Research

QUALITY IMPROVEMENT AND IMPLEMENTATION SCIENCE

One of our areas of research aims specifically on ways to make a positive impact to burn care in low and middle income (LMIC) environments. It is composed of several work streams, each focused on assessing and improving the quality and skills of burn care services and burn care professionals in LMICs.

Quality Improvement

This first work stream will evaluate the impact and effectiveness of a burn unit Quality Improvement (QI) approach, and will develop a toolkit and implementation framework which will enable the QI approach to be scaled up and r

The key aim – to enable the Quality Improvement approach for burn services to be scaled up and replicated in other countries. To achieve this Interburns and the Centre will evaluate the QI approach and develop a toolkit and implementation framework for it.

The QI approach assesses and measures burn units against international operational standards. This supports local teams to transform burn care through a series of tailored interventions. This Delivery Assessment Tool was developed by Interburns – an international volunteer network of expert health professionals working to transform global burn care and prevention. A DfID funded programme from 2013-2016 helped deliver this approach in Nepal and Bangladesh and received a final project score of A+ for its impact on over 15,000 burn patients. We are now working to evaluate the approach and develop a comprehensive toolkit and implementation framework to aid the use and impact of the tool in burn services globally.

In summary – this work stream aims to review the effectiveness of the QI approach for burn care services and to understand how it can be implemented across low and middle-income countries (LMICs).

Measuring contractures

The key aim – to research objective measures applied in burn care settings, and especially in the appearance and severity of contractures in burn.

Our PhD student RuthAnn Fanstone’s research focuses on establishing a tool to classify burn contractures. A burn contracture is the tightening and scarring of skin following a serious burn that can cause restriction of movement. The severity of the contracture could reflect the adequacy of initial burn care. This classification tool could then assess the quality of burn service provision. This measure could then be applied at scale to analyse the impact of Quality Improvement interventions on patients. Her fieldwork took place in Bangladesh.

In summary RuthAnn’s research could be used to assess the impact of specific elements in burn care on contractures, which could advice the quality improvement efforts to burn services to help burn patients.

Implementation and Improvement Science

The key aim to develop research skills among health professionals working in burn service provisions in LMICs.

The CGBIPR has developed a portfolio of training specifically designed to develop skills in implementation science and burns research in LMICs. These programmes will be used to train an international network of researchers to work in the global burns and trauma field.

Health Economics

The key aim – researchers will utilise economic modelling techniques to quantify the long-term costs of burn injuries and the cost benefits of improved care and prevention.

The Swansea Centre for Health Economics (SCHE) team, which is based in the College of Human and Health Sciences, is working with the Centre for Global Burn Injury and Policy Research to conduct specific studies relevant to the global burn injury field.

The SCHE team has completed a study to quantify the cost effectiveness of using specific dressings in mass casualty scenarios in low resource settings.

Another study is focusing on the costs of illness of burn injuries in Nepal, with a paper on the current state of research soon to be published. This research sets out to quantify the burden of burns, helping to raise awareness and urge policy change.

In summarythis work will provide the foundation for making evidence-based recommendations on the optimal use of available resources to deliver cost effective interventions in resource poor settings.

Malawi nurses course group photo

This work stream will enable those individuals with the greatest knowledge of research needs in their local context – the local healthcare professionals – to carry out relevant studies, and to translate findings into action.

Recently completed was a course designed to train nurses working in burn care units. This initially took place in Malawi but moved online for the final teaching week due to COVID-19 travel restrictions. It was designed to equip nurses in low-income countries and low resource areas with improved research skills and train them to apply quality improvement research on their burn care ward. All nurses have not only completed the course successfully but also finished a quality improvement project in their hospitals.

In addition, an Implementation and Improvement Science workshop was hosted by the Centre at Swansea University in January 2019. The workshop was designed for healthcare workers who had set up, or who wanted to set up, a basic burn care unit in LMIC’s or conflict environments. The participants were taught the basic principles of implementation and improvement science, agile care, health economics, and leadership skills to help maximise applied learning in burn centres. All participants had experience and a role within their respective hospitals, which allowed them to integrate the improvement and implementation skills within their burn centre.

The Centre is now working to translate this Implementation and Improvement Science workshop for LMIC burn care professionals into an online course.

In summary – there is a lack of coherence between researchers and those working on the front line. This work stream seeks to address that by equipping nurses, surgeons and others on the frontline in LMIC with the skills and knowledge to drive quality improvement

Using health systems thinking and implementation science to transform burn care in resource-poor and conflict environments

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