Work at the Centre for Global Burn Injury Policy & Research has been collated into various forms of publications including informative posters, presentations, articles, and papers. We are able to share some of these with our community and those interested in global health, specifically burn care.
Practical Guide to Quality Improvement for Burn Care
This guide is an educational tool, which provides a practical 8 step framework for quality improvement in burn care in low-resourced settings. This has been developed together with nurses from Ethiopia and Malawi, who were participants of our QI course for nurses.
Read below or download the pdf. Share with others using this link: Guide to QI for burn careA Practical Guide to Quality Improvement for Burn Care
The cost of inpatient burn management in Nepal
Authors: Narayan Poudel, Patricia Price, Julia Lowin, Rojina Shilpakar, Kiran Nakarmi, Tom Potokar
Abstract: The management of burns is costly and complex with inpatient burns accounting for a high proportion of the costs associated with burn care. We conducted a study to estimate the cost of inpatient burn management in Nepal. Our objectives were to identify the resource and cost components of the inpatient burn care pathways and to estimate direct and overhead costs in two specialist burn units in tertiary hospitals in Nepal.
Published in: Narayan Poudel, Patricia Price, Julia Lowin, Rojina Shilpakar, Kiran Nakarmi, Tom Potokar, ‘The cost of inpatient burn management in Nepal’, Burns, 2021. https://doi.org/10.1016/j.burns.2021.01.016 (https://www.sciencedirect.com/science/article/pii/S0305417921000231)
Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020
AUTHORS: Amy Hughes, Stian Kreken Almeland, Thomas Leclerc, Takayuki Ogura, Minoru Hayashi, Jody-Ann Mills, Ian Norton, & Tom Potokar.
ABSTRACT: Health and logistical needs in emergencies have been well recognised. The last 7 years has witnessed improved professionalisation and standardisation of care for disaster affected communities – led by the World Health Organisation Emergency Medical Team (EMT) initiative.
Mass casualty incidents (MCIs) resulting in burn injuries present unique challenges. Burn management benefits from specialist skills, expert knowledge, and timely availability of specialist resources. With burn MCIs occurring globally, and wide variance in existing burn care capacity, the need to strengthen burn care capability is evident. Although some high-income countries have well-established disaster management plans, including burn specific plans, many do not – the majority of countries where burn mass casualty events occur are without such established plans. Developing globally relevant recommendations is a first step in addressing this deficit and increasing preparedness to deal with such disasters.
Global burn experts were invited to a succession of Technical Working Group on burns (TWGB) meetings to:
1) review literature on burn care in MCIs; and
2) define and agree on recommendations for burn care in MCIs.
The resulting 21 recommendations provide a framework to guide national and international specialist burn teams and health facilities to support delivery of safe care and improved outcomes to burn patients in MCIs.
PUBLISHED IN: Amy Hughes, Stian Kreken Almeland, Thomas Leclerc, Takayuki Ogura, Minoru Hayashi, Jody-Ann Mills, Ian Norton, Tom Potokar,
Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020, Burns, 2020. https://doi.org/10.1016/j.burns.2020.07.001.
A Structured Review to Assess the Current Status of Cost-Based Burns Research in Nepal
AUTHORS: Julia L. Lowin, Ak Narayan Poudel, Patricia E. Price, Tom S. Potokar
ABSTRACT: The management of burns is costly and complex. The problem is compounded in low and middle income countries (LMICs) where the incidence of burn injuries is high but infrastructure and funding for management and prevention is limited. Cost of illness studies allows for quantification of the costs associated with public health problems. Without cost quantification, focus and allocation of funding is challenging. The authors explored the availability of cost-focused burns research data in a target LMIC. The focus of their research was Nepal. A structured literature review including published papers, Ministry of Health (MOH) and World Health Organization (WHO) statistics was conducted to identify cost of illness studies or evidence relating to burn-related resource and costs. Gaps in the evidence base were highlighted. Research methodologies from other LMICs were reviewed. We found 32 papers related to burn injury in Nepal, one key MOH document and one relevant WHO data source. Most research focused on the epidemiology and etiology of burns in Nepal. Of the papers, only 14 reported any type of burn-related resource use and only 1 paper directly reported (limited) cost data. No studies attempted an overall quantification of the cost of burns. MOH statistics provided no additional insight into costs. Our study found an almost complete lack of cost-focused burns research in Nepal. Primary research is needed to quantify the cost of burns in Nepal. Initial focus could usefully be on the cost of care in tertiary hospitals. A full cost of burns for Nepal remains some way off.
PUBLISHED IN:Julia L Lowin, MSc, Ak Narayan Poudel, PhD, Patricia E Price, PhD, Tom S Potokar, FRCS (Plast), A Structured Review to Assess the Current Status of Cost-Based Burns Research in Nepal, Journal of Burn Care & Research, , iraa125, https://doi.org/10.1093/jbcr/iraa125
A comprehensive, integrated approach to quality improvement and capacity building in burn care and prevention in low and middle-income countries: An overview
AUTHORS: T. Potokar, R. Bendell, S. Chamania, S. Falder, R. Nnabuko, P.E. Price
ABSTRACT: Consistent evidence has emerged over many years that the mortality and morbidity outcomes for burn patients in low and middle-income countries (LMICs) lag behind those in more resource rich countries. Interburns is a charity that was set up with the aim of working to reduce the disparity in the number of cases of burns as well as the outcomes for patients in LMICs. This paper provides an overview of a cyclical framework for quality improvement in burn care for use in LMICs that has been developed using an iterative process over the last 10 years. Each phase of the process is outlined together with a description of the tools used to conduct a gap analysis within the service, which is then used to frame a programme of capacity enhancement. Recent externally reviewed projects have demonstrated sustained improvement with the use of this comprehensive and integrated approach over a three-year cycle. This overview paper will be supported by further publications that present these results in detail.
PUBLISHED IN: T. Potokar, R. Bendell, S. Chamania, S. Falder, R. Nnabuko, P.E. Price, ‘A comprehensive, integrated approach to quality improvement and capacity building in burn care and prevention in low and middle-income countries: An overview’, Burns (in press; available online 11 June 2020) https://www.sciencedirect.com/science/article/pii/S0305417920304149?via%3Dihub
Burns in Nepal: a participatory, community survey of burn cases and knowledge, attitudes and practices to burn care and prevention in three rural municipalities.
AUTHORS: Kamal Phuyal, Edna Adhiambo Ogada , Richard Bendell, Patricia E. Price, Tom Potokar
ABSTRACT: Objectives As part of an ongoing, long-term project to co-create burn prevention strategies in Nepal, we collected baseline data to share and discuss with the local community, use as a basis for a co-created prevention strategy and then monitor changes over time. This paper reports on the method and outcomes of the baseline survey and demonstrates how the data are presented back to the community. Design a community-based survey. Setting Community based in three rural municipalities in Nepal. Participants 1305 households were approached: the head of 1279 households participated, giving a response rate of 98%. In 90.3% of cases, the head of the household was male. Results We found that 2.7% (CI 1.8 to 3.7) of 1279 households, from three representative municipalities, reported at least one serious burn in the previous 12 months: a serious burn was defined as one requiring medical attention and/or inability to work or do normal activities for 24 hours. While only 4 paediatric and 10 adult cases in the previous 12 months reached hospital care, the impact on the lives of those involved was profound. Only one patient was referred on from primary to secondary/ tertiary care; the average length of hospital stay for those presenting directly to secondary/tertiary care was 21 days. A range of first aid behaviours were used, many of which are appropriate for the local context while a few may be potentially harmful (e.g., the use of dung). Conclusion. The participatory approach used in this study ensured a high response rate. We have demonstrated that infographics can link the pathway for each of the cases observed from initial incident to final location of care.
PUBLISHED IN: Phuyal K, Ogada EA, Bendell R, et al, ‘Burns in Nepal: a participatory, community survey of burn cases and knowledge, attitudes and practices to burn care and prevention in three rural municipalities’, BMJ Open (2020) ;10:e033071. doi: 10.1136/bmjopen-2019-033071
Finding the Best Way to Deliver Online Educational Content in Low-Resource Settings: Qualitative Survey Study
AUTHOR: Lucy Kynge
ABSTRACT: The reach of internet and mobile phone coverage has grown rapidly in low- and middle-income countries (LMICs). The potential for sharing knowledge with health care workers in low-resource settings to improve working practice is real, but barriers exist that limit access to online information. Burns affect more than 11 million people each year, but health care workers in low-resource settings receive little or no training in treating burn patients. Interburns’ training programs are tailor-made to improve the quality of burn care in Asia, Africa, and the Middle East; the challenge is to understand the best way of delivering these resources digitally toward improved treatment and care of burn patients.
PUBLISHED IN: Kynge L, ‘Finding the Best Way to Deliver Online Educational Content in Low-Resource Settings: Qualitative Survey Study’, JMIR Med Educ 2020;6(1):e16946. URL: https://mededu.jmir.org/2020/1/e16946. DOI:10.2196/16946. PMID: 32452810
Estimating the cost impact of dressing choice in the context of a mass burns casualty event
AUTHORS: Lowin J, Winfield T, Price P, Anderson P, Potokar T
ABSTRACT: Mass casualty burn events (MCBs) require intense and complex management. Silver-infused longer use dressings might help optimise management of burns in an MCB setting. We developed a model estimating the impact of dressing choice in the context of an MCB. The model was developed in Excel in collaboration with experienced emergency response clinicians. The model compares use of silver-infused dressings with use of traditional dressings in patients with partial thickness burns covering 30% of their body. Costs were estimated from a UK perspective as a proxy for a funded emergency response team and limited to cost of dressings, bandages, padding, and analgesia and staff time. Expected patient costs and resource use were summarised over an acute 2-week intervention period and extrapolated to estimate possible timesaving’s in a hypothetical MCB. Per patient costs were estimated at £2,002 (silver) and £1,124 (traditional) (a daily additional spend of £63). Per patient staff, time was estimated at 864 minutes (silver) and 1,200 minutes (traditional) (a daily time saving of 24 minutes). Multiplying up to a possible MCB population of 20 could result in a saving equivalent to 9 staff shifts over the 2-week intervention period. The model was sensitive to type of silver dressing, frequency of dressing change and staff costs. We found increased costs through use of silver dressings but timesavings that might help optimise burns management in an MCB. Exploring the balance between costs and staff time might help future MCB response preparation.
PUBLISHED IN: Lowin J., Winfield T., Price P., Anderson P., Potokar T., ‘Estimating the cost impact of dressing choice in the context of a mass burns casualty event’, Annals of Burns and Fire Disasters, vol. XXXII n. 3, (2019), pp. 222-226. https://cronfa.swan.ac.uk/Record/cronfa53529. http://www.medbc.com/annals/review/vol_32/num_3/v32n3content.htm
Review of the epidemiology of burn injuries in Ethiopia; implications for study design and prevention
AUTHORS: Edna Adhiambo Ogada, Abiye Hailu Gebreab, Thomas Stephen Potokar
ABSTRACT: Background: 90% of burn deaths occur in lower resource settings, where prevention programs are uncommon. Efficient planning and resource allocation for prevention requires consistent and reliable data. Published research on burn epidemiology from these settings is limited in scope and rigor and often not replicable. Objective: The objective of the review was; to examine the literature to determine what information exists on the epidemiology of burn injuries in Ethiopia; to assess its utility and suitability for planning interventions for burn prevention. Methods: Taking a public health approach in which burn injuries fall within the broader field of injury, a broad key term search was performed in Safety Lit and MEDLINE. We reviewed the literature on burn epidemiology in Ethiopia, to assess its utility and suitability for planning interventions for burn prevention. Results: Our search strategy yielded more information than burn specific search strategies. We identified 23 studies drawn from observational and primarily hospital-based, cross sectional studies. They offer a preliminary evidence base that can be used to make recommendations for future surveillance, risk factor exploration and prevention initiatives. Conclusion: We conclude that the low rate of burn cases identified from observational studies; the challenge of defining and coding injury in the field; recall bias; mean case series data from tertiary units are more efficient and sustainable for monitoring burn epidemiology in Ethiopia. We recommend the establishment of a national trauma registry or WHO’s Global Burn Registry (GBR) to gather data in Ethiopia and countries in comparable settings. Community studies, provide the best avenue to gauge knowledge, attitudes and practices relevant to injury prevention, first aid and health seeking behaviour. This critical preliminary synthesis on burn epidemiology frames future national research and policy on burn surveillance and prevention.
PUBLISHED IN: Edna Adhiambo Ogada, Abiye Hailu Gebreab, Thomas Stephen Potokar, ‘Review of the epidemiology of burn injuries in Ethiopia; implications for study design and prevention’, Burns Open 3 (2019), pp. 75–82. https://doi.org/10.1016/j.burnso.2019.05.002.
Developing and implementing a community led burn prevention programme and first aid programme in three rural municipalities in Nepal.
AUTHORS: Edna Adhiambo Ogada, Kamal Phuyal, Richard Bendell, Patricia Price, Tom Potokar
ABSTRACT: A poster to summaries the work carried out in Nepal. The poster highlights the geographic regions of the community survey into burn incidence and treatment, the main objectives and methods, proposed interventions, and the barriers and facilitators to the prevention propositions. It showcases how the CGBIPR uses implementation science to study knowledge, attitudes and practices surrounding burns and design effective community prevention programmes.
PRESENTED AT: Phuyal, Kamal; Ogada, Edna (presenter); Bendell, Richard; Price, Patricia and Potokar, Thomas, ‘Developing and implementing a community-led burn prevention and first aid programme in three rural municipalities in Nepal’, presented at Global Implementation Conference, Glasgow, 16-17 September 2019.
Implementation and Improvement Science: A course for nurses working in burns units in Malawi and Ethiopia
AUTHOR: Maria Holden (nee Beard)
ABSTRACT: A poster detailing the course aims and summary for the Implementation & Improvement Science workshop. The workshop was designed for nurses working in low to middle income countries in burn care settings and this pilot took place with nurses from five hospitals in Malawi and Ethiopia. The aim of this course was to improve the burn care in these areas by training nurses in quality improvement processes to be applied on their own wards.
PRESENTED AT: Beard, Maria (presenter); Ogada, Edna, ‘Implementation and Improvement Science: A course for nurses working in burns units in Malawi and Ethiopia’, presented at International Nurses Day is Nurses: A Voice to Lead – Health for All Event at University of Nottingham, Nottingham, 2019.
Advanced Burn Care Report
AUTHOR: Caitlin Hebron
ABSTRACT: A report on the Advanced Burn Care training that took place in Addis Ababa, Ethiopia (March 2020). The report details each day of the training, the topics covered, and the issues currently faced. This course was designed to enhance burn care through education and knowledge share to those working in burn units in low resource settings.
PRESENTED AT: Disseminated online.