Carlee Lehna

Development of a Fire Risk Model to Identify Areas of Increased Potential for Fire Occurrences.

The purposes of this study were to use geographic information systems to create a cartographic risk model predicting areas of increased potential for fire occurrences and to validate the model. Seven literature-identified risk factors associated with burn injury were older than 65 years, non-white race, below high school education, low socioeconomic status, rented housing, year home built, and home value. Geographic information system methods were used in risk factor model development. Model validation occurred using residential county fire dispatch data and statistical analysis. Areas of high and severe risk were primarily located in the northwestern and central county regions. A strong correlation (r = .66) was found between risk model scores and fire incidence rates. Significant differences in mean fire rates by risk category (F (187,3) = 87.58, P < .0001) were found, with the exception of the low and medium risk categories. Fire incidence rates among census tracts showed positive spatial autocorrelation (Moran’s I = 0.542, P < .0001) producing a map showing a significant cluster of high fire incidence in the northwestern region. The risk model has potential to lead to more targeted and effective fire prevention education programs. Such models would allow fire departments to focus limited resources in areas of highest fire risk.

A web-based educational module increases burn prevention knowledge over time

Unfortunately, burn prevention knowledge is low among nurses. Establishing efficient ways in which to increase burn prevention knowledge in nurses is warranted. The current multi-center study evaluated whether a web-based educational module was successful at increasing burn prevention immediately and whether the knowledge was retained over time. A valid, reliable burn prevention knowledge exam was administered to nurse at three time points (prior to receiving the educational module, immediately following receiving the educational module, and at least a minimum of two weeks after receiving the educational module). Generalized linear mixed effects modeling methods were used to evaluate whether scores on the burn prevention knowledge exam increased over time, while adjusting for traditional covariates (e.g., specialty area, years as a nurse, and years in current work area). Mean scores on the burn prevention knowledge exam increased over time (p=0.003); establishing that the educational module significantly improves scores over time. Mean score prior to receiving the educational module was 82.3%; the mean score was 83.8% immediately following receiving the educational module, and 86.1% two weeks after receiving the educational module. The educational module developed by the authors (www.burnpreventionstudy.org) is an efficient way in which to increase burn prevention knowledge and is available at their convenience. This education module could be used as a training module with nurses involved in burn prevention outreach, and with nurse practitioners, physicians, and emergency responders involved in primary care across the life span.

The effect of transfers between health care facilities on costs and length of stay for pediatric burn patients

Hospitals vary widely in the services they offer to care for pediatric burn patients. When a hospital does not have the ability or capacity to handle a pediatric burn, the decision often is made to transfer the patient to another short-term hospital. Transfers may be based on available specialty coverage for children; which adult and non-teaching hospitals may not have available. The effect these transfers have on costs and length of stay (LOS) has on pediatric burn patients is not well established and is warranted given the prominent view that pediatric hospitals are inefficient or more costly. The authors examined inpatient admissions for pediatric burn patients in 2003, 2006, and 2009 using the Kids’ Inpatient Database, which is part of the Healthcare Cost and Utilization Project. ICD-9-CM codes 940 to 947 were used to define burn injury. The authors tested if transfer status was associated with LOS and total charges for pediatric burn patients, while adjusting for traditional risk factors (eg, age, TBSA, insurance status, type of hospital [pediatric vs adult; teaching vs nonteaching]) by using generalized linear mixed-effects modeling. A total of n = 28,777 children had a burn injury. Transfer status (P < .001) and TBSA (P < .001) was independently associated with LOS, while age, insurance status, and type of hospital were not associated with LOS. Similarly, transfer status (P < .001) and TBSA (P < .001) was independently associated with total charges, while age, insurance status, and type of hospital were not associated with total charges. In addition, the data suggest that the more severe pediatric burn patients are being transferred from adult and non-teaching hospitals to pediatric and teaching hospitals, which may explain the increased costs and LOS seen at pediatric hospitals. Larger more severe burns are being transferred to pediatric hospitals with the ability or capacity to handle these conditions in the pediatric population, which has a dramatic impact on costs and LOS. As a result, unadjusted, pediatric hospitals are seen as being inefficient in treating pediatric burns. However, since pediatric hospitals see more severe cases, after adjustment, type of hospital did not influence costs and LOS. TBSA and transfer status were the predictors studied that independently affect costs and LOS.

Increasing burn prevention knowledge: web-based versus classroom education

Increasing burn prevention (BP) knowledge in nurse practitioners leads to better care for patients who suffer a burn injury. Web-based and classroom-based approaches to increasing an individual’s knowledge, in general and specifically to BP knowledge, is currently an area of interest for researchers. As a result, the purpose of this study was to test and evaluate the influence two methods (classroom and Web-based) has on BP knowledge; and whether a difference existed between teaching modalities. Generalized mixed-effects modeling techniques were used to test for differences in scores across three time points: 1) baseline, 2) immediately after viewing the educational module online (recall), and 3) at least 2 weeks after viewing the educational module (retention); and between the groups. There was no difference in scores between online vs classroom education method (P = .894); therefore, a pooled analysis was performed (n=54). Mean scores on the BP knowledge exam increased over time (P = .003) (regardless of educational method), establishing that the education module significantly increases BP knowledge in nurse practitioners over time. Mean score before receiving the education module was 75.6%; the mean score was 81.9% immediately after the module; and 85.6% 2 weeks after receiving the education module. Either method can be used to educate and train health care providers in BP, which may provide health care providers with useful and cost-effective ways in which to improve BP knowledge and the quality of care for patients who suffer a burn injury.

Where are length of stays longer and total charges higher for pediatric burn patients

Treatment of pediatric burn patients is costly and may require long length of stay in the hospital (LOS). Establishing where these LOS and charges are highest is warranted. The current study investigated whether pediatric burn patients had higher total charges and longer LOS when seen at teaching hospitals, when compared with nonteaching hospitals. The study reviewed inpatient admissions for pediatric burn patients in 2003, 2006, and 2009 by using the Kids’ Inpatient Database, which is part of the Healthcare Cost and Utilization Project. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 940-947 were used to define burn injury, LOS, total charges, and type of hospital. The authors tested for differences between the LOS and total charges between children seen at three types of hospitals (pediatric, nonpediatric/teaching, nonpediatric/nonteaching) while adjusting for traditional risk factors (eg age, total burn surface area) by using generalized linear mixed-effects modeling. A total of N=28,777 children had burn injuries (n=16,115, 56.0% seen at pediatric hospitals; n=9353, 32.5% seen at nonpediatric/teaching hospitals; and n=3309, 11.5% seen at nonpediatric/nonteaching hospitals). Pediatric burn patients seen at pediatric hospitals, unadjusted, have significantly longer LOS (5.54 days vs 4.25 days and 4.00 days, P<.001) and more total charges in 2009 dollars (

Nursing students practice primary fire prevention

31,319 vs

Development of an instrument that assesses individuals' burn prevention knowledge.

24,413 and

Geographic Mapping as a Tool for Identifying Communities at High Risk for Fires.

21,499, P<.001). In addition, patients seen at pediatric hospitals had significantly more total burn surface area (P<.001), more comorbidities (P=.021), and were younger (P<.001). After adjusting for total burn surface area, number of comorbidities, and age, no differences existed between teaching and nonteaching hospitals for LOS (P=.481) or total charges (P=.758). Although pediatric burn patients may have increased LOS and total charges when seen at teaching hospitals, when taking an unadjusted perspective, this may be an artifact that teaching hospitals see pediatric burn patients who are younger, have more comorbidities, and have more total burn surface area. As such, after adjustment, type of hospital may have no influence on LOS and total charges.

Home fire safety education for parents of newborns

UNLABELLED The purpose of this project was to evaluate a standardized, interactive, home fire safety program for elementary school students. BACKGROUND Senior baccalaureate nursing students in their pediatric clinical rotation taught burn prevention techniques using Hazard House, a model house filled with common household fire hazards (Hazard House, 2006, Ref. 1). Elementary school students were encouraged to identify the hazards and discuss ways in which the house could be made safer. Local firemen then briefly presented what to do if a fire occurred, how firemen may look during a rescue, and the importance of working smoke alarms in the home. METHODS A pretest-posttest design was used to examine the effectiveness of an educational intervention. The three groups of participants included 128 kindergarten students, 311 students in grades 1-2, and 61 students in grades 3-4. The tests and interventions were tailored appropriately for each age group. RESULTS There was no difference in pre- and post-test scores for the students in kindergarten and grades 3-4 (p>0.05). However, there was a significant difference for students in grades 1-2 (p<0.001). CONCLUSION It is important for nurses to assess for and teach about fire injury prevention to prevent potentially devastating irreversible injuries. The results suggest that the educational intervention was effective in improving the understanding of fire safety for students in grades 1-2. Future studies may need to include a larger sample of students for the other grades.

Impact of children with special needs on differences in fire-safety education priorities, preferred method of education, and parent actions

Currently, no valid and reliable instrument that assesses an individuals burn prevention knowledge exists. Therefore, it is difficult to evaluate whether interventions aimed at increasing burn prevention knowledge are effective and useful. This study developed and tested a novel instrument that assessed an individuals burn prevention knowledge. This instrument may be used to evaluate the effect interventions aimed at increasing burn prevention knowledge have on an individuals burn prevention knowledge. Initially, a focus group composed of 22 American Burn Association Burn Prevention Committee members prioritized areas that individuals with increased burn prevention knowledge should be well informed about (ie, scalds, gasoline, elders, juvenile fire setters, and abuse). Then, 39 questions were developed (by the authors) to assess an individuals knowledge in these five priority areas and tested for their reliability and validity. Factor analysis techniques were used to develop the final survey (15 questions, explaining 76% of the variance in responses) that was administered in a larger sample (n = 113) to achieve adequate power for the study. The final survey was administered and tested in a group of pediatric, emergency department and clinic registered nurses for reliability and validity. The final survey developed has moderate interrater reliability (Cohens kappa = 0.611), high intrarater reliability (intraclass correlation coefficient = 0.713), and good internal consistency (Cronbachs alpha = 0.604). In addition, the final survey was determined to have face validity as well as construct validity (five components had eigenvalues >1.0). The survey developed is positioned to be tested in a multisite and multi-investigator study. If results from this study hold consistent in future studies, the survey developed can be used by researchers in future interventional studies aimed at increasing burn prevention knowledge without reservation.