Chapter 06. Adult and Pediatric Burn Center Standards

Maintain a designated unit or units for specialized acute burn care;

Be a hospital designated as a Level II or higher trauma center;

If an in-State hospital, have one of the following issued by the Maryland Health Care Commission:

Demonstrate commitment to the optimal care of the hospital’s burn injured patients by the hospital’s board of directors, administration, medical staff, and nursing staff by formulating a board of director’s resolution, updated yearly, stating that:

Complete transfers to in-State hospitals, or to out-of-State hospitals listed in the Maryland Emergency Medical Services Interhospital Transfer Resource Manual, in accordance with the guidelines contained in the Maryland Emergency Medical Services Interhospital Transfer Resource Manual without the need for separate transfer agreements;

Have a written transfer agreement in place for transfer of a patient to an out-of-State hospital not listed in the Maryland Emergency Medical Services Interhospital Transfer Resource Manual, if the hospital transfers to such out-of-State hospital more than five times a year;

Have a written transfer agreement in place for transfer of a patient to a rehabilitation hospital if the hospital transfers to such a rehabilitation hospital more than two times a year;

Have and maintain current accreditation by an organization that has been granted deeming authority by the Centers for Medicare & Medicaid Services and approved by the Maryland Department of Health to accredit hospitals in the State;

Use the resources of the burn center for patients with burn injuries and those suffering from burn-like diseases; and

Have administrative and budgetary commitment in order to support the needs of the burn center, inclusive of clerical and clinical nursing personnel, that helps fulfill needs of the concurrent PI, outreach, injury prevention, and research.

Maintain access to an EMS system for the transport of patients (public safety and commercial services) with burns from referral sources within the geographic service area;

Participate in regional or State EMS committees and councils at least three times per year;

Have a written hospital emergency preparedness/multiple casualty incident (MCI) plan for the triage and early treatment of adult and pediatric patients burned in an MCI;

Ensure that the MCI plan for the geographic service area is reviewed and updated on an annual basis by the hospital Emergency Preparedness Committee and EMS liaisons and drill inclusive of burn patients annually; and

Provide education on the current concepts in triage and burn care treatment to prehospital and hospital care providers within its geographic service area.

A burn center shall formally establish and maintain an organized burn service that is responsible for coordinating the care of the burn patient.

A burn center shall maintain an organizational chart relating personnel within the burn unit to other hospital staff; a combined leadership model for trauma and burn center is acceptable.

A burn center shall maintain an appropriate policy and procedure manual that:

The burn center shall participate in the State Burn Registry for burn patients, both inpatient and outpatient modules.

The State Burn Registry shall include all patients who are treated at the burn center inclusive of outpatient and inpatient venues for burn care treatment.

A burn center shall treat an average of 100 or more unique inpatients and outpatients (ED treat and discharge and first clinic visit) with acute burn injuries annually.

A burn center shall admit at least 60 patients annually who meet the referral criteria in Regulation .17 of this chapter.

A burn center director is authorized to direct and coordinate all medical services for patients admitted to the burn service.

Medical care for patients in the burn center shall be provided by the burn center director or qualified physicians approved by the director and shall conform to burn center care protocols.

Privileges for physicians participating in the burn service shall be approved by the burn center director and determined by the medical staff credentialing process.

A burn center shall appoint a qualified burn center director to oversee the care of patients in the burn service.

A burn center director shall meet the requirements in Regulation .05 of this chapter.

Creation of policies and procedures within the burn center that specify the care of burn patients and ensures that medical care conforms to burn center protocols;

Creation of policies and protocols for use throughout the burn care system for initial care, triage, and transport of burn patients;

Cooperation with regional EMS authorities in regard to all aspects of burn treatment;

Communication with physicians and other authorities regarding patients who have been referred and admitted for follow-up and/or feedback;

Direction of a burn center’s administrative functions;

Direction and active participation in a burn center quality management program;

Acting as liaison between adjacent and regional burn centers;

Development of and participation in both internal and external continuing medical education programs in the care of burn injuries;

Maintaining current ABLS®; and

Oversight of the burn prevention program and initiatives.

Be assigned to the burn service;

Be available within 15 minutes, 24 hours a day;

For the adult burn center, be current in ATLS® or ABLS®; and

Have a liaison to the burn QM program with 50 percent attendance.

For the adult burn center, be current in ATLS® or ABLS®; and

A liaison to the burn QM program with 50 percent attendance.

General surgery/pediatric surgery;

Thoracic surgery;

Neurologic surgery;

Obstetrics/gynecology;

Ophthalmology;

Orthopedic surgery;

Otorhinolaryngology;

Plastic surgery;

Urology; and

Vascular.

Anesthesiology;

Critical care medicine;

Pediatrics;

Psychiatry;

Interventional radiology (perform complex imaging studies or interventional procedures); and

Interventional angiography.

Cardiology;

Patient protection service (adult or child);

Gastroenterology;

Hematology;

Infectious disease;

Nephrology;

Neurology;

Pathology; and

Pulmonology.

Psychology; and

Physiatry.

A burn center shall have a clinical nurse manager who is administratively responsible for the burn unit.

A nurse manager shall:

A burn center shall have an organizational chart relating the nurse manager to the burn service and other members of the burn team.

Have qualified nurses to take care of burn patients;

Have a plan to determine staffing and overall care including:

Have a burn unit orientation program that documents nursing competencies specific to care and treatment of burn patients, including critical care, wound care, psychosocial, and rehabilitation, inclusive of a basic trauma course;

Require each new staff nurse hired for the burn units to complete the orientation program before assuming independent practice in the burn units; and

Provide burn center staff with a minimum of continuing education annually of:

Permanently; or

On a rotating basis for at least 1 year;

Have a social service consultation available to the burn service; and

Assign a social worker to the burn center for both inpatients and outpatients, either:

A pharmacist available for consultation;

A respiratory therapist to assess and manage patients on the burn service; and

For pediatric burn centers, a child life specialist.

A burn service shall have a QM program that is multidisciplinary.

A burn center director is responsible for the QM program.

A burn unit multidisciplinary committee shall:

A burn center shall hold patient care conferences at least weekly to review and evaluate the status of each patient admitted to the burn center.

Each clinical discipline shall be represented to appropriately contribute to the treatment plan for each patient.

Patient care conferences shall be documented in the progress notes of each patient or in minutes of the conferences.

Hold morbidity and mortality conferences at least monthly; and

Maintain appropriate documentation of morbidity and mortality conferences.

Severity of burns;

Mortality;

Incidence of complications;

Length of hospitalizations; and

Hospital charges for care.

A burn center shall have an educational program for the medical staff.

If residents rotate on the burn service, a burn service director or the director’s designee shall provide an orientation program for new residents.

A burn center shall have effective means of isolation that are consistent with principles or universal precautions and barrier techniques to decrease the risk of cross-infection and cross-contamination.

A burn center shall:

Recreational or child-life therapy;

Psychosocial support for family members or other significant persons;

Availability for continuing age appropriate academic courses for the patient;

Coordinated discharge planning;

Follow-up after hospital discharge;

Access to community resources;

Evaluation of the patient’s physical, psychological, developmental, and vocational status; and

Planning for future rehabilitative and reconstructive needs.

Weight measurement devices for kilogram measurement;

Difficult airway equipment capable for surgical intervention;

Emergency carts with age-appropriate equipment; and

Temperature control/measurement devices for:

That allograft tissues are to be obtained only from those tissues banks that adhere to the standards of the American Association of Tissue Banks, if applicable; and

Compliance with U.S. Food and Drug Administration regulations published in 21 CFR Part 1270 Human Tissue Intended for Transplantation;

Complicate management;

Prolong recovery; and

Affect mortality;

If trauma poses the greater immediate risk, the patient may be treated initially in the trauma center until stable before being transferred to a burn center; and

Physician judgment is necessary in these situations and shall be in concert with the regional medical control plan and triage protocols;

Provide evidence and maintenance of qualifications including academic and burn-related education and clinical experience;

Comply with a job description developed by the hospital that reflects the role and responsibilities as defined by COMAR, and an organizational chart depicting the relationship between the BPM and other services, including the Department of Nursing/Trauma and Burn Nursing;

Ensure participation in local, State, and national burn-related activities, including but not limited to EMS Advisory Councils, State burn-related committees and events, and national burn-related activities and events;

Participate in burn educational activities external to the institution’s staff development programs;

Maintain and provide evidence of 8 hours annually of internal and 8 hours external burn-related CE; and

Supervise burn registry staff, burn clinical performance improvement staff, injury prevention staff, and outreach staff.

Demographic data;

Injury data;

Hospital data;

Description of injury;

Diagnosis;

Comorbidities;

Procedure codes;

Complications;

Outcome; and

Outpatient module, which includes outpatient information, Lund and Browder, treatment, complications, and comorbidities.

Anatomy and physiology; and

Medical terminology.

Ensuring assigned cases are compliant with MD Data Dictionary Inclusion Criteria or other burn center self-defined criteria;

Compiling abstracted data for BR case from various sources; and

Appropriately coding injuries, complications, and procedures.