Playing with fire: missed opportunities in the referral and follow-up to pre-school burns

Abstract

Aims Every year in the UK, 50 000 children <5 years sustain burns. Health visitor (HV) follow-up after injury attendances to emergency departments (ED) signifi cantly reduces further injury, improves home safety practices and reduces hazards, and may identify potential safeguarding concerns. We evaluated ED burns referrals to HV, to identify what follow-up occurs and the factors infl uencing this decision. Methods All pre-school burn attendances to ) were identifi ed. A postal questionnaire was sent to HVs, supplemented with telephone interview. χ 2 , Student's t test and OR at 95% CI were performed. Results Of 176 cases identifi ed, 140 questionnaires were sent (25 outside catchment, 11 no available records) and 97 (69%) responded. There were no signifi cant differences in burn type and severity between responders and non-responders, although responders patients were younger (13.7 vs 22.3 months, twosample t (138)=3.76, p<0.001). Among responders, scalds accounted for 57%, the commonest agent was hot drinks (39%) followed by hair straighteners (14%). The ED notifi ed HVs in 82% of cases. Information in the referral varied greatly: 90% detailed the burn agent, 68% the burn mechanism and 40% whether the child was supervised. Half the cases were followed-up by a HV, 30% by home visit. Knowledge of the family, routine follow-up, the age of the child and severity of the burn were the main reasons given by HVs for deciding to follow-up. However only increased percentage burn surface area (two-sample t (88)=2.15, p=0.034) and 'burns follow-up was routine' (OR=3.54, 95% CI 1.30 to 9.70) were actually associated with a home visit. After knowledge of the family, caseload (15%) and ambiguous or absent referrals (15%) were the commonest reasons given for not following-up. Conclusions Despite a policy to refer all burns cases, almost a fi fth are not referred and vital information is often omitted; only half of cases are followed-up. Making burns follow-up routine and improving inter-professional communication may reduce the risk of missing these important follow-up opportunities. Further studies should identify other ways of improving follow-up and maximizing the impact of burn prevention advice.group.bmj.com on June 20, 2015 -Published by http://adc.bmj.com/ Downloaded from

Factors Influencing Clinicians', Health Visitors' and Social Workers' Professional Judgements, Decision‐Making and Multidisciplinary Collaboration When Safeguarding Children with Burn Injuries: A Qualitative Study

“…Previous research has shown that over half of notifications to HVs about ED attendances for child injury did not result in any action (Kendrick et al, 2001). A survey of 82 HVs of children who attended an ED with a burn found that information contained in notifications was variable and lacking in detail, and HVs had to use their own knowledge of the family to inform decisions regarding further action (Saunders et al, 2011). A recent study demonstrated that, for children attending ED settings with a burn, key risk factors for child maltreatment included on a standardised, evidence‐based burns proforma were often not identified or recorded by ED clinicians (Nuttall et al, 2020).…”