THE JACK BROCKHOFF CHURCHILL FELLOWSHIP to investigate ... · ACKNOWLEDGMENTS I would like to express my gratitude and sincerest thanks to Mr. James Guest, AM, OBE and The Jack Brockhoff

THE WINSTON CHURCHILL MEMORIAL TRUST OF AUSTRALIA

FINAL REPORT BY HENRIETTA H.Y. LAW 1996 JACK BROCKHOFF CHURCHILL FELLOW

THE JACK BROCKHOFF CHURCHILL FELLOWSHIP

to investigate integrated rehabilitation services which will enhance burn patient’s potential and maximize quality of life

HL96JBCF/REPORT 1

INDEX TITLE Page 1 INDEX Page 2 ACKNOWLEDGMENTS Page 3 INTRODUCTION Page 4 - 10 EXECUTIVE SUMMARY Page 11 PROGRAMME Page 12 - 13 MAIN BODY Page 14 - 33 CONCLUSIONS Page 34 - 35 BIBLIOGRAPHY Page 36 - 37

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ACKNOWLEDGMENTS I would like to express my gratitude and sincerest thanks to Mr. James Guest, AM, OBE and The Jack Brockhoff Foundation for their generosity in sponsoring my Churchill Fellowship study tour. Special thanks to The Alfred Hospital Senior Medical Staff Executives and The Alfred Hospital Whole Time Medical Specialists for their generous support. I considered myself very fortunate to be able to work so closely with the following talented individuals and groups, their inspiration, assistance, support and encouragement to me throughout my Churchill Fellowship study tour had been invaluable: Admiral Ian Richards Australian Physiotherapy Association A/Professor John Masterton Caulfield General Medical Center A/Professor Alison Street Department of Human Services, Victoria Dr Jenny Bartlett Haemophilia Foundation Australia Dr Michael “Taffy” Jones Haemophilia Foundation Victoria Dr Andrew Nunn Jobst Beiersdorf Australia Ltd Mr Rick Smith Monash Medical Center Physiotherapy Department Mrs Mary Buttifant The Alfred Hospital Burns Unit Mrs Elvie Munday The Alfred Hospital Haemophilia Treatment Center Ms Janet Compton The Alfred Hospital Medical Services Ms Judy Hodge The Alfred Hospital Physiotherapy Department Ms Dorothy Jewell The Alfred Hospital Public Relations Department Ms Sandra King The Alfred Hospital Visual Communication Services Ms Janet Secatore The Winston Churchill Memorial Trust Professor John Funder Tourism Victoria Professor Joan McMeeken Vikora Australia Pty Ltd My gratitude to all the professionals and patients from the seven centers visited, their enthusiasm and lavishness in teaching and sharing had made the tour rewarding and stimulating. Last but not the least, my burns clients, who keep me active and interested towards the betterment of Burn Rehabilitation.

Henrietta H.Y. Law 1996 Jack Brockhoff Churchill Fellow

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INTRODUCTION Sophisticated advances in technology have increased survival rate of burn victims (Table 1). Provision of specialized integrated care to these patients can be demanding as timely rehabilitation is crucial for better quality of life and outcome. The introduction of Diagnostic Related Group (DRG) funding in Victoria in 1994, had brought about further difficulties in finding appropriate placement for burn rehabilitation. A national telephone survey done by the author in February 1995 (Table 2 - 3), followed by a postal survey done in May 1996 (Table 4 - 6) showed that most burns rehabilitation services in Australia were fragmented, with limited resources and skilled staff. In the past few years, America and Europe had devoted much funding and research into “Burn Rehabilitation”. A survey by Cromes & Helm (1) concluded that comprehensive burn rehabilitation had resulted in an overall improvement in the outcome for burns. With the recent firm commitment from the Department of Human Services, the new Helen M Schutt Victorian Burns Unit is going to be constructed in mid April 1997 at the 6th Floor of the Alfred Hospital. In order to maximize the Helen M Schutt Victorian Burns Unit’s capacity to provide best practice and maintaining highest quality of patient-focussed care, it is essential to provide an integrated service from acute to ultimate rehabilitation. The purpose of The 1996 Jack Brockhoff Churchill Fellowship study tour was to investigate integrated rehabilitation services offered in seven world renowned burn centers in America and Europe. A thorough evaluation of the method used and the strategies learned from this study tour will provide a substantial knowledge base to enhance and develop the current burn rehabilitation program at the Alfred Hospital for the benefit of the Australian community. 1. Cromes GF & Helm PA, “The Status of Burn Rehabilitation Services in the United States: Results

of a National Survey”, Journal of Burn Care & Rehabilitation, 1992; 13:656-62.

(Table 1) HL96JBCF/REPORT 4

REFERRALS FOR ADULT BURN REHABILITATION IN VICTORIA AUDIT OF ALFED HOSPITAL BURNS UNIT (1/1/1988 - 31/12/1996) (Source: The Alfred Hospital Burns Unit Discharge Book)

Year No. of patient admitted

No. of patients over 20 % TBSA

No. of patients over 50 % TBSA

Deceased No. of patients referred to RehabHospital

1996 127 30 9 4 9 - CGMC

2 - BH

2 - ERH

1995 150 33 12 5 6 - CGMC

2 - ERH 1994 110 33 15 5 1 - ERH

1993

70 27 4 3 0

1992

74 19 3 1 5 - HRH,

ERH &

RTGRH

1991

110 29 9 9 1 - HRH

1990

85 25 6 9 2 - HRH

1989

106 18 5 6 2 - HRH

1988

113 20 6 9 1 - RTGRH

BH - Bethesda Hospital CGMC - Caulfield General Medical Center ERH - Essendon Rehabilitation Hospital HRH - Hampton Rehabilitation Hospital RTGRH - Royal Talbot General Rehabilitation Hospital

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(Table 2) NATIONAL TELEPHONE SURVEY OF ADULT BURNS REHABILITATION SERVICES ( FEB 1995)

CENTER Burn Rehab bed within hospital setting

Burn Rehab bed outside hospital setting

Out-patient service

Burns clinic

Who do garment/ scar Mx/ splint

Who do face mask

AHG No Plan trial with CGMC

No Yes

but limited

Yes Sc-PT G -PT Sp-OT

P & O and RT

RAH No No Yes Yes Sc-OT G -OT Sp-PT & OT

OT

RBH No No Yes Yes Sc-OT G -OT Sp-OT

Don't use

RCH No No Yes Yes Sc-OT G -OT Sp-PT

OT

RDH (No Burns Unit)

No Likely in future

No Yes No Sc-OT G -OT Sp-PT & OT

Send out to other state

RHH

No patient D/C home

No Yes Yes Sc-OT G -OT Sp-PT

OT

RPH No No, extreme case RPRH

Yes Yes Sc-OT G -OT Sp-PT(LL) OT(UL)

OT & RT

WH No Yes to St Joseph Rehab Hosp

Yes Yes Sc-OT G -OT Sp-PT(LL) OT(UL)

OT

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(Table 3) NATIONAL TELEPHONE SURVEY OF ADULT BURNS REHABILITATION SERVICES( FEB 1995)

CENTER Burns Support Group

Work Harden Program

Job re- development

Isokinetic training/ assessment

D/C info verbal/ written video

Enough facilities for burns Rehab

AHG No No No, refer out if needed

No Verbal & Written

No

RAH No No No, refer out if needed

No Written

No

RBH

No No No No Written & video

No

RCH No No No No Verbal No

RDH No No No No No No, FU only in RDH

RHH No No No No Verbal No, FU only in RHH

RPH Yes No No No Written No, FU mainly in RPH

WH Yes No No, refer out if needed

No Verbal & Written

Yes, St Joseph staff been taught

AHG - Alfred Healthcare Group, Vic OT - Occupational Therapist RAH - Royal Adelaide Hospital, SA P & O - Prosthetic & Orthotics RBH - Royal Brisbane Hospital, Qld PT - Physiotherapist RCH - Royal Concord Hospital, NSW RT - Radiotherapy Dept RDH - Royal Darwin Hospital, NT RHH - Royal Hobart Hospital, Tas RPH - Royal Perth Hospital, WA WH - Westmead Hospital, NSW PRRH - Royal Perth Rehabilitation Hospital, WA

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(Table 4)

NATIONAL POSTAL SURVEY OF ADULT BURNS REHABILITATION SERVICES (MAY 1996)

CENTER Burn Rehab bed within hospital setting

Burn Rehab bed outside hospital setting

Out-patient service

Burns clinic

Who do garment/ scar Mx/ splint

Who do face mask

AHG No but close relationship with CGMC

No Yes but limited

Yes Sc-PT G -PT Sp-OT

P & O

RAH No Yes, Hamsted Rehab

Yes Yes Sc-PT & OT G -PT & OT Sp-PT & OT

OT & RT

RBH No No Yes Yes Sc-OT G -OT Sp-OT

OT

RCoH No , Patient should be self care prior to discharge

No Yes

if they attend

Yes Sc-OT & PT G -OT Sp-PT & OT

P & O

RHH

No No Yes Yes Sc-OT G -OT Sp-Pt

OT

RNSH No Yes, Coorabel Rehab Hospital

Yes Yes Sc-PT G - PT Sp-PT

PT

RPH No No, other rehab

Yes Yes Sc-OT & PT G -OT Sp-PT(LL) OT(UL)

OT & P & O

TBH Yes No, general unit beds only

Yes No Sc-PT G -PT Sp-PT

-

WH No Yes refer to St Joseph Hospital

Yes Yes Sc-OT & PT G -OT Sp-PT(LL) OT(UL)

OT

WVH No Yes, under surgical bed

Yes Yes Sc-OT&PT G -OT Sp-OT

OT & RT

HL96JBCF/REPORT 8

(Table 5)

NATIONAL POSTAL SURVEY OF ADULT BURNS REHABILITATION SERVICES ( MAY 1996)

CENTER Work Harden Program

Job re-develop- ment

D/C info verbal/ written video

Burns Support Group

Enough facilities for burns Rehab

Utilizing community Resources

Need to educate Peers

AHG No No, refer out if needed

Verbal & Written

No No Yes Yes

RAH No No, refer to CRS

Verbal, video and written

No No Yes Yes

RBH No No Written, slide & video

Yes No Yes Yes

RCoH No No, refer to CRS

Verbal , video & written

Yes No, refused because of inadequate training

Yes Yes

RHH No No, refer to CRS

Verbal & written

Yes, small but active

Yes

Yes Yes, due to lack of experience

RNSH No No, done Coorabel

Verbal & written

Yes No, not enough support & counseling

Yes Yes

RPH No No, refer to CRS or private

Written & verbal

No, tried but failed

No

Yes Yes

TBH No No, refer to CRS

Verbal Yes No No Yes

WH No No, refer to CRS or private

Verbal , video & written

Yes No No Yes

WVH Yes No, refer CRS or Comcare

Verbal & written

No Yes Yes Yes

AHG - Alfred Healthcare Group, Vic OT - Occupational Therapist RAH - Royal Adelaide Hospital, SA P & O - Prosthetic & Orthotics RBH - Royal Brisbane Hospital, Qld PT - Physiotherapist RCoH - Royal Concord Hospital, NSW RT - Radiotherapy Dept RHH - Royal Hobart Hospital, Tas RPH - Royal Perth Hospital, WA TBH - Tamworth Base Hospital, NSW WH - Westmead Hospital, NSW WVH - Woden Valley Hospital, ACT

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(Table 6) NATIONAL POSTAL SURVEY OF PAEDIATRIC BURNS REHABILITATION SERVICES (MAY 1996)

CENTER Burn Rehab bed within hospital setting

Burn Rehab bed outside hospital setting

Out-patient service

Burns clinic

Who do garment/ scar Mx/ splint

Who do face mask

NCH No No Yes Yes Sc-PT G -PT Sp-PT & OT

-

PMH Yes No Yes Yes Sc-PT & OT G -OT Sp-PT

P & O & OT

RCHQ No Yes Yes Yes Sc-OT G -OT Sp-OT

OT

RCHV No No Yes Yes Sc-PT & OT G -PT & OT Sp-PT & OT

P & O

CENTRE School Re-entry Program

D/C info verbal/ written video

Burns Support Group

Enough facilities for burns Rehab

Utilizing community Resources

Need to educaPeers

NCH Yes Verbal Yes No Yes

Yes

PMH No Verbal & written

No - Yes

Yes

RCHQ No Verbal, video & written

Yes No Yes Yes

RCHV Yes Verbal & written

No, camp or once a year

No, not enough off site rehab

Yes Yes

NCH - New Children’s Hospital, NSW OT - Occupational Therapist PMH - Princess Margaret Hospital, Western Australia P & O - Prosthetic & Orthotics RCHQ - Royal Children’s Hospital, Queensland PT - Physiotherapist RCHV - Royal Children’s Hospital, Victoria RT - Radiotherapy Dept

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EXECUTIVE SUMMARY NAME: Henrietta H.Y. Law ADDRESS: c/o Physiotherapy Dept., Alfred Hospital, Commercial Road Prahran, 3181, Australia POSITION: Senior Clinician Physiotherapist, Burns, Plastics & Haemophilia TELEPHONE: (03)9276 3450 ( Office), (03) 9776 0606 ( Home) PROJECT To investigate integrated rehabilitation services which will enhance DESCRIPTION: burn patient’s potential and maximize quality of life. HIGHLIGHTS: Burn Centers visited: May 13 - 17, 96 Harborview Medical Center, Seattle, USA May 20 - 28, 96 Shriners Burns Institute, Galveston, Texas, USA June 03 - 07, 96 Massachusetts General Hospital, Boston, USA June 10 - 13, 96 Shriners burns Institute, Boston, USA June 17 - 21, 96 Selly Oak Hospital, Birmingham, UK July 01 - 09, 96 Canniesburn Hospital, Glasgow, UK July 11 - 19, 96 Hvidovre Hospital, Copenhagen, Denmark Valuable contacts: Ms Merilyn Moore, PT Supervisor, Harborview Medical Center; USA Ms Rhonda Meyers, Director of Rehabilitation Services, Shriners Burns Institute, Galveston, USA; Ms Monica Pessina, Director of Rehabilitation Services, Shriners Burns Institute, Boston, USA; Mr John Gowar, Consultant in Plastics Surgery & Burns, Selly Oak Hospital, Birmingham, UK; Mr Ian Taggart, Consultant in Plastics Surgery & Burns, Canniesburn Hospital, Glasgow, UK; Ms Bolette Draslov, Burns PT, Hvidovre Hospital, Denmark. MAJOR LESSONS - Primary therapist concept for better holistic management; LEARNED: - Integration of Plastics and Burns Unit for better outcome; - Integration of ICU beds into Burns Unit for better continuity of care; - Close Proximity of Outpatient clinic with/within Burns Unit; - Multi-disciplinary communication meetings and education to facilitate patient/family centered care and streamline discharge; - Outcome orientated data collections and research. METHOD OF - Report back lessons learned to Alfred Hospital Burns Team, DISSEMINATION & Australian New Zealand Burns Association and other appropriate IMPLEMENTATION: bodies - Formulate suggestions, initiate consultations and discussions; - Set consented strategies, implementation and evaluations; - Foster strategies by ongoing education & quality improvement program.

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PROGRAMME OVERSEAS BURNS CENTERS VISITED 1. Professor David Heimbach, MD, FACS Travel: 9-17/5/96 Director, Professor of Surgery Visit: 13-17/5/96 Harborview Medical Center ZA-16 325 Ninth Avenue 34 beds Burns Center Seattle, Washington 98104 USA Ph: 0011+1+206+731-3140 Fax: 0011+1+206+731-3656 Physiotherapist: Merilyn Moore, Physical Therapy Supervisor, Burns/Plastics Ph: 0011+1+206+731-8711 Fax: 0011+1+206+731-8636 2. Professor David N Herndon, MD Travel: 18-29/5/96 Chief of Staff Visit: 20-29/5/96 Jesse H. Jones Distinguished Chair in Burn Surgery 30 beds Burns Center The University of Texas Medical Branch Shriners Hospitals for Crippled Children Burns Institute, Galveston Unit 815 Market Street, Galveston Texas 77550-2725 USA Ph: 0011+1+409+770-6731 Fax:0011+1+409+770-6919 Contact: Ms Rhonda Meyers, Director of Rehabilitation Services, ext 6682 , fax 6684 3. Professor Ronald G Tompkins, MD Chief, Trauma & Burns Services Travel: 30/5-7/6/96 Massachusetts General Hospital Visit: 3/6-7/6/96 Boston, MA 02114 USA 36 beds Burns Unit Ph: 0011+1+617+726-3712 Fax:0011+1+617+726-4127 Nursing Manager: Tony Digiovine, Ph:0011+1+617+726-3354

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OVERSEAS BURNS CENTERS VISITED (CONTINUED) 4. Professor Ronald G Tompkins, MD Chief of Staff Travel: 8-13/6/96 Shriners Hospitals for Crippled Children Visit: 10-13/6/96 Burns Institute, Boston Unit 51 Blossom Street, Boston 30 beds Burns Unit Massachusetts 02114-2699, USA Ph: 0011+1+617+722-3000, Ms Monica Pessina: ext 4749 Fax:0011+1+617+523-1684 Contact:Ms Monica Pessina, Director of Rehabilitation Services 5. Mr. John Gowar, MB, FRCS Consultant in Plastic Surgery & Burns Travel: 14-23/6/96 South Birmingham Trauma Unit Visit: 17-21/6/96 West Midlands Regional Burns Unit and South Birmingham Plastic Surgery Unit 20 beds Burns Unit Selly Oak Hospital Raddlebarn Rd, Birmingham B29 6JD United Kingdom Ph: 0011+44+121+627-1627 Fax:0011+44+121+627-8794 6. Mr. I. Taggart Travel: 29/6-9/7/96 Consultant Plastic Surgeon Visit: 1/7-9/7/96 Canniesburn Hospital Switchback Road, Bearsden 19 beds Burns Unit Glasgow G61 1QL United Kingdom Ph: 0011+44+141+211-5600 Fax:0011+44+141+211-5651 7. Mr. Bjarne Alsbjorn, MD, DM Sc Travel: 10-21/7/96 Chief Surgeon Visit: 11-19/7/96 Hvidovre Hospital Kettegard Alle 30 32 beds Burns Center DK-2650 Hvidovre - Copenhagen Denmark Ph: 0011+45+3632-3632 Fax:0011+45+3147-3941

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MAIN BODY Sophisticated advances in technology have greatly increased the survival rate of burn victims. Provision of specialized integrated care to these patients can be demanding as timely rehabilitation is crucial for better quality of life and outcome. With the current changes in the Healthcare System in Australia, funding issues for management and rehabilitation of complex and long term burns patients has been put under threats. There are a lot of push to shorten the length of stay in this client group, however, resources for burn rehabilitation services are very fragmented Australia-wide. In the past few years, America and Europe had devoted much funding and research into “Burn Rehabilitation”, into efficacy and cost effectiveness means to improve outcome. A survey by Cromes and Helm (1) concluded that comprehensive burn rehabilitation had resulted in an overall improvement in the outcome in Burns. In order to maximize the Alfred Hospital Burns Unit’s capacity to provide best practice, it is essential to provide an integrated service from acute to ultimate rehabilitation. A thorough evaluation of the method used in other Burns Centers in America and Europe will provide a substantial knowledge base to achieve this. The Jack Brockhoff Churchill Fellowship study tour included visits to seven world renowned Burn Centers with four in America, two in United Kingdom and one in Denmark. The travel themes were: - Meeting and spending time with various staff of the Burns Team; - Observe ward activities +/- surgery; - Attend ward rounds/ inservices/ research meetings; - Attend team meetings/ conferences/ discharge planning meeting; - Attended outpatient clinic(s); - Visit relevant rehabilitation hospital/ resources/ affiliations. A postal survey to all burn therapists in Australia and New Zealand was conducted in April-May 1996 to update current services delivery pattern and resources for burn rehabilitation. The responses of the survey were very encouraging, with a 75% response rate, burn therapists Australia-wide had submitted their questions for exchange with therapists overseas (there was no response received from New Zealand). The list of topics generated as listed below were used for discussion during exchange with therapists throughout the tour: - Burn survival - special techniques/products used to enhance survival; - Burn dressings - products used and reason for choice; - Assessment - format for physical, emotional, vocational and psychological aspects and method of how outcomes were measured; - Pain control - how to assess its adequacy, how to treat acute and chronic pain in children; - Positioning - current practice, difficult positions eg. head, neck and shoulders; - Splinting - new technique/regime, ideas for web space of the burned hand; - Mobility - when to start post grafting, what were the type of support used; - Hand management - comment on use of coban; - Scar management - contact media and effectiveness; - Social - means to improve services delivery and compliance; - Rehabilitation - rural set up, community resources, how was outcome assessed. Detailed below were the Centers visited and the lessons observed or learned:

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HARBORVIEW MEDICAL CENTER

SEATTLE, USA

MAY 13 - 17, 1996

HL96JBCF/REPORT 15

HARBORVIEW MEDICAL CENTER, SEATTLE, USA ( MAY 13 - 17, 1996 ) The Burn Center, Harborview Medical Center had been the University Hospital Burn Unit since 1974. The unit consisted of a 22-bed acute burns/trauma ward and a 12-bed burns/trauma Intensive Care Unit (ICU). It serviced both children and adult trauma and burns for the state of Washington, Alaska, Montana and Idaho with a population of 5,631,000. The Plastics Surgical Unit was fully integrated into the Burn Center. This Center published the second largest series of books and research studies relating to burns in the United States of America. The Team: Director: Professor David Heimbach Burns Surgeon: Dr Roberta Mann, Dr Nicole Gibram Chief Plastics Surgeon: Dr Loren Engrav Plastics Surgeon: Dr Nick Vedder, Dr Joe Gruss Nursing Managers: Ms Patti Dimick (ICU) Ms Margaret Sandvig (Burns/Trauma Ward) Ms Verna Cain (Outpatient Clinic) Research Nurses: Shari and Brenda Discharge Planning: Ms Cindy Peterson Rehabilitation Counselor: Ms Sabina Brych Physiotherapists: Ms Merilyn Moore, Mr David Colescott Occupational Therapists: Ms Dana Nakamura, Ms Beth Costa Recreation Therapist: Ms Kathleen Jones Social Worker: Ms Katy Crouch Psychologist: Mr David Patterson Program: • Meeting and spending time with members of the Team; • Attended Rehabilitation Department handover meeting; • Attended daily ward round, wound round; once weekly grand round, psychosocial round and discharge planning meeting; • Attended respective Burns and Plastics Surgery Outpatient Clinics; • Specific meeting with Recreation Therapist, Rehabilitation Counselor and Nursing Manager of ICU to gain insight of their specific services; • Attended inservices and research meeting about “Burn Injury Rehabilitation Model System”, a project sponsored by the National Institute on Disability & Rehabilitation Research in USA; • Visited Harborview Medical Center Rehabilitation Department regarding burn rehabilitation; • Exchange and sharing in treatment principles and techniques with various members of the burns rehabilitation team; • Gain insight of research currently happening in Burn Center/Rehabilitation Services. HARBORVIEW MEDICAL CENTER, SEATTLE, USA ( MAY 13 - 17, 1996)(Continued)

HL96JBCF/REPORT 16

Findings: Burns Center, Harborview Medical Center is one of the three centers in USA that was granted a three year research grant (US$1,000,000) by the National Institute on Disability & Rehabilitation Research (NIDRR) in USA. Their research theme was on “BURN INJURY REHABILITATION MANAGEMENT SYSTEM”. The Center achieved their aims through seven objectives: 1. Establish, demonstrate and evaluate a model system. 2. Conduct scientific program of research with goals to reduce disability, better treatment and rehabilitation. 3. Demonstrate and evaluate treatment of rehabilitation methods to: - enable patients to treat themselves; - provide a system to educate services providers; - increase patient’s compliance with aid application eg. pressure garment, splint etc. 4. Demonstrate and evaluate approach to independent living, vocational rehabilitation and community re-integration. - This objective was achieved by utilizing part of the NIDRR grant (amounting US$10,000) for the appointment of a “Burns Rehabilitation Counselor” till October 1997 to oversee the co-ordination of vocational and community re-integration. 5. Study various aspects of burns rehabilitation processes; 6. Participation in a national data base; 7. Dissemination of information to target survivors, families and providers, so that burns rehabilitation might be improved. Burn Center, Harborview Medical Center adopted a FACTS Models for Quality Improvement, where FACTS stands for: • Find a process • Analyze a process • Create a way to change the process • Take action • Standardization HARBORVIEW MEDICAL CENTER, SEATTLE, USA ( MAY 13 - 17, 1996)(Continued) Specific professionals and their roles: HL96JBCF/REPORT 17

Rehabilitation Counselor: Rehabilitation counseling is a new trial service, the project was a grant of US$10,000 funded by NIDRR. Roles of rehabilitation Counselor were to: • advocate early intervention for job/community re-integration; • provide early contact with patient and family to discuss issues related to job/vocational

aspects, and to reinforce the possibility of early return to work; • establish close liaison with respective rehabilitation case manager for work related

patients; • refer non-compensable patients to relevant Divisions of Vocational Re-education (DVR) facilitating early planning and job retraining; • offer employer the opportunities to visit and understand the running of the Burn Center; • empower patient confidence and skills to negotiate with employer; • participate in NIDRR study , perform psychological testing at the following time frame: post admission (if appropriate), before discharge, at 6 month, 1 year and 2 years; • refer relevant patient to recreational therapist for community re-integration to re-establish

interest or lifestyle adaptation post burn. Recreational therapist: Roles of recreational therapist were to: • provide rehabilitation through play therapy and family intervention; • provide pre-operation education utilizing puppet/cartoon to explain procedure/surgery in a

non-threatening manner; • facilitate school re-entry:

- responsible for liaison between hospital and school, - obtain information from school regarding patient’ s background, interests, attendance,

behavior and problems, - provide school program/hospital homework or tutor program to children with longer than

4 weeks stay in the Center, • Assist school re-entry: - close liaison with teacher and school-mates, - provide written or video information about burn and patient, - visit school on the first day when child returns to school to help to ease the anxiety of both party. HARBORVIEW MEDICAL CENTER, SEATTLE, USA (MAY 13 - 17, 1996)(Continued) Outcome Measures and Research:

HL96JBCF/REPORT 18

“Research is one of the mission of the Burn Center, in fact part of the definition of the concept of ‘Burns Center’” (2). The research efforts in Harborview included pain control studies (NIH funding of US$1,000,000), rehabilitation and outcome studies (NIDRR funding of US$1,000,000) and numerous industry sponsored studies - cytokine inhibitors, WBC adhesiveness inhibition, various skin substitutes, and wound healing enhancers. “Prospective Randomized Study of the Effect of Pressure Garment on the Rate of Wound Maturity in Burns Patients” by Chang et al (3) strongly suggested that pressure garment therapy did not play a role in the rate of maturation of the closed burns wound. This study had stimulated a challenging era for pressure therapy. In order to objectively evaluate the application of pressure therapy in detail, Marilyn Moore (Physiotherapist) from Burns Center, Harborview Medical Center utilized The I-Scan System (cost US$15,000) from Tekscan Inc of Boston, Massachusetts to quantify pressure delivered by pressure garments. The I-Scan System by Tekscan was a versatile pressure measurement system utilizing thin-film pressure sensing technology. At the system’s heart was a high resolution, matrix based tactile sensor capable of measuring pressure as low as 5mm Hg and as high as 30,000 Psi. The System assisted therapists in critical analysis of various types of pressure application, in addition, it provided data on pressure changes with aging of garments and/or changes in scar height. Assessment of pressures over bony prominence could be documented, identifying burns patients at high risk for skin and scar breakdown due to increase pressure over these areas. The use of pressure therapy and custom fit garments was a great expense for most Burns Units, documentation of the actual pressures provided by custom fit or interim garments, would give the clinicians the ability to objectively follow patient’s progress and likely problems encountered over time. The System would enhance future research and facilitate objective evaluation in the efficacy of pressure garment used in the treatment of burn scars. “Do Custom Fitted Pressure Garment Provide Adequate Pressure?” presented by Moore et al at the 1995 American Burns Association Meeting (ABAM) found that “custom fitted pressure garments frequently provided less than 24 mm Hg of pressure at the scar-garment interface, particularly for abdomen, thigh, posterior trunk, anterior chest and buttocks. Forearm and dorsal hand garments provided higher pressure over 90% of the time.’(4), and she concluded that “precise determination of pressure ‘dose’ must be made before the efficacy of pressure garment therapy can be objectively determined.”. The I-Scan System Study was planned for two years, the result of the study and the ultimate implication to therapists and burns clients would provide another dimension to future burn scar management. 2. Heimbach D, Burn Pearls, 14th Edition, University of Washington Burns Center, Seattle, USA,

1995:7. 3. Chang et al, “Prospective Randomized Study of the Effect of Pressure Garment on the Rate of Wound

Maturity in Burns Patients”, Journal Burn Care and Rehabilitation,1995; 16:473-5. 4. Moore et al, “Do Custom Fitted Pressure Garment Provide Adequate Pressure?”, American Burns Association Meeting Abstracts, 1995:84. HARBORVIEW MEDICAL CENTER, SEATTLE, USA ( MAY 13 - 17, 1996 )(Continued) Burns Center, Harborview Medical Center in conjunction with Taiwan and Japan was using a New Scar Rating Scale in assessing scars, this method was also presented by Yeong et al at

HL96JBCF/REPORT 19

the American Burns Association Meeting. The following was extracted from the ABMA Abstract (5).

The Numerical Scar Rating Scale (Circle one response on the scale. Do not make between grid marks.)

1. Burns Scar surface

-1 0 1 2 3 4 smooth normal rough rough rough rough

2. Burn scar border height -1 0 1 2 3 4

depressed normal raised raised raised raised

3. Burns scar thickness -1 0 1 2 3 4

thinner normal thicker thicker thicker thicker

4. Color differences between scar and adjacent normal skin -1 0 1 2 3 4

hypopigmented normal hyper hyper hyper hyper The study found a high inter-rater reliability, and suggested that the rating system might be a useful tool for the clinical evaluation of scars.

Rehabilitation Rehabilitation was mostly provided by the rehabilitation team from the Burn Center. Despite there were inpatient rehabilitation services within the Hospital complex, the annual burns rehabilitation referral was only a few. The Burn Center had also developed a very comprehensive discharge package for services providers and carers of the distant clients. 5. Yeong et al, “Improved Burn Scar Assessment Using New Scar Rating Scale”, American Burns

Association Meeting Abstracts, 1995:82

HL96JBCF/REPORT 20

SHRINERS BURNS INSTITUTE

GALVESTON, USA

MAY 20 - 28, 1997

HL96JBCF/REPORT 21

SHRINERS BURNS INSTITUTE, GALVESTON, USA ( MAY 20 - 28, 1997 ) Shriners Burns Institute, Galveston was one of the three Shriners Burns Centers in North America. The Institute provided services to 29 States in America and Mexico. It was fully funded and run by the Shriners with all the services provided free. Shriners, or Shrine Masons, belonged to the Ancient Arabic Order of the Nobles of the Mystic Shrines for North America (A.A.O.N.M.S.). The Shrine was an international fraternity best known for its colorful parades, its distinctive red fez, and its official philantrophy, Shriners Hospitals for Crippled Children (a network of 19 orthopaedic hospitals and three burn institutes), which often called “the heart and soul of the Shrine”. The Institute consisted of a 15 beds acute Burns ward with ICU facilities and a 15 beds Reconstruction ward, housed in a purpose-built luxurious seven storey hotel-like Hospital. The Plastics Surgical Unit was fully integrated into the Burn Institute. The Burns ward provided inpatient and outpatient follow up from infant to the age of 18, while the Reconstructive ward provided services up to the age of 21. Shriners Burns Institute, Galveston had the largest series of burns related publications and was world renowned for training and research of burns management. It was also the origin of the use of Jobst pressure garment for burns. The Team: Chief of Staff: Professor David Herndon Burns Consultant: Mr Manubhai Desai Chief Plastics surgeon: Mr Robert McCauley Plastics Consultant: Mr Joseph Mlaka Director of Nursing: Ms Janet Marvin Director of Rehabilitation: Ms Rhonda Meyers Rehabilitation Therapists: Ms Linda Roberts (OT) Ms Karen Mendiola (OT) Ms Leah Kalka (OT) Ms Linda Coleman (OT) Ms Amy Groce (PT) Ms Sandra Gonzalez (OT) Ms Julie Kornhoff (PTA) Child Life Therapist: Ms Tracey-Lynn Akitt Program: • Meeting and spending time with members of the Burns Team; • Attending Rehabilitation Department Handover Meeting; • Attending grand round, discharge planning meeting and pain management round; • Attending Burns & Plastics Surgery Outpatient Clinics; • Specific meeting with Child Life Therapist regarding school re-entry program; • Specific meeting with Professor Janet Marvin, Director of Nursing; Nursing Manager of

Reconstructive Surgery Ward and staff anaesthesiologist to gain insight in pain management;

• Attended Inservices and research meeting; • Exchange and sharing of treatment principles and techniques with various member of the

Burns Rehabilitation team; • Gain insight of research currently happening in Burns Institute and Rehabilitation Services.

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SHRINERS BURNS INSTITUTE, GALVESTON, USA ( MAY 20 - 28, 1997 )(Continued) Findings: The total admission of patients to the Institute at 1995 was 790, with a mortality rate of around 0.6 - 5%, while length of stay was 0.6 days per % of burn. The Institute had 94 publications and published journal articles in the year 1995. Shriners Burns Institute, Galveston conducted 16 outreach clinics each year to 9 places in USA from New Orleans to California. The purpose of the outreach clinics were: • to mobilize the whole burns team to provide care and monitoring to the burn patients

living far away from the Institute; • to provide education to the services providers and carers in the region. Shriners Burns Institute, Galveston did not have rehabilitation beds, instead the Institute provided 4 well-equipped and furnished units within the hospital and 5 family units outside the Institute for patient and family (especially those from Mexico) during early discharge, enabling the child to continue adequate and appropriate rehabilitation intervention prior to return back home. The Institute also provided schooling in-house. The Child Life Therapy Department facilitated school re-entry through school visits and maintained close liaison with the teacher and school; the department also provided play therapy, music therapy, skin care program and “Burn Camp” to their clients. Research: Major research interests focused on 5 main streams: • cardiopulmonary pathophysiology • metabolism • molecular response to injury • sepsis • wound healing During the visit period, the Institute was involved in a multi-center trial regarding “The use of Recombinant Human Growth Hormone (genotropin), anabolic agent and diet on improvement of wound healing”. There was also research plan for a multi-Institute study on “Pressure Garment” with the use of the I-Scan System (the same System used by Harborview Medical Center).

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MASSACHUSETTS GENERAL HOSPITAL

BOSTON, USA

JUNE 3 - 7, 1996

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MASSACHUSETTS GENERAL HOSPITAL, BOSTON, USA ( JUNE 3 - 7, 1996 ) Massachusetts General Hospital (MGH) Sumner Redstone Burns Center was a 36-bed unit for the care of both Burns and Plastics Surgical patients. The Center consisted of 4 ICU beds, 2 High Dependency beds, 20 Burns bed and 10 Plastics Surgical beds, mostly the Unit operated at around 30 beds. Even though the Plastics Surgical Unit was integrated into the Burns Center at early 1996, the running of the two units was still separated and independent. Similar to Australia, shortage of resources and staffing was evident due to manage care and downsizing. The Center had a just newly appointed a Research Nurse to initiate quality management and to collaborate research activities. The Team: Chief of Staff: Professor Ronald Tompkins Chief Consultant: Dr Colleen Ryan

Dr Robert Sheridon Nursing Manager: Mr Tony Digiovine Physiotherapist: Ms Janet Wilson Occupational Therapist: Ms Amy Jones Program: • Meeting and spending time with members of the Burns Team; • Attended daily ward round and weekly grand round; • Attending Burns Outpatient Clinics; • Exchange and sharing in treatment principles and techniques with physiotherapist and

occupational therapist of the burns team; • Visited Spaulding Rehabilitation Hospital regarding adult burn rehabilitation in Boston. • Gain insight of research currently happening in Burns Center and Rehabilitation Services. Findings: Due to shortage of resources and downsizing, low staff moral was evident, two very enthusiastic consultants ran the operation of the Center. The Burns Center conducted daily ward round that was attended by most members of the team, it was felt that daily round would facilitate better communication and streamline discharge planning. In addition to daily round, there were weekly grand round, which gave staff the opportunity for Departmental inservices and weekly audit of services provided. To further centralize burns services, the Center was attempting to integrate the Outpatient Clinic into the Burns Unit, by converting 2 single ward rooms into outpatient consultation rooms. The Center endorsed the belief that “pressure garment therapy did not play a role in the rate of maturation of the closed burns wound”, as described by Chang et al (2), pressure garment was only ordered when keloid scar had developed. Rehabilitation of burns was mostly provided by the therapists of the Burn Center, the annual burns rehabilitation referral to Spaulding Rehabilitation Hospital was usually very low (1-2 annually). Research The Burn Center had developed a very good competency package for Burn Nursing, a research nurse was newly appointed to oversee research activities for the Burn Center.

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SHRINERS BURNS INSTITUTE

BOSTON, USA

JUNE 10 - 13, 1996

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SHRINERS BURNS INSTITUTE, BOSTON, USA ( JUNE 10 - 13, 1996 ) Shriners Burns Institute, Boston (one of the three Shriners Burns Institute) was a thirty-bed paediatric Burn Institute with 12 acute burns (including ICU) beds and 18 reconstructive beds. The Institute was a very dynamic Hospital with patient/family centered care philosophy, the Institute conducted 8 outreached clinic each year to the distant clients. The Team: Chief of Staff: Professor Ronald Tompkins Assistant Chief of Staff: Dr Robert Sheridon Consultant: Dr Colleen Ryan Director of Rehabilitation: Ms Monica Pessina Rehabilitation therapists: Mary-Jo Baryza (Research Physiotherapist) Hilary Gresser (OTR) Cathie Miller (OTR)

Kim Prodanas (PT) The Program: • Meeting and spending time with members of the Burns Team; • Attended Rehabilitation Department handover meeting; • Attended grand round and discharge planning meeting; • Attended Burns & Plastics Surgery Outpatient Clinic; • Attended Inservices and research meeting; • Exchange and sharing in treatment principles and techniques with various members of the

burns rehabilitation team; • Visited Spaulding Rehabilitation Hospital regarding burn rehabilitation in children; • Gain insight of research currently happening in Burns Institute and Rehabilitation Services. Findings: The Center had a very dynamic Rehabilitation Services, which adopted a generic therapist approach, a rehabilitation therapist could be either a PT/OT, through a very well established competence package for rehabilitation staff, in-house cross training for the two professions was provided. A half time physiotherapist was employed to oversee and design various research activities for the Institute, “Plexiglas tool for Burn Scar Index” is one of the research outcome from research therapist Mary Jo Baryza (6). Use of Fluidotherapy (7) in burns: Fluidotherapy uses air fluidized solid as a heat transfer medium in thermal therapy application coupled with massage and pressure fluctuation, used instead of water, paraffin or air. The fluidized bed behaved like a low viscosity fluid - patient could exercise freely as in the bath almost as freely as in water. It was found to be particularly useful for hand, arm and foot burns for functional training and desensitization. Rehabilitation of burns was mostly provided during inpatient stay, except very complicated case(s), referral to Spaulding Rehabilitation Hospital was rare. 6. Baryza et al, “The Vancouver Scar Scale: An Administration Tool and Its Interrater Reliability”,

Journal Burn Care and Rehabilitation, 1995; 16:535-8. 7. Henley EJ., “Fluidotherapy: Clinical application & Techniques”, Physical & Rehabilitation

Medicine, CRC Press, 1991: Vol. 3, 2:151-173.

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SELLY OAK HOSPITAL

BIRMINGHAM,UNITED KINGDOM

JUNE 17 - 21, 1996

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SELLY OAK HOSPITAL, BIRMINGHAM,UNITED KINGDOM ( JUNE 17 - 21, 1996 ) The Burns Unit, Selly Oak Hospital in Birmingham was purpose-built in November 1995, the Unit consisted of 14 adult beds ( 4 high dependency and 10 acute beds ) and 6 paediatric beds, amounting to a total of 20 beds. The Plastics Surgical Unit was fully integrated into the Burns Unit. The Burns Unit Complex had in-built operation theatre and conference facilities, but did not provide ICU burn services. The outpatient department, though separated from the ward, was situated within the Burns Unit Complex. The outpatient department offered a once-a-month cosmetic camouflage session (given by volunteers from The Red Cross) facilitating improvement of cosmetic outlook and psychosocial support for their burn clients. The Team: Head of Burns Unit: Mr Rayners Consultant: Mr John Gowar

Mr Peart Ms Rona Slator

Nursing Manager: Sr Alison Poole Physiotherapist: Ms Maureen Morton Ms Lisa Simpson Occupational therapist: Ms Ginny Puzey Play therapist: Ms Helen King The Program: • Meeting and spending time with members of the Burns Team; • Attended daily doctors’ handover meeting and ward round; • Attended Burns & Plastics Surgery Outpatient Clinic; • Attended weekly grand round and inservices; • Exchange and sharing in treatment principles and techniques with various members of the

burns/plastics surgical team; • Observe burn and plastics surgery; • Visited West Heath Rehabilitation Hospital regarding burn rehabilitation; • Gain insight of research currently happening in Burns Unit and Rehabilitation Services. Findings: To facilitate continuity of comprehensive care, nursing staff from the ward was rostered for a one-month rotation to the outpatient clinic, staff found the rotation very rewarding. The Unit had a well-established mentor system for medical staff training; communication of the Burns team was enhanced by daily round and weekly grand round with staff inservice. Ms Helen King was a very dynamic play therapist, she was currently involved in a research study “on emotional effect of burn injury to children”. As for rehabilitation, therapists within the team were new and not very experienced, community rehabilitation resource for burns was minimal due to lack of skilled staff. Generally, a short physiotherapy session was given during outpatient visit, pressure garment was manufactured and supplied by the occupational therapy department. West Heath Rehabilitation Hospital provided rehabilitation for severe burns where necessary, however, due to the low number of referrals (1-2 yearly), the rehabilitation staff felt that they were not adequately trained/supported to provide optimal burn rehabilitation.

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GLASGOW ROYAL INFIRMARY

CANNIESBURN HOSPITAL

GLASGOW, UNITED KINGDOM

JULY 1 - 9, 1996

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GLASGOW ROYAL INFIRMARY AND CANNIESBURN HOSPITAL, GLASGOW, UNITED KINGDOM ( JULY 1 - 9, 1996 ) Glasgow Royal Infirmary (GRI) was a 202-year-old hospital, the Burns Unit was situated at the basement of the old hospital building, there was proposed plan to rebuild and upgrade the facilities of this 19-bed Unit. Since the retirement of Professor William Reid, the previous head of the Burns Unit in 1995, the Unit was headed by two young plastics surgeons from the Plastics Surgical Unit of Canniesburn Hospital (CH). The annual admission of the Unit was around 300, due to the social circumstances of the burn admissions in Glasgow (mostly unemployed or drug/alcoholic dependent) there was necessity to run a methadone program within the Burns Unit. The Team: Consultants: Mr Ian Taggart Ms Stewart Watson Registrars: Mrs Eva Weiler-Mithoff Mr Charles Malata Nursing Manager: Sr Boner (GRI) Physiotherapists: Susan Hasting (GRI)

Cassandra Harkness (CH) Catrina Futter (CH) Occupational therapist: Ann McCall (CH) The Program: • Meeting and spending time with members of the Burns Team and Plastics Surgical team; • Attended Burns & Plastics Surgery Outpatient Clinics; • Exchange and sharing in treatment principles and techniques with various members of the

burns/plastics surgical team; • Observe burn and plastics surgery; • Gain insight on current changes in burn practices and proposed future development of

burns management. Findings: The two young Plastics Surgeon were very enthusiastic, before taking up the position to lead the Burns Unit, they had both spent three months intensive training at Galveston Shriners Burns Institute. Both Mr Ian Taggart and Stewart Watson were keen to bring about some changes in burns management, and planned to integrate outpatient services into the new Burns Unit. Already hydrocolloid dressing was starting to be used in the outpatient setting, however, due to resistance to change by the old staff, both consultants believed that it would take a long time for effective changes to occur. Even though the current facilities and resources were very restricted, the level of care delivered especially those by the Plastics Surgeons were excellent. Mr Ian Taggart said, “It is not so much the venue and the facilities that matters, it is the dedication of the people that really counts! Environment is not a crucial factor, the main factor is to keep people interested in treating Burns.”

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HVIDOVRE HOSPITAL

COPENHAGEN, DENMARK

JULY 11 – 19, 1996

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HVIDOVRE HOSPITAL , COPENHAGEN, DENMARK (JULY 11 – 19, 1996 ) One of the two burns centers in Denmark with a population of roughly 5.1 million. The Burn Center, Hvidovre Hospital was a 32-bed Burn Center consisted of 10 acute severe burns bed, 5 reconstructive beds and 17 subacute/rehabilitation beds. The Burn Center did not offer ICU management for severe burns. The Plastics Surgical Unit was fully integrated into the Burns Unit. In the last few years, the Unit had successfully proven to their government that Hvidovre Burn Center was much more cost effective in treating burns than other hospitals in Denmark, thus instead of downsizing, Hvidovre Hospital was expanding, funding was provided to allow for inpatient burns rehabilitation. The Team: Chief Surgeon: Mr Bjarne Alsbjorn Consultants: Dr Thomsen

Dr Nielson Physiotherapist: Ms Bolette Draslov The Program: • Meeting and spending time with members of the Burns Team; • Attended Burns Outpatient Clinic; • Exchange and sharing in treatment principles and techniques with various members of the

burns and rehabilitation team; • Gain insight of research currently happening in Burns Center and Rehabilitation Services. Findings: The time of visit was the national holiday season, the Burn Center was only operating in half its usual capacity, therefore not all members of the Burns Team was present. Overall, the Center was very different and dynamic. Most patients upon admission, would be managed by open (nude) method in a temperature regulated single room, to enable superficial and partial thickness burn area to scalp and peeled off naturally. Area that took longer than two weeks to heal would be grafted surgically. A very dynamic functional approach (using early functional activities and activities for daily living) was administered, substituting the conventional physiotherapy modalities such as passive stretches and splinting. Very experienced burns physiotherapist Ms Draslov found functional activities to be much more successful in preventing contractures and achieving best rehabilitation outcome. The Burn Center was planning to develop research activities regarding the followings: - developing rehabilitation links for families far away from Center and/or patients from deprived background; - to enhance outreach education to therapists or carers; - to investigate how and what made scar differed with different patient groups.

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CONCLUSIONS Listed below were all the lessons learned from the visits of the seven Burn Centers: • Integration of Plastics Unit with the Burns Unit for better outcome; • Integration of ICU beds (where resources allowed ) into Burns Unit for better continuity of

care; • Close proximity and liaison of Outpatient Clinic with the Burns Unit; • Multi-disciplinary communication meeting to facilitate patient/family centered care and

streamline discharge; • Strategies for on-going rehabilitation management; • Primary therapist concept for better holistic management; • Outcome orientated data collection; • Current research on pressure therapy and scar assessment. The experiences gained from this study so far had been tremendous and rewarding, it had not only given the author the opportunity to validate the current practices of the Alfred Hospital Burns Unit, in addition, it provided the Unit with another dimension of evaluating and considering services delivery. The current research, objective data collections and assessment formats used overseas would be very beneficial to the Unit and other Burns Unit in Australia. The above lessons learned had been disseminated to member of the Alfred Hospital Burns Team, and the Rehabilitation Team of Caulfield General Medical Center during August to December 1996 through formal and informal channels. In early 1997, the author conducted a SWOT (strengths, weaknesses, opportunities and threats) Analysis of the Alfred Hospital Burns Unit and a climate for change was cultivated. Strengths: Threats: Known recognition Shrinking health dollars Comprehensive services Funding issues High standard of care Shrinking client size Team with expertise Advances in technology Strong dynamic Team Advances in research Dedicated Staff Competitors Technological support Ethical dilemma Fund raising capacity Unrealistic expectations The new Burns Unit Weakness: Opportunities: Lack of clear strategic directions Setting strategic goals Lack of research and development Improve data collection system Inadequate communication Implement QA processes Lack of human resources management Enhance education & training Internal operational problems Promote research & development Weak market image Enhance staff/team support Lack of collaboration Promote market image Inadequate after-care services Promote/participate in prevention Staff burns out Establish new services Funding issues Improve communication

& collaboration Expand service support to Asia The Burns Unit Development Day for strategic planning of Burns Unit was initiated by the author at 6th

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February, 1997. The Development Day was attended by 33 professionals from the Alfred Hospital Intensive Care Unit, Burns Unit, Outpatient Department and the Rehabilitation Services of Caulfield General Medical Center. The forum provided the opportunity to brainstorm suggestions, facilitated open discussions and formulation of strategies for delivering better-integrated care to the burn clients at the Alfred Hospital. The outcome of the Burns Unit Development Day resulted in: a) The establishment of the bi-monthly BURNS UNIT PROFESSIONAL MEETING -

the first professorial forum for burns to facilitate education and development. b) The formation of four major work groups, namely:

• Data Collection and Outcome Measure Group • Burn Dressing and Wound Management Group • Psycho-social Assessment and Burns Support Group • Nutrition Group

c) Two researches studies in burns, titled: I) “Pilot study to investigate long term psychosocial adjustment to serious burn injuries”, and II) “The quality and quantity of vocational rehabilitation and its influence on return to work rates for burns patients”.

The aims of strategic planning were to: • Provide best practice for integrated patient-centered care to the burn survivors from acute

to ultimate rehabilitation; • Provide better data collection system enhancing outcome orientated management; • Develop and enhance research and development of burns management; • Promote the image, publicity and visibility of the Alfred Hospital Burns Unit as the sole • Victorian Adult Burn Center; • Enhance strengths, neutralize or circumvent weaknesses, maximizing opportunities and • minimizing threats, to sustain viability and growth. The lessons learned and the practical changes implemented at the Alfred Hospital Burns Unit was presented to all staff of the Alfred Healthcare Group on 3rd April, 1997 with great success and very positive response. The above details shall be presented by the author to members of the Australian and New Zealand Burns Association at the forthcoming National Conference in Queenstown, New Zealand in September 1997. The Burn Unit work groups are planning to present their achievement at the December meeting of the Burns Unit Professional Meeting. Through active participation, continuous improvement, collaboration and teamwork, the Alfred Hospital Burns Unit shall continue to provide the best patient-centered care to the Australian community.

“We learn by doing, by being involved, by being active.

Our interest makes us Active!”

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BIBLIOGRAPHY Baryza MJ and Baryza GA, “the Vancouver Scar Scale: An Administration Tool and Its Interrater Reliability”, Journal of Burn Care & Rehabilitation, 1995. Chang P, Laubenthal KN, Lewis RW, Rosenquist MD, Lindley-Smith L, and Kealey GP, “Prospective Randomized Study of the Effect of Pressure Garment on the Rate of Wound Maturity in Burns Patients”, Journal of Burn Care & Rehabilitation, 1995. Cromes GF and Helm PA, “The Status of Burn Rehabilitation Services in the United States: Results of a National Survey”, Journal of Burn Care & Rehabilitation, 1992. Heimbach D, Burn Pearls, 14th Edition, University of Washington Burns Center at Harborview, 1995. Henley EJ., “Fluidotherapy: Clinical application & Techniques”, Physical & Rehabilitation Medicine, CRC Press, 1991. Moore M, Mann R, Yeong EK, Colescott D and Engrav LH, “Do Custom Fitted Pressure Garments Provide Adequate Pressure?”, American Burns Association Meeting Abstracts, 1995. Yeong EK, Mann R, Engrav LH, Goldberg, and Lee J, “Improved Burn Scar Assessment Using New Scar Rating Scale”, American Burns Association Meeting Abstracts, 1995:82

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“Desire is the key to motivation, but it’s the determination and commitment to an unrelenting pursuit of your goal – a commitment to excellence – that will enable you to attain the success you seek.”

Mario Andretti

Race Car Driver

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