Last month, the University of Colorado Burn Center underwent the American Burn Association (ABA) Survey, a verification process that occurs every three years. The Burn Center has achieved continual verification since its first ABA Survey in 1998, and that trend continues this year. The Burn Center received its verification confirmation on May 19, 2021, to continue through April 2024.
Anne Wagner, MD, medical director of both the Burn Center and associate professor of surgery, says the team is “really happy with the way the survey turned out.”
“Not to have any deficiencies — that’s a big deal,” she says.
The Burn Center is the first and longest-standing ABA-verified burn center in the Rocky Mountain region and one of only two in the state of Colorado. Wagner and the other two attending physicians — Arek Wiktor, MD, the Burn Center’s associate director, and Patrick Duffy, MD — along with their multidisciplinary team care for approximately 550 patients each year.
The Burn Center treats a variety of conditions, including thermal burns, electrical burns, lightning injuries, chemical burns, frostbite and hypothermia, degloving injuries, and soft-tissue diseases.
“We treat the whole patient,” Wagner says. "After their initial clinical care, we continue to work with the patient, even after discharge, and many of them belong to our peer support group called SOAR (Survivors Offering Assistance in Recovery). We also do laser treatments and reconstructive surgeries for patients, so we follow many of them for years.”
Navigating a new burn survey format
This year’s Burn Survey was markedly different from years past. Due to COVID-19, the “visit” was virtual instead of in-person. The CU Burn Center was the first in the country to go through both the virtual survey format as well as a new assessment tool called the Burn Quality Improvement Program (BQIP), a developing ABA program to collect more data from burn centers, such as outcomes, complications, and processes of care. The aim is to merge this data with existing patient data in the National Burn Repository to better identify patient risk factors as they relate to outcomes.
"The verification process takes about a year of preparation, even for centers that are already verified,” Wagner says. “It's always a lot of work. And this year, the pre-review questionnaire that we sent through the new BQIP process was 873 pages long. It’s meant to answer a lot of the verifiers’ questions before they get here, so that they can complete the verification in a shorter amount of time.”
Despite the extra work, Wagner says she was happy to put in the effort. “The ABA worked really closely with us, and they're very excited that we were the first center to do this for them. We were excited to kick it off, knowing that at some point in the future it will save us and other centers a lot of time.”
Survey strengths and suggestions
Another change from past surveys was that this year’s survey team included not just two burn surgeons, but also a nurse and a physical therapist, illustrating the ABA’s dedication to a more holistic approach to burn care.
Some of the main CU Burn Center strengths the survey team noted included:
- Robust and well-appreciated program with excellent institutional support and a collaborative team and environment.
- Research is impressive and has improved significantly since the last survey.
- Palliative care program involvement with Burn Center.
- Psychosocial support for the program is commendable.
- Collaboration with emergency medical services through education and follow up.
- Growth and development of telehealth to reach patients across the region.
- Infection control collaboration and performance improvement.
- Nursing collaboration and support is very strong throughout the care continuum.
- Nursing clinical ladder program is robust.
- Nurse-driven burn resuscitation protocol is novel and should be further shared through publication.
- In-house inpatient rehabilitation is remarkable.
- Sensible and balanced leadership in the therapy space that promotes depth and education for therapy providers.
- Clinical ladder for burn therapists.
- Well-developed competency system for therapists and nursing staff.
Wagner is thrilled that the survey team recognized the improvements the center has made since its last verification, especially in the realm of research.
“When we got verified last time, we had almost no research that had been independently published,” she says. “This time, we had about 32 published papers, and we have 22 active Institutional Review Boards. So, we are seen as very robust research program now.”
Another boon was its new telehealth program. “They were excited about our telehealth program and felt that it would continue to benefit our patients even after the pandemic,” Wagner says. She says the pilot telehealth clinic that the Burn Center established in Montrose, Colorado, has been “working beautifully” and that they’ve already received around a 300% increase in referrals from that part of the state. Wagner predicts that the building out the Burn Center’s telehealth network will help decrease the average hospital length of stay, one of the survey team’s recommendations.
“Our patients who live within 100 miles have an average hospital length of stay of 11 days, but patients who live farther out have an average length of stay of 19 days,” Wagner says. “So, those numbers are skewing our overall numbers. With telehealth, we’ll be able to shift some of that aftercare to virtual visits.”
The survey team was also impressed by the Burn Center’s educational outreach to other health care facilities. Before the pandemic, Wager spent much of her vacation time traveling to far-flung hospitals and clinics in Montana, North and South Dakota, Wyoming, New Mexico, and other states to educate health care providers on the latest in burn care. She hopes that this education will not only help these facilities provide better care to their own patients, but also prime them as potential telehealth partners in the future.
During the pandemic, the Burn attending surgeons have continued to offer virtual education over platforms like Zoom.
“Those have been tough, since you can’t tell how people are reacting to you,” Wagner admits. “But last week I was in the operating room and one of the nurses came up to me and said, ‘My husband works for Life Flight and he saw one of your talks and said it was the best presentation he's seen all year.’ That was really gratifying to hear. I always hope I’m helping.”
Even when the survey team offered constructive criticism, it was usually suggestions for improvements rather that corrections. “They were always quick to say, ‘This is actually a strength, but you could do even better,’” Wagner explains.
For instance, the survey team encouraged the Burn Center to continue growing its already strong psychosocial support program, which Wagner plans to do by hiring a new burn psychologist and two additional social workers, as well as reenacting the center’s burn psychology fellowship, which just received funding.
“I'm also looking at expanding the role of our social workers so that they will do more counseling on mental health and addiction, since we have a fairly large percentage of patients that have one or both of those diagnoses,” Wagner adds.
What’s next for the CU Burn Center
Wagner’s biggest priority for the Burn Center is to continue growing the team over the next few months. In addition to the new burn psychologist and social workers, she hopes to hire additional advanced practice providers and burn therapists, a dedicated Doctor of Pharmacy, and another burn surgeon.
“When I came here in 2015, we had four surgeons and were admitting about 300 patients a year. Now we have three providers and more than 550 patients a year,” Wagner says. “Both we and the survey team want us to improve that number.”
She’s also excited to continue the Burn Center’s focus on research, including publishing the research coming out of the Burn Center nurses’ multiple leveling-up projects.
“Our nurses are doing some really cool stuff with their projects, from updating our current protocols to launching brand-new projects.” Wagner cites one project by Kelley Tuohy, a Burn Center charge nurse, that had a particularly significant impact: “She started screening patients for acute stress disorder and post-traumatic stress disorder. We were the first place in the hospital to do that, and we were able to leverage what we learned to hire a burn psychologist to work with those patients both during and after their hospital stays.”