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Biomedical subjects

L Yurko

Publications and source records attributed to L Yurko.

6 recordsLinked to original sources
PubMedDate not supplied

Mixing inpatient with outpatient care: establishing an outpatient clinic on a burn unit.

Outpatient care of patients with burns is an important aspect of a total health care plan. Changes in the health care system, which focuses on cost containment, force reevaluation of the methods used for delivery of high-tech care, particularly in areas such as burn care. Great advances that have taken place over the past decade in the field of burn care have enabled health care providers to treat more patients with burns as outpatients. Those who are specially trained in burn care continue to be the optimal caregivers. The appropriate facilities, spray tables, hydrotherapy, and dressing rooms in which patients with burns are treated are equally important and must be adapted to meet the needs of patients who are ambulatory. The goals of an outpatient burn clinic should be to provide daily wound care and patient education to prevent unnecessary admissions and to promote early discharge for hospitalized patients. Nurses trained in burn care are the optimal providers of ambulatory burn care; therefore the clinic location should be where the caregivers are available. Several obstacles needed to be overcome before an outpatient clinic could be established on the burn unit itself. Wound care is now provided by burn unit nurses, which leads to better results and more consistent follow-up. Patient satisfaction is increased, patient teaching is provided by experienced staff, unnecessary admissions are prevented, and patients are able to be discharged from the hospital earlier or to be followed as outpatients even if surgery is eventually required.

Burn Units↗
PubMedDate not supplied

When is enough enough? Ethical dilemmas on the burn unit.

Modern burn care often leads to the dilemma of what should or should not be done for patients with clinical deterioration and organ system failure who fail to respond to therapy. The questions are, "When is enough enough?" and "Who decides?" We have developed a structured conference to address these issues and to help us decide whether to recommend continued invasive diagnostic and therapeutic intervention or to allow the patient to "die with dignity." This conference can be requested by any member of the burn team who feels uncomfortable with what is being done for and/or to a patient. It is a meeting of the entire team, and its purpose is to discern the judgment of the group. When the consensus decision is to forego additional therapy, the decision is then presented to the patient (if he or she is able to understand and respond) and to the patient's family. The decision made by the group removes the responsibility of any individual from making a stressful decision if the patient's condition deteriorates abruptly. Patients who accept this decision exhibit a peaceful calm that invariably reaffirms the group dynamics. The family often experiences a great deal of relief, because they are not forced to make the decision even though they wanted it made. Inviting nurses to be active participants in the decision process builds their personal and professional self-esteem and binds the team members into a more tightly knit community. The attending staff may perceive this process as an abdication of responsibility; however, in our experience the consensus conference has led to a conviction that the wisdom of the team is always best.

Adult↗
PubMedDate not supplied

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.

Burn Units↗
PubMedDate not supplied

Triage of minor burn wounds: avoiding the emergency department.

Many patients with minor burn wounds will initially be evaluated in an emergency department (ED) and incur unnecessary costs that could be avoided through a direct referral to a burn center. In June 1997, use of an ED burn triage protocol was begun at our hospital. Adults with uncomplicated burns that covered more than 1% and less than 15% of total body surface area (TBSA) and children with burns that covered more than 1% and less than 10% of TBSA were to be triaged directly to the outpatient clinic of the burn center without registering in the ED. From 1996 to 1997, 653 patients were seen in the ED for burn injuries. Approximately 500 patients fit the present criteria for direct triage to the burn center. Since the triage protocol began, the percentage of patients triaged to the burn center has increased from 27% in the first month of use (July 1997) to 73% in December 1997. At least 33% of ED patients were eligible by protocol but not triaged. The average ED visit time for these patients was 103 minutes versus 44 minutes for patients who were sent directly to the burn clinic. An estimated $125,000 per year decrease in charges would occur with use of the protocol. Implementation of an ED triage protocol leads to avoidance of emergency room visits for the majority of patients with minor burn injuries, which results in more efficient, less expensive, faster care.

Adult↗
PubMedDate not supplied

Physical therapy acute burn evaluation tool.

A physical therapy acute burn evaluation tool was developed to provide a concise evaluation of the patient with burns in accordance with our hospital's physical therapy department protocols. Previous burn evaluations were either written on a generic physical therapy form or written out in the subjective, objective, assessment, and plan format. They required 20 to 30 minutes for completion, depending on the extent of the burn and any subsequent physical impairment. The new form is primarily laid out in a check-off design, with additional space for comments. Documentation time has decreased to 10 to 15 minutes, and that time does not appear to be affected by the burn experience of the therapist. This new evaluation tool has also proved useful for educating the student physical therapists that have rotated through our unit.

Acute Disease↗