Emergency room management of minor burn injuries: a quality management evaluation

The vast majority of acute burns are initially seen and treated in emergency departments (EDs). Most of the individuals caring for these patients have little or no specialized training in the multidisciplinary approach to the burned patient. Burns of limited severity are treated immediately and then followed on an outpatient basis; therefore reviews of documented practices in emergency departments were not found. It was hypothesized that follow-up care may be suboptimal in this population. The medical records of 791 patients treated at three EDs in a Midwestern regional referral area from January 1991 through December 1991 were evaluated to assess the documentation of care provided. The three hospitals included a tertiary care teaching facility, a pediatric facility, and a community-based teaching hospital. Only the charts of patients treated and released from the ED were evaluated. The data demonstrate that there was suboptimal documentation of diagnosis, treatment, and follow-up care of the thermally injured patients who were initially treated in these EDs. Burn team members should develop educational and clinical relationships with EDs in the referral area to optimize both the delivery and documentation of outpatient burn care. This is especially important in today's health care environment, in which reimbursement is based on services rendered.