Related Experiment Video
Updated: Jun 29, 2025
Author Spotlight: A Multi-Depth Porcine Model for Comprehensive Study of Burn Injuries and Healing Processes
Published on: February 23, 2024
Implementation and Maintenance of a Pediatric Severe Burn Guidelines Quality Improvement Project
Kristin J Dolan1, Jennifer L Flint2, Tara C Benton2
1From the Section of Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
Insights
Implementing specialized burn teams and guidelines significantly improved fluid resuscitation accuracy and timely nutritional support for critically injured pediatric burn patients. This standardized care enhances critical patient outcomes in pediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Burn management
- Clinical quality improvement
Background:
- Critically injured pediatric burn patients require specialized care, but verified pediatric burn centers are scarce in the U.S.
- Many pediatric hospitals lack standardized care guidelines for severe burns, impacting patient outcomes.
- A specialized burn team and clinical guidelines can standardize care and improve outcomes.
Purpose of the Study:
- To improve morbidity and mortality in severely burned pediatric patients admitted to the pediatric intensive care unit.
- To enhance the accuracy of fluid resuscitation.
- To ensure timely nutritional support for pediatric burn patients.
Main Methods:
- Retrospective preintervention and postintervention study over 9 years (2010-2019).
- Formation of a multidisciplinary burn leadership committee.
- Development and implementation of Pediatric Severe Burn Guidelines.
- Primary outcomes: fluid resuscitation accuracy and timely nutritional support.
Main Results:
- Acceptable fluid resuscitation increased from 25% pre-protocol to 61.5% post-protocol (P=0.04).
- Post-protocol patients showed improved timely placement of postpyloric feeding tubes.
- Initiation of nutritional feeds within 48 hours of admission improved post-protocol.
Conclusions:
- Implementing extensive guidelines requires careful monitoring for adherence.
- Creating specialized burn teams and clinical guidelines standardizes care.
- Standardized care through specialized teams and guidelines leads to improved critical patient outcomes.
Introduction:
Critically injured pediatric burn patients require specialized management, yet few verified pediatric burn centers exist in the United States. Many pediatric hospitals have resources to care for severely burned patients but lack standardized care guidelines, which improve outcomes. To improve the morbidity and mortality of severely burned pediatric patients admitted to the pediatric intensive care unit, we created a specialized burn team. We implemented Pediatric Severe Burn Guidelines, focusing on improving fluid resuscitation accuracy and providing timely nutritional support.
Methods:
This investigation is of a 9-year (2010-2019) retrospective preintervention and postintervention study of the effect of the formation of a multidisciplinary burn leadership committee and development and implementation of Pediatric Severe Burn Guidelines. The primary outcome measures are increasing the accuracy of fluid resuscitation and improving the timely administration of nutritional support. The process measure is the percentage of time the electronic health record power plan was used for burn admissions with burn leadership review of the cases. Balancing measures are pediatric intensive care unit and hospital length of stay.
Results:
Preprotocol patients received acceptable fluid resuscitation 25% (5/20) of the time compared to 61.5% (8/13) of the time in postprotocol patients (P = 0.04). In postprotocol patients, there is an improvement in the timely placement of postpyloric feeding tube and initiation of feeds 48 hours after admission.
Conclusions:
Extensive guidelines for standardized care require careful implementation and monitoring of adherence gaps. Creating a specialized burn team and implementing clinical guidelines standardize care leading to improvement in critical patient outcomes.
Related Concept Videos
01:22Burn Injuries
The damage results in the death of skin cells, which can lead to a massive loss of fluid. Dehydration, electrolyte imbalance, and renal and circulatory failure follow, which can be fatal. Burn patients are treated with intravenous fluids to offset...
01:11Guidelines for Writing Outcome
Patient outcomes reflect the patient's response to the goal rather than what the nurse aims to achieve. Terminology should be observable and measurable to avoid the reader's interpretation. The desired outcome should be realistic and achievable in the designated care timeframe. Expected outcomes should align with adjunctive therapies. The outcome should enhance care...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:15Nursing Implementation
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
01:30Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
01:29Nursing Interventions II: Selecting and Classifying the Nursing Interventions