The Evolution of Resource Utilization in Regional Burn Centers

Abstract

Regional burn centers provide unique multidisciplinary care that has been associated with dramatically improved outcomes for burn victims. Patients with complex skin and soft tissue injuries are increasingly admitted to these centers for definitive care. This study was designed to assess current trends in burn center resource utilization. Members of the Multicenter Trials Group of American Burn Association were invited to participate in this retrospective review of all patients admitted to their respective regional burn centers during a 10-year period. Collected data included admission diagnosis, demographics, length of stay (LOS), hospital charges, and mortality. Five regional academic burn centers participated. They collectively admitted 18,246 patients during the study period, of whom 15,219 (83.4%) had a primary burn diagnosis and 3027 (16.6%) were patients with nonburn diagnoses. During this period, annual admissions for the five centers increased by 34.7%, ranging from 19 to 83% for individual centers. Simultaneously, mean burn size decreased from 12.3 to 8.8% TBSA. From 1998 to 2006, admissions for nonburn diagnoses increased by 244.9%, whereas burn admissions increased by 31.1%. Although mean LOS was reduced by >25%, total charges for all patients increased by 37.7% after adjustment for inflation. Nonburn patients had significantly higher mean age, longer LOS, greater mortality, and higher daily charges. This review of admissions to five academic burn centers reveals that these centers are treating more patients with smaller burns and an increasing number of complex nonburn conditions. Nonburn patients represent an older and more debilitated population that consumes disproportionately more resources than burn patients. These data show a dramatic shift in burn center resource utilization and the concurrent evolution of regional burn centers into centers for the care of complex wounds.

Trends in the epidemiology of major burn injury among hospitalized patients: A population-based analysis

“…Some data exist to suggest regionalization has occurred throughout the United States. Kastenmeier et al found that admissions to five regional burn centers in the United States increased by 31% over 1998 to 2006(22); given reports of stable, or decreasing incidence of burn injury overall, this increase in admissions likely reflects improved regionalization of care. Similarly, in New York, the proportion of patients receiving burn center care increased from 33% to 77% between 1985 and 2006(3).…”

Patients With Burns Versus Patients With Complex Skin and Soft-Tissue Disease

“…Nonburn patients also had significantly higher mean age, longer length of stay, and greater mortality. 2 We found that the average age of the nonburn group was 63.7 years, whereas in the burn group, the average age was 40.1 years. Not surprisingly, given the older age of the nonburn patient group, there was an increased incidence of almost all medical comorbidities including congestive heart failure, coagulopathy, depression, diabetes (both uncomplicated and chronic), hypertension, neurological disorders, obesity, peripheral vascular disease, valvular disease, and renal failure.…”

“…2 Patients with necrotizing skin and soft-tissue infections and exfoliative skin conditions have also been successfully treated in burn units with improved outcomes and costeffectiveness. Most of these have been smaller retrospective studies regarding specific diagnoses such as necrotizing fasciitis, Fournier's gangrene, or exfoliative skin conditions like Stevens-Johnson syndrome or toxic epidermal necrolysis (TENS).…”

Problems and Costs That Could Be Addressed by Improved Burn and Wound Care Training in Health Professions Education

“…12 This problem is compounded by a broader issue facing the medical community-rapidly increasing specialization of care. Some of the trend toward increasing specialization is in response to the exponentially increasing amount of medical knowledge-requiring specialization for competency.…”