POPULATION OF INTEREST

All burn casualties (as identified by diagnosis code).

INTENT (EXPECTED OUTCOMES)

1. All burn patients with GCS < 8, symptomatic inhalation injury, deep facial burns, or burns ≥ 40% receive a definitive airway (endotracheal tube, cricothyroidotomy, or tracheostomy) prior to interfacility transfer (Role 2 to Role 3 or Role 3 to Role 4).
2. All patients with burns ≥ 20% TBSA receive formal fluid resuscitation documented on the burn flow sheet.
3. Urine output is documented for any patient undergoing fluid resuscitation.
4. Debridement (cleansing) of wounds with a surgical antiseptic to remove blisters and debris and application of a topical antimicrobial occurs within 24 hours of injury.
5. Escharotomy is performed for circumferential full-thickness burns.

PERFORMANCE/ADHERENCE METRICS

1. Patients with burns ≥ 40% TBSA or GCS < 8 or inhalation injury with AIS severity code > 1 or facial burns with face AIS >2 who receive a definitive airway (endotracheal tube, cricothyroidotomy, or tracheostomy) at first surgical capability.
2. Patients with burn ≥ 20% TBSA who have burn flow sheet completed.
3. Patients have UOP documented during fluid resuscitation.
4. Patients who undergo debridement and application of a topical antimicrobial within 24 hours of injury.
5. Patients with circumferential full-thickness burn who receive escharotomy.

DATA SOURCE

- Patient Record
- Department of Defense Trauma Registry (DoDTR)
- Burn Navigator data.

SYSTEM REPORTING & FREQUENCY

The above constitutes the minimum criteria for PI monitoring of this CPG. System reporting will be performed annually; additional PI monitoring and system reporting may be performed as needed.

The system review and data analysis will be performed by the Joint Trauma System (JTS) Chief and the JTS PI team.

RESPONSIBILITIES

It is the trauma team leader’s responsibility to ensure familiarity, appropriate compliance, and PI monitoring at the local level with this CPG. It is the responsibility of the nurse assigned to the trauma patient to ensure the Burn Navigator or Burn Flow Sheet (Appendix D) is initiated and completed.