Table 3.

Results PJM tool Spreadsheet One. Scientific standards and family and healthcare providers meeting standards

Burn care standards [30–32, 34, 35]	The injury	Emergency care	Ambulatory care	Admission	In-patient care	Discharge	Rehabilitation
Standards achieved by healthcare service and healthcare professionals	⋅ 20 min cool running water within first 3 h ⋅ Remove jewellery and clothing ⋅ Cover with non-adherent dressing ⋅ Seek medical assistance ⋅ Keep warm ⋅ Provide access to basic online first aid training on burn injury to target the community ⋅ Ensure first aid courses contain burn first aid content		⋅ Burns greater than 5% in children ⋅ Full Thickness burns greater than 5% ⋅ Burns of special areas ⋅ Burns in very young ⋅ Children up to their 16th birthday should be transferred to a children's burn unit ⋅ Metro clients access tertiary facilities directly, and outer regions require routine links to tertiary facilities ⋅ Access to specialist service	⋅ Consult with a burn surgeon ⋅ Access to physiotherapy, · occupational therapy, social work, speech pathology, nutritional support, clinical psychology ⋅ Ambulatory burn clinic provides assessment and dressing of minor and non-severe burns, rehabilitation interventions, follow-up burn dressing and skin graft management for patients after discharge ⋅ long-term scar management and symptom control ⋅ patient and family teaching and support ⋅ ongoing complication risk management and treatment ⋅ advisory service to other hospitals, healthcare professionals and community	⋅ Social worker undertakes thorough psychosocial assessment to review family history and address psychosocial issues in the acute phase ⋅ Accurate assessment undertaken in the ED in accordance with the admission guidelines for individual burn unit ⋅ Laser Doppler Imaging to assess depth ⋅ Rehabilitation starts on admission and whole patient and family are considered when addressing rehabilitation needs ⋅ Care plan is developed and documented and reviewed on a continual basis . Case management is commenced on admission ⋅ Allied health contributes to all stages of continuum of care guided by clinical practice guidelines ⋅ Nurses provide holistic care and are integral to patient care from point of admission to rehabilitation to ambulatory care ⋅ Multi-disciplinary teams coordinate individual clinical pathways ⋅ Each discipline contributes to treatment plan	⋅ Social work and clinical psychology provide assessment and intervention ⋅ Dietician assessment for burns > 10%, < 1yo, burn to mouth/hands ⋅ Nursing staff work closely with comprehensive pain management service incorporating a range of modalities and including non-pharmacological and complementary therapies ⋅ Care plan incorporates rehabilitation throughout all stages of care starting at time of injury and family are considered when addressing rehabilitation needs ⋅ Major burn patients should be assessed within 24 h of admission by physiotherapy OR occupational therapy ⋅ Multidisciplinary plan of care · Allied health contributes to all stages of continuum of care guided by clinical practice guidelines ⋅ Multi-disciplinary teams coordinate individual clinical pathways ⋅ Receive multi-disciplinary inpatient care ⋅ Each discipline contributes to treatment plan ⋅ Burn injury team liaises with microbiology and infection control ⋅ The burn injury team works closely with the pharmacist in the management of care ⋅ State-wide e-health service supporting consultant-led on-call advisory service ⋅ Patients managed in ICU require coordination of wound care by burn care nurses ⋅ Access to pathology services ⋅ Nursing staff provide holistic care ⋅ 24 h access to operation rooms ⋅ Paediatric treatment rooms · Child protection unit involvement	⋅ Pharmacist to provide regular information to child, family, carer on medication at admission and discharge ⋅ Allied health contributes to all stages of continuum of care guided by clinical practice guidelines ⋅ Social work and clinical psychology provide assessment and intervention ⋅ Address psychosocial issues, prior to discharge . Case management for complex cases continues throughout long-term care to facilitate periodic re-assessment and monitor changes in functionality ⋅ Patients to receive 'Nutrition for burns' pamphlet prior to discharge
Standards not achieved by healthcare service and healthcare professionals			⋅ Provide 7 day/week ambulatory burn service co-located with acute inpatient burn unit ⋅ Burn injury patients have access to ‘hospital-in-the-home’ services post inpatient discharge	⋅ Clinical psychology provides assessment and intervention at admission	⋅ Comprehensive nursing care plan developed in consultation with patient and/or caregiver on admission to unit	⋅ Facilitated early discharge by accessing ‘hospital-in-the-home’ services, and by using a step down to local non-tertiary hospital for transition to rehabilitation	⋅ Use telehealth for ongoing post-acute care of burn patients ⋅ Rehabilitation team provides referral to external rehabilitation facilities for ongoing management ⋅ Be referred to OT/physio at local services where available, with support from burn unit therapists ⋅ Patients and families continue to receive psychosocial intervention and refer to other agencies where required
Standards not applicable for this burn care journey		⋅ Inhalation, electrical, circumferential and chemical burns ⋅ Burns with illness ⋅ Burns with major trauma ⋅ Any burn where the referring worker requires management or advice from the paediatric burn service ⋅ Burn injury with suspicion of non-accidental injury ⋅ Appropriate communication and management instigated for interstate transfers within 4 h ⋅ The facility who has first contact with the burn injury contacts the unit for support and advice ⋅ For minor burns, communication with unit regardless of confidence in assessment and plan of care ⋅ For moderate burn, communicate with unit early and adopt recommended guidelines ⋅ Laser Doppler technology is used to assess depth ⋅ Initial assessment in ED where staff communicate with state unit, providing 24-h turnaround service via email images for clinical advice	· accept patients referred from a hospital emergency department, general practitioners, other hospitals, community health services, or self-referred ⋅ burn injury of up to 10% of total body surface area may be managed on an ambulatory basis · Outpatient community care may include home, school, pre-school and workplace visits ⋅ Referral to dietician if deemed to be at nutritional risk; followed by nutritional assessment for social and cultural needs ⋅ Use of step-down facility to allow access to ambulatory care services for rural and remote families ⋅ patients with a burn who require surgery, with interim burn care until the day of surgery	⋅ Emergency surgery within 24 h post-deep circumferential burn ⋅ Access to Burn Unit is dependent on post-assessment classification of the burn injury using E-health Outreach Service via non-specialist centres for regional/rural/remote	⋅ Education teacher on daily basis ⋅ Psychosocial assessment focussing on the accident causing injury and family member’s perceptions around this, past experiences of trauma, family dynamics, cultural and socio-economic factors, barriers to coping and family strengths and supports ⋅ Long term access to psychological support	⋅ Provide access to sub/acute/step-down facilities ⋅ Referral to community agencies for support at home if required
Standards unable to be assessed			⋅ Staff attending burn patients in outpatient setting observe standard precautions at all times, including hand hygiene and aseptic non-touch technique and relevant PPE				⋅ Step-down facilities are linked to acute services to achieve a seamless continuum of care ⋅ Provide access to burn camps for children ⋅ Contribute to cooperation between family and school ⋅ Visit school with burn team to educate
Data from Case Notes and discussions (where able) regarding how standards were/were not applied
Caregiver	Had completed first aid training		Accessed emergency ambulance care	Travelled in private car to appointments. From daily dressing to once every 6 weeks	Time in emergency department then transferred to ICU	Four days in ICU (and staying at home at nights) and four weeks in surgical unit (staying at home and sometimes in hospital)	Travelled home in private car. Felt hurried out and inadequately prepared to provide necessary at-home care
Family	N/A		Contacted by phone after accident occurred	Travelled in private care with caregiver occasionally	Arrived at hospital after admission to ICU	Visited often in private car
Aboriginal Health Worker (AHW)	No AHW employed		No AHW employed	No AHW employed	No AHW employed	No AHW employed	No AHW employed
ACCHS	Not accessed by the family		Not utilised by the family	Not accessed by the family	Not utilised by the family	Not utilised by the family	Not utilised by the family
Emergency Care Provider	Not able to contact place of injury or those present at time of injury		Not able to contact Ambulance worker Case Notes: Mandatory notifications made	N/A	N/A	N/A	N/A
Surgeon	N/A		N/A	Consults as necessary	Surgical assessment within 4 h of admission to hospital	Surgical intervention	Discharge note made
Burn Nurse	N/A		N/A	Arranged care appointments and supported caregiver in minimising time spent in hospital	Support transition to ICU and then to ward. In regular contact with caregiver and giving constant information	Developed initial care plan. Led case conferences with medical staff. Involved multidisciplinary team. Reviewed at least daily	Gave information regarding required care Arranged follow-up appointments
A/ILO	N/A			No support provision	Not notified	On A/ILO list. Seen and offered support. Did not attend case conferences	Seen prior to discharge and support offered
Traditional Healer	N/A		No traditional healer employed	No traditional healer employed	No traditional healer employed	No traditional healer employed	No traditional healer employed
Occupational Therapist	N/A		N/A	Consults in scar clinic	Assessed within 8 h of admission	In patient care provided. Attended case conference Input into care plan	Discharge note made
Physiotherapist	N/A		N/A	Consults in scar clinic	Assessed within 24 h of admission	In patient care provided. Attended case conference Input into care plan	Discharge note made
Psychologist	N/A		No input into care. Not able to be contacted	No input into care. Not able to be contacted	No input into care. Not able to be contacted	No input into care. Not able to be contacted	No input into care. Not able to be contacted
Social Worker	N/A		Attended ED. Supported, engaged and explained	No input into care	Able to provide support to caregiver and available for all level 1 trauma	Provided initial assessment of caregiver, supported, engaged and provided intervention where necessary and supported access to fuel and food vouchers. Attended case conference	Discharge note made