1. Introduction
Pinderfields Regional Burn Centre serves a population of approximately 5 million, spread across 3000 square miles of Yorkshire and North Lincolnshire. In the past 5 years, we have seen an average of 1028 adults and 795 of children new referrals each year. All children and many of adult patients are accompanied by carers or relatives. In compliance with the national guidelines for burn injury management during the COVID-19 pandemic [1], we made some changes to the referral pathway and follow-up protocol aiming at limiting hospital visits without compromising the standard of service.
2. Our Eexperience
2.1. Telemedicine and Outreach Soutreach service
Online burns consultation and referral system was adopted by our burn centerre in May 2019. Medical Data Solutions and Services (MDSAS) software has been used to give advice as regard to initial management and transport arrangements, mainly for patients who are referred from distant units, until they arrive for assessment.
In response to COVID-19 situation, all burn patients referred to Pinderfields Burn Center, including those presented to our trust emergency departments, get an MDSAS referral form created. This is to generate a unique QR code, for each patient, that is used for secure upload of clinical photographs.
In selected cases, with small burn wounds that are manageable by dressing changes at home, patient are provided with a printout of their unique QR code. They are advised to upload photos of their burn wounds on each dressing change for virtual clinic follow up. Patients are reassured that by using Secure image Data smartphone app (SiD), images are not saved to the device and are automatically transferred in an encrypted format and stored in a secure NHS data centre. They are also provided with ‘Patient Information Leaflet’ for further guidance. Supply of dressings is posted or delivered to these patients. Further follow ups are carried out by outreach nurse visits or phone consultations, as appropriate. Burn physiotherapist attend some of these visits as required.
2.2. MDT meetings
Daily MDT meetings take place every morning with limited number of staff members to comply with social distancing. To ensure that patients are still managed safely and at high standards, all referrals, clinical photos and follow up plans are presented and discussed in presence of burn consultant, senior nurse, and burns physiotherapist.
Between 24th March– and 20th April 2020, we were referred 121 patients (49 children and 72 adults). 74 patients were seen by burns on-call team at Pinderfields Hospital (33 children and 41 adults). Of these, 37 required admission (21 children and 16 adults). In 47 cases, advice was given to the referring unit about dressing management, and further arrangements were made for virtual clinic follow up and/or outreach visits as required.
2.3. Burn Pphysiotherapy services
Patients who require burns physiotherapy therapy input, as advised during the daily MDT meeting, are followed up via phone or Attend-Anywhere video consultations. Only urgent cases who require splinting and ‘hands on’ stretches are offered face to face appointments. Secure departmental NHS email account is used to communicate information to patients such as leaflets and photographs.
2.4. Psychology services
Patients who require psychological support or input are identified and discussed during the daily MDT meeting. Our adult and paediatric psychologists are provided with patients’ contacts. Phone or Attend-Anywhere video consultations are arranged as appropriate.
2.5. Scar Cclinics
Attend-Anywhere video consultation is used to run scar clinics by burn consultant, therapist, and psychologist. Telephone appointments and uploading photos are offered, as an alternative, if more suitable and convenient to patients.
Pressure garments are posted, by our therapists, to the patients who do not need re-measuring. Other scar treatments such as silicone products are also provided, with information leaflets, following video consultations or review of clinical photographs.
2.6. Staff Wwellbeing
Video and phone psychology live sessions are available every day, including weekends, to support our trust clinicians. Links to generic psychological support sessions are provided; these are bookable via trust intranet to enhance availability of support across the week.
3. Discussion
Managing burn centre that serves big population during the current COVID-19 pandemic is challenging. This is more difficult when the burn centre is located within a hospital with a big number of COVID-19-positive inpatients. We are sharing our experience in limiting patient visits to our burn centre by putting more effort in telemedicine, virtual clinics, MDT discussions and outreach follow ups to ensure that a high-standard service is provided to these patients.
Funding
None.
Conflict of interest
None.
Acknowledgments
We thank our consultant burn surgeons Mr Alan Phipps, Miss Orla Austin and Mr Umair Anwar; consultant psychologist Dr David Aaron; senior burn therapist Ann Sanderson; charge nurse Claire Swales, senior outreach nurse Nicole Rayner and all burns team at Pinderfields Hospital for their valuable input, personal communications and comments.
References
- 1.British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS). COVID-19 Advice for Madvice for members. Burns services and COVID-19. BAPRAS website http://www.bapras.org.uk/docs/default-source/covid-19-docs/burns-covd19.pdf?sfvrsn=2 (Accessed April 17, 2020). [accessed 17.04.20].