Complete integration of inpatient and outpatient burn care: evolution of an outpatient burn clinic

Burn centers are under continuing pressures to lower costs and maintain quality of care. One method of achieving this goal is to integrate inpatient and outpatient care in the burn unit. In 1991, our unit instituted an on-site outpatient clinic that was expanded significantly in 1996. The clinic is staffed by the inpatient personnel and allows for 24-hour availability and accommodation of all nurse and physician visits. The number of outpatient visits has increased from 1604 in 1992 to 4728 in 1996, despite a 33% reduction in registered nurse staffing during this time. From 1990 to 1996, the average length of inpatient stay for burns of 0% to 5% total burn surface area (TBSA), 6% to 10% TBSA, and 11% to 15% TBSA has decreased from 7.5 to 3.7 days, 10.3 to 7.7 days, and 16.6 to 11.8 days, respectively. Complete integration of inpatient and outpatient burn care can be achieved. An expanded on-site outpatient facility leads to optimal continuity of care, outpatient management of a larger percentage of burn injuries, and a shift in census from the inpatient to outpatient settings.