Bi-National Burns Registry 2 years on

Transcription

1 Medicine, Nursing and Health Sciences Bi-National Burns Registry 2 years on Natalie Picton Bi-NBR Project Coordinator

2 Overview i. Bi-NBR is a Clinical Quality Registry for Australia and New Zealand Burns Units ii. Capturing Epidemiology & Quality of Care Outcome data iii. Implemented 1st July

3 Australia & NZ Burns Units 17 Burns Units

4 Timeline of Events ANZBA commenced registry $1000 start-up ANZBA appoints Monash University (Alfred Campus) to manage registry. JBBT Funding 1 st Years data 11 / 17 Burns Units 2,103 cases ANZBA appoints 0.2 Data Coordinator (based at VABS) Registry LIVE 1 st July Dataset Review - Database Rebuilt - Governance Structure - ACSQHS Funding 1 st Annual Report released

5 Governance Steering Committee (oversee project) Quarterly Management Committee (Monash Project Team) Fortnightly SC Chair Prof Peter Cameron Head Critical Care Unit Head Victorian State Trauma Registry DEPM, Monash University Alfred Campus Reference Committee (Revision/Development) Quarterly Burns Unit Data Collectors Quality Indicator Long Term Outcomes Outpatients Working Parties

6 Steering Committee Peter Cameron Belinda Gabbe Dina Watterson Natalie Picton Andrew Hannaford Heather Cleland Yvonne Singer Kathy Bicknell Michael Rudd Roy Kimble Belinda Wallis Peter Maitz John Harvey Anne Darton Mihaela Lefter Sheila Kavanagh Ian Mackie Sanjeev Khaurana Linda Quinn Fiona Wood Dale Edgar Alison Mustapha Jan Diwell Tracey Perrett Richard Wong She Deb Bates Cynthia Banham Monash University (Chair) Monash University Monash University Monash University Monash University The Alfred The Alfred The Royal Children s Royal Brisbane & Women s Royal Children s Royal Children s Concord General Repatriation Westmead Statewide Burn Injury Service Royal Hobart Royal Adelaide Royal Adelaide Women & Children s Women & Children s Royal Perth Royal Perth Royal Darwin Royal Darwin New Zealand Middlemore Julian Burton Burns Trust Consumer Representative Reference Committee Belinda Gabbe Monash University Dina Watterson Monash University Natalie Picton Monash University Andrew Hannaford Monash University Yvonne Singer The Alfred Kathy Bicknell The Royal Children s Belinda Wallis Royal Children s Teresa Matthews Royal Brisbane & Women s James Scott Concord General Repatriation Tim Pruyn Concord General Repatriation Anne Darton Statewide Burn Injury Service Rebecca Schrale Royal Hobart Carolyn Hynes* Royal Hobart Suzanne Land* Royal Hobart Sheila Kavanagh* Royal Adelaide Sally McRae Royal Adelaide Darren Nesbitt Royal Adelaide Natasha Forster* Women & Children s Alex Manna Women & Children s Linda Quinn Women & Children s Phil Calvert / Rochelle Kurmis Women & Children s Joy Fong Royal Perth Dale Edgar* Royal Perth Lisa Martin Princess Margaret Tania McWilliams Princess Margaret Alison Mustapha Royal Darwin Jan Diwell Royal Darwin Tracey Perrett New Zealand Frances James / Ash Carr* Middlemore, NZ Hilary Neighbours Hutt, NZ Margaret Conaglen Christchurch, NZ Presentation title 28th February

7 Inclusion Criteria Outpatient Presentation Inpatient Stay Long Term Outcomes > 24 hrs admission < 24 hrs + operation All deaths

8 Inclusion Criteria Admitted/Consulted under Burns Unit 1 st admission within 28 days of injury LOS > 24 hrs or LOS < 24 hrs + Burn Procedure in Theatre All deaths included Readmissions within 28 days from discharge from first admission

9 Burn Registries Around the World Britain NBID America NBR Netherlands R3 China Australian & New Zealand Bi-National Burns Registry

10 Annual Report Bi-National Burns Registy 7th October

11 Annual Report Overview 1 st Jul Jun burns units 2103 burn patients Adults - 73% Paeds - 27% Capture rate est. 97% (10/11 sites) Epidemiology and clinical outcome data

12 Burn Severity TBSA% Paediatrics Adults No % No % 0-9% , % % % * TOTAL

13 Outcome Quality Indicators Adults Paediatrics Median Length of Stay (LOS) 7 days (range 3-13) 4 days (range 2-9) ICU Stay 12% 6% ICU LOS 96 hrs (range ) 86 hrs (range ) Ventilator Time Mortality 72 hrs (range ) 158 hrs (range ) Death rate 1.6% (33/2103 cases) * Death Rate to 55% for burns > 50% TBSA

14 Quality Indicator Working Party Peter Cameron Dina Watterson Dale Edgar Joy Fong Heather Cleland Yvonne Singer Dr John Harvey Anne Darton Catherine Tonkin Sheila Kavanagh Mark Wiggins Tracey Perrett Monash University, Melbourne Monash University, Melbourne Royal Perth Hospital Royal Perth Hospital The Alfred, Melbourne The Alfred, Melbourne Children s Hospital Westmead, Sydney Severe Burn Injury Service, NSW Royal Hobart Hospital, Tasmania Royal Adelaide Hospital, Adelaide Middlemore Hospital, New Zealand National Burn Service Coordinator, New Zealand

15 Structural Quality Indicators N=8 sites Is a Burns Surgeon available on call 24 hours? Is a Burns theatre available on a 24 hour basis? Is Multidisciplinary care provided within the burns unit? 7/8 8/8 8/8 Are weekly multidisciplinary team meetings conducted in the burns unit? 8/8 Does your unit routinely complete infection surveillance swabs on admission? 6/8 * Response Rate 73% (8/11 sites)

16 Was there a delay in transfer from injury to admission to the Burns Unit? Adults Paediatrics Admitted to burns unit within 2 hours of injury 51% 36% Median time (hours) from injury to admission 9 hours (range 3-229) 8 hours (range 3-50)

17 Senior Burns Clinician Assessment Adults > 15% TBSA Paediatrics > 10% TBSA (1) During admission? 77% 63% (2) Within 24 hours of admission? 51% 44% (3) Within 24 hours of admission if inhalation injury present 73% 71%

18 Burn wound excision Adults Paediatrics Did patient go to theatre for burn wound excision? 71% 80%

19 Physical Functioning Assessment Adults > 15% TBSA Paediatrics > 10% TBSA Was a physical functioning assessment (by OT or Physio) completed within 48 hours of admission? 84% 73%

20 Enteral/Parenteral Feeding Adults > 20% TBSA Paediatrics > 10% TBSA Was supplementary feeding (either enteral or parenteral) documented as commencing within 48 hours of admission? 66% 75%

21 Blood Cultures Adults Paediatrics For patients where blood cultures were taken, did patient have a positive blood culture result? 5% 6.5% Of the cases that had a +ve blood culture result & wound swabs taken on admission (n=47), was their positive wound cultures on admission? 11 cases 8 cases

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23 Thank You