Joseph Myers

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 (

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

31,319 vs

Home fire safety education for parents of newborns

24,413 and

Unintentional, non-fatal drowning of children: US trends and racial/ethnic disparities

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.

Effect of Fireworks Laws on Pediatric Fireworks-Related Burn Injuries

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.

An organizational process for promoting home fire safety in two community settings

In children under 1 year of age, the proportion of unintentional burns increases with infant age and mobility. Infants are not able to avoid burns and are dependent on parental or adult help. Treatment of burns in young children is expensive in terms of the life-long costs. The purpose of this study was to examine changes in home fire safety (HFS) knowledge and practices over time for parents of newborn children and expecting parents. HFS knowledge of 103 parents was assessed at baseline, immediately after watching a DVD on HFS (recall), and at 2-week follow-up (retention). In addition, the United States Fire Administration (USFA)/Federal Emergency Management Agency (FEMA) Home Safety Checklist which examines HFS practices in the homes was administered. Seventy percent of the participants were Caucasian, 65% were married, and 81% were first-time parents. HFS knowledge increased significantly from baseline to recall (45±12% vs. 87±17% correct responses, p<0.0001), but declined to 75±18% correct at retention. That is, an individuals baseline scores nearly doubled at recall (42±11% change in baseline score), but only increased by 67% at retention (30±15% change in baseline score). For a subsample of parents who completed the USFA Checklist (n=22), the mean percentage of advocated practices followed was 71±11% (range: 40-89%). Using DVDs was an effective educational modality for increasing HFS knowledge. This addressed an important problem of decreasing burns in infants through increasing parent knowledge and HFS practices using a short, inexpensive DVD.

Estimating the national cost burden from burns resulting from methamphetamine manufacturing.

Objective The current study aimed to better understand trends and risk factors associated with non-fatal drowning of infants and children in the USA using two large, national databases. Methods A secondary data analysis was conducted using the National Inpatient Sample and the Nationwide Emergency Department Sample databases. The analytic sample (n=19 403) included children <21 years of age who had a diagnosis code for near-drowning/non-fatal drowning. Descriptive, χ2 and analysis of variance techniques were applied, and incidence rates were calculated per 100 000 population. Results Non-fatal drowning incidence has remained relatively stable from 2006 to 2011. In general, the highest rates of non-fatal drowning occurred in swimming pools and in children from racial/ethnic minorities. However, when compared with non-Hispanic Caucasian children, children from racial/ethnic minorities were more likely to drown in natural waterways than in swimming pools. Despite the overall lower rate of non-fatal drowning among non-Hispanic Caucasian children, the highest rate of all non-fatal drowning was for non-Hispanic Caucasian children aged 0–4 years in swimming pools. Children who were admitted to inpatient facilities were younger, male and came from families with lower incomes. Conclusions Data from two large US national databases show lack of progress in preventing and reducing non-fatal drowning admissions from 2006 to 2011. Discrepancies are seen in the location of drowning events and demographic characteristics. New policies and interventions are needed, and tailoring approaches by age and race/ethnicity may improve their effectiveness.