Using data to drive service improvement: false dawns and a promised land?

Increasing emphasis and expectation is being placed on the role of healthcare data in addressing the problems faced by the NHS. The ideal is to replace the current fragmented system of individual systems and registries with a universal, integrated data system that provides frontline staff with what they need while also allowing monitoring of services, intelligent population-based commissioning and the facilitation of quality improvement (QI) and research. With the recently published tender for the creation of a federated data platform (FDP) there is optimism that these aspirations are being addressed; however, concerns remain that the future use of healthcare data in the UK will not fulfil its potential if the current well-recognised shortcomings of existing systems and processes are not dealt with.

Surviving Burn Injury: Drivers of Length of Hospital Stay.

With a reduction in the mortality rate of burn patients, length of stay (LOS) has been increasingly adopted as an outcome measure. Some studies have attempted to identify factors that explain a burn patient's LOS. However, few have investigated the association between LOS and a patient's mental and socioeconomic status.

Burn service costing using a mixed model methodology.

Introduction: The escalating cost of modern healthcare is threatening the fundamental "free at the point of delivery" principle of the UK National Health Services. A new remuneration system using a fixed tariff for pre-assigned diagnostic groups caters poorly for the heterogeneity of burn injuries. This study was to develop a system for Patient Level Costing (PLC), the first steps of which were to determine the true cost of burn care at service level.

Extracorporeal membrane oxygenation in severe respiratory failure resulting from burns and smoke inhalation injury.

Extracorporeal membrane oxygenation (ECMO) is one of the most frequent forms of extracorporeal life support (ECLS) and can be used as rescue therapy in patients with severe respiratory failure resulting from burns and/or smoke inhalation injury. Experience and literature on this treatment option is still very limited, consequently results are varied. We report a retrospective analysis of our experience with veno-venous (VV) ECMO in burn patients.

Mortality risk prediction in burn injury: Comparison of logistic regression with machine learning approaches.

Introduction: Predicting mortality from burn injury has traditionally employed logistic regression models. Alternative machine learning methods have been introduced in some areas of clinical prediction as the necessary software and computational facilities have become accessible. Here we compare logistic regression and machine learning predictions of mortality from burn.

A review of the international Burn Injury Database (iBID) for England and Wales: descriptive analysis of burn injuries 2003-2011.

Objective: To describe, for the first time, distribution (by geography, age, sex) and time trends in burn injury in England and Wales over the period that the international Burn Injury Database (iBID) has been in place.

Setting: Data from the iBID for the years 2003-2011 were used for a retrospective descriptive observational study of specialised services workload and admissions in England and Wales.

Participants: All patients who have been visited or admitted to the burn injury specialised health service of England and Wales during the time period 2003-2011.

Geographical analysis of socioeconomic factors in risk of domestic burn injury in London 2007-2013.

Purpose: This study aims to explore the geographical distribution of burn injuries in Greater London and the association of socioeconomic factors in areas at risk.

Methods: Data on burn injury cases classified as occurring in patients' own homes in Greater London and admitted to a specialised burns service for ≥1 day during a 7-year period were obtained from the International Burn Injury Database (iBID). Age- and gender-adjusted standardised incidence ratios (SIRs) were calculated for each Lower Layer Super Output Area (LSOA) in Greater London.

A model of British in-hospital mortality among burns patients.

Introduction: Mortality among patients treated in hospital for burn is routinely examined, but none of the many models in use in the UK was developed using nationwide data. The aim of this research was to develop a prediction model using national data, representative of the British population.

Methods: Data were gathered from the international Burns Injury Database (iBID) and included 66,611 patients from England and Wales from 2003 to 2011.

Accuracy of commercial reporting systems to monitor quality of care in burns.

Introduction: Capse Healthcare Knowledge Systems (CHKS) is a global commercial organisation that operates health benchmarking programmes in the UK and internationally. In absence of a specialty-specific quality monitoring programme for burn services, CHKS has been producing comparative quality data for burn services for a number of years. The major quality indicator reported by CHKS is mortality as a Risk Adjusted Mortality Index (RAMI).

Predicting length of stay in thermal burns: a systematic review of prognostic factors.

Background: Continued improvement in all aspects of the management of thermal injury has resulted in marked improvements in the traditionally reported outcome of mortality. This has resulted in the search for alternative parameters that can be monitored to indicate the performance of burn services. Length of stay (LOS) in hospitalised burn patients has long been considered reflective of injury-associated morbidity, cost and the quality of care, which can be monitored consistently across services.

Burns represent a significant proportion of the total serious trauma workload in England and Wales.

Traumatic injury is the leading cause of death in the first four decades of life. However, current estimates for traumatic injury rates fail to take into account burns. The aim of this work was to estimate the contribution of burns to serious traumatic injury in England and Wales.

Do illness perceptions and mood predict healing time for burn wounds? a prospective, preliminary study.

Unlabelled: Some burn wounds take longer to heal than others, but this cannot be fully explained by physical factors such as burn size and depth. Research interest has therefore focussed on the potential contribution of psychological factors, such as perception of the burn and distress, to the wound healing process.

Objectives: Using the framework of Leventhal's Common-Sense Model, we investigated whether patients' perceptions of their burn wounds and distress contributed to healing time, and whether this was via the mediating role of adherence to treatment recommendations.

Three-dimensional imaging of human skin and mucosa by two-photon laser scanning microscopy.

Background: Various structural components of human skin biopsy specimens are difficult to visualize using conventional histologic approaches.

Methods: We used two-photon microscopy and advanced imaging software to render three-dimensional (3D) images of in situ nerves, blood vessels, and hair follicles labeled with various fluorescent markers. Archived frozen human skin biopsy specimens were cryosectioned up to 150 micro m in thickness and fluorescently stained with rhodamine- or fluorescein-labeled antibodies or lectins.