Burn rehab program cuts acute hospital stay
Patients can start rehab earlier
A comprehensive burn rehabilitation program that allows severely burned patients to leave the acute care hospital much earlier has slashed the average post-acute length of stay from 27 to 19 days at Braintree Hospital Rehabilitation Network in Boston.
The program includes therapists trained in wound management and is equipped to take Level 1 burn patients who require up to four hours of burn care a day. That means patients can be admitted to Braintree as much as three weeks earlier than to other rehab programs. Most rehab programs provide only two hours of burn care a day.
Some patients begin their rehab at Braintree, transfer to an acute care hospital for grafting, then transfer back to Braintree when they are medically stable. Because of the special training and equipment at Braintree, burn patients can be admitted as early as 48 hours after surgical grafting.
Braintree’s burn rehab program is on a 43-bed unit that also treats amputees, orthopedic patients, and complex medical patients. The unit has four telemetry beds, making it possible to admit burn patients who also need cardiac monitoring.
The burn treatment team includes nursing (RNs and licensed practical nurses), case management, dietetics, social services, and psychology. The physicians who work with the patients are mostly internal medicine specialists and are on staff. A pain management team consults with patients who need its services. The team includes nursing, physical therapy, occupational therapy, medicine, and neuropsychology. All staff who work on the unit are cross-trained to treat burn patients. In addition to burn care, patients receive at least three hours of therapy a day during the week and at least one hour a day on weekends.
When patients are referred to the Braintree program, they are screened before admission by nurses with specialized training in burn and trauma care. The treatment team meets before admission and develops comprehensive treatment plan before the patients arrive.
Nurses who work in the burn unit are rehab nurses who have received additional training in treating burn patients. They have undergone a program of classroom training, inservice programs, and independent study developed by Leslie Desanti Matossian, RN, a burn trauma resource clinician who works part-time for Braintree and oversees competency testing for the clinicians in the burn program. Before working with patients, the nurses must pass a competency test showing they are qualified to provide care to burn patients and to recognize if treatment is no longer effective, she says. The training covers assessing and treating burns, dealing with psychosocial issues, and meeting the special nutritional needs of burn patients.
Since the three hours of therapy and up to four hours of burn care occupy a sizeable portion of the patient’s day, the therapist and nurse often meet early in the morning to decide who treats the patient at what time and when more than one clinician is needed, she adds.
The Braintree program includes a heavy psychological component to help the patient and family deal with the problems that accompany a burn trauma.
"Because the patient has been in the acute care setting, we receive information before admission about how the family is coping and any particular nuances we need to cover. This puts us in a position to be proactive and to anticipate the patient and family’s needs," Matossian says.
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