far

Establishing multidisciplinary outreach teams combined with Telehealth options

Burn Telehealth project - in diagnostic phase

Focused reintegration of back to work, community and school programs including psychosocial

supports

Burn Hub proposal led by our consumer/burn survivor representative

Case management positions/roles to coordinate discharge and ongoing services and

care. Currently this only occurs with compensable work insurance cases.

Proposal being developed for a trial of “care navigator” for major burns

Agreed standards of burn care service validated/accredited and be applicable for the

burn services across Australia and New Zealand through ANZBA (Australian & New

Zealand Burn Association)

Burns Quality Improvement Program BQIP (ANZBA) commenced

Adopting camouflage make- up as an adjunct to therapy for patients with potential to

improve self-esteem and psychological well being

Resources for camouflage make-up explored and now made available to patients

Exploring the use of Laser treatment for scars in the public health setting

Ultra Pulse Laser machines now purchased at CRGH & CHW (from trust funds)

What we have done so far

Establishing multidisciplinary outreach teams combined with Telehealth options

Burn Telehealth project - in diagnostic phase

Focused reintegration of back to work, community and school programs including psychosocial

supports

Burn Hub proposal led by our consumer/burn survivor representative

Case management positions/roles to coordinate discharge and ongoing services and

care. Currently this only occurs with compensable work insurance cases.

Proposal being developed for a trial of “care navigator” for major burns

Agreed standards of burn care service validated/accredited and be applicable for the

burn services across Australia and New Zealand through ANZBA (Australian & New

Zealand Burn Association)

Burns Quality Improvement Program BQIP (ANZBA) commenced

Adopting camouflage make- up as an adjunct to therapy for patients with potential to

improve self-esteem and psychological well being

Resources for camouflage make-up explored and now made available to patients

Exploring the use of Laser treatment for scars in the public health setting

Ultra Pulse Laser machines now purchased at CRGH & CHW (from trust funds)

What we have done so far

Establishing multidisciplinary outreach teams combined with Telehealth options

Burn Telehealth project - in diagnostic phase

Focused reintegration of back to work, community and school programs including psychosocial

supports

Burn Hub proposal led by our consumer/burn survivor representative

Case management positions/roles to coordinate discharge and ongoing services and

care. Currently this only occurs with compensable work insurance cases.

Proposal being developed for a trial of “care navigator” for major burns

Agreed standards of burn care service validated/accredited and be applicable for the

burn services across Australia and New Zealand through ANZBA (Australian & New

Zealand Burn Association)

Burns Quality Improvement Program BQIP (ANZBA) commenced

Adopting camouflage make- up as an adjunct to therapy for patients with potential to

improve self-esteem and psychological well being

Resources for camouflage make-up explored and now made available to patients

Exploring the use of Laser treatment for scars in the public health setting

Ultra Pulse Laser machines now purchased at CRGH & CHW (from trust funds)

What we have done so far

Establishing multidisciplinary outreach teams combined with Telehealth options

Burn Telehealth project - in diagnostic phase

Focused reintegration of back to work, community and school programs including psychosocial

supports

Burn Hub proposal led by our consumer/burn survivor representative

Case management positions/roles to coordinate discharge and ongoing services and

care. Currently this only occurs with compensable work insurance cases.

Proposal being developed for a trial of “care navigator” for major burns

Agreed standards of burn care service validated/accredited and be applicable for the

burn services across Australia and New Zealand through ANZBA (Australian & New

Zealand Burn Association)

Burns Quality Improvement Program BQIP (ANZBA) commenced

Adopting camouflage make- up as an adjunct to therapy for patients with potential to

improve self-esteem and psychological well being

Resources for camouflage make-up explored and now made available to patients

Exploring the use of Laser treatment for scars in the public health setting

Ultra Pulse Laser machines now purchased at CRGH & CHW (from trust funds)

What we have done so far

Establishing multidisciplinary outreach teams combined with Telehealth options

Burn Telehealth project - in diagnostic phase

Focused reintegration of back to work, community and school programs including psychosocial

supports

Burn Hub proposal led by our consumer/burn survivor representative

Case management positions/roles to coordinate discharge and ongoing services and

care. Currently this only occurs with compensable work insurance cases.

Proposal being developed for a trial of “care navigator” for major burns

Agreed standards of burn care service validated/accredited and be applicable for the

burn services across Australia and New Zealand through ANZBA (Australian & New

Zealand Burn Association)

Burns Quality Improvement Program BQIP (ANZBA) commenced

Adopting camouflage make- up as an adjunct to therapy for patients with potential to

improve self-esteem and psychological well being

Resources for camouflage make-up explored and now made available to patients

Exploring the use of Laser treatment for scars in the public health setting

Ultra Pulse Laser machines now purchased at CRGH & CHW (from trust funds)

What we have done so far

Establishing multidisciplinary outreach teams combined with Telehealth options

Burn Telehealth project - in diagnostic phase

Focused reintegration of back to work, community and school programs including psychosocial

supports

Burn Hub proposal led by our consumer/burn survivor representative

Case management positions/roles to coordinate discharge and ongoing services and

care. Currently this only occurs with compensable work insurance cases.

Proposal being developed for a trial of “care navigator” for major burns

Agreed standards of burn care service validated/accredited and be applicable for the

burn services across Australia and New Zealand through ANZBA (Australian & New

Zealand Burn Association)

Burns Quality Improvement Program BQIP (ANZBA) commenced

Adopting camouflage make- up as an adjunct to therapy for patients with potential to

improve self-esteem and psychological well being

Resources for camouflage make-up explored and now made available to patients

Exploring the use of Laser treatment for scars in the public health setting

Ultra Pulse Laser machines now purchased at CRGH & CHW (from trust funds)

Overall …….

Learnt about not just post acute care but all aspects of burn care in UK

There were elements in all the facilities visited that had something that was

different to NSW burns care and showed positive outcomes for patients

Established ongoing connections with colleagues in the UK and share the

NSW experience.

Similarities in the burn care services in the UK and those currently delivered

in NSW.

No single service that was visited in the UK had an ideal model of post-acute

care.

Level 4, Sage Building

67 Albert Avenue, Chatswood NSW 2067

PO Box 699

Chatswood NSW 2057

T + 61 2 9464 4666

F + 61 2 9464 4728

info@aci.health.nsw.gov.au

www.aci.health.nsw.gov.au