Referral patterns and severity distribution of burn care: implications for burn centers and surgical training

The purpose of this investigation was to examine burn-patient referral patterns and severity of burn distribution, as well as to determine the impact these patterns may have on the education of surgeons in training. Data from the 1998-1999 National Inpatient Sample (NIS) and the Michigan Hospital Association (MHA) were analyzed based upon burn diagnostic-related groups (DRGs; 504-511) and their referral distribution was documented. Providers were segregated into high-volume hospitals (HVHs) treating >100 patients per year, moderate-volume hospitals treating 25 to 99 patients per year, and low-volume hospitals (LVHs) treating <25 patients per year. Surgical training programs were identified within the state of Michigan and examined for an educational affiliation with a burn center. Across the United States, 47.5% of burn patients receive care at HVHs. Patients with the highest severity (ie, DRGs 504 and 505) were usually (77%) treated in HVHs. Within the state of Michigan, 4 HVHs were identified, which represent 50.8% of the total burn admissions. At least 1 HVH received over 80% of its admissions from adjacent or distant counties and subsequently represented a higher proportion of higher-severity burn DRG admissions. Twenty-three percent of general surgical programs within the state of Michigan do not have a formal burn rotation or affiliation with a regional burn center for educational training. Several programs have affiliations with low-volume burn providers. The most severe burns are reaching high-volume centers, but many burns continue to remain within LVHs. A wide variation in patient distribution occurs throughout the United States. Matching the patient and resident distribution is essential for effective training of surgical residents.