Ms Yvonne Singer¹, Miss Heather Cleland, Mr Dane Holden

¹Victorian Adult Burns Service, Melbourne, Australia

Abstract:

Early recognition and response to deterioration is a cornerstone of safe and quality healthcare that can minimise patient harm and improve patient safety and outcomes.

For clinicians providing care to burns patients, the physiological effects of burn injury increase the complexity of recognising and responding to deterioration. Organisational-wide Medical Emergency Team (MET) criteria for recognising deterioration have reduced sensitivity and specificity for burn patients. Burn patients frequently have abnormal baseline parameters, caused from the overwhelming inflammatory response, that often require altered MET criteria. Diagnosing sepsis in burn patients is complicated by the reduced specificity of fever and elevation of systemic inflammatory markers caused by the injury itself.

Moreover, on any given day the capacity for the burns team to recognise and respond to deterioration is influenced by multiple factors that include patient heterogeneity, but also team skills and experience, communication, environment, workload and culture. Their complex interactions and inter-dependence have all the hallmarks of a complex adaptive system and mean that cause and effect is neither linear nor predictable.

A two-year review of METs involving burn patients at the Victorian Adult Burn Service (VABS) identified that patients admitted to Intensive Care (ICU) post MET had similar severe injuries, clinical parameters, and acute medical issues. Importantly, in some near miss incidents, nurses identified burn-specific parameters, independent of MET criteria, to recognise deterioration and created informal escalation pathways to the senior burns medical team. These decisions resulted in shorter response times and treatment intervention which improved patient outcomes.

This presentation will provide an overview of 1) unique contextual characteristics of recognising and responding to deterioration in burns care and 2) a snapshot of the VABS quality improvement activities underway to understand and address local barriers to early recognition and response to deterioration to improve patient safety.

Biography:

Yvonne has worked at VABS for 20 years, and serves on Committees for the ABA, ISBI and BRANZ. Her interests intersect at using implementation science, human factors, and registries to improve patient care and safety. Yvonne is a Churchill fellow, currently completing her MPH whilst also starting her PhD candidacy.