Benefits of an outreach education coordinator: a burn center's experience

Abstract

Education of first responders and referring medical professionals is considered vital to high-quality burn care. Prior to 1999, the community education program at The Burn Center of MedStar Washington Hospital Center (MWHC) was staffed by ICU nurses who volunteered their time. As the program became more popular in the mid-1990s, the requests for lectures exceeded the capacity of a volunteer program. A request to hospital administration for a full-time education coordinator position was rejected in the climate of budget cut-backs and declining reimbursement. A business-oriented proposal, ultimately accepted, promised an increase in admissions, an improved payor mix, and an annual review of data to demonstrate the cost/benefit advantage. To advertise the creation of the coordinator position and education programs, letters were mailed to local fire departments, nursing schools and emergency departments. The response was positive, and, with a full-time coordinator, the requests were accommodated in a timely manner. Community education programs increased almost four-fold. Average annual admissions increased initially from 292 to 374 and have continued to increase, rising to 812 in fiscal year 2008. As expected, the average percent total body surface area burns decreased (from 10.8% to 6.9%), reflecting increased referral of smaller burns and, inferentially and per analysis, an improved payor mix. Most impressive was the increase in charitable donations, from an annual average of $27,500 before the position was created to an average of $183,000 annually thereafter. From this experience as well as the experience discovered by a national survey, there are desirable side effects of a full-time community burn education program coordinator, and the cost for The Burn Center at MWHC has been more than balanced by the benefits.

Keywords: brûlure; formation locale de la communauté; prévention; soins.

Fig. 1. Burn Center admissions. Annual admissions were queried from the Burn Registry of MWHC for each fiscal year. The left panel shows the trends by year for admission numbers to The Burn Center at MWHC and the right panel shows averages before and after the inception of the outreach education coordinator program. The average number of admissions increased from 297 ± 20 to 525 ± 166, which was statistically significant with a p value of 0.0016. Error bars represent standard deviations of the mean. Values represented as triangles correspond to years prior to the inception of the coordinator position. Circles represent data from years since the creation of the position.

Fig. 2. Decreases in burn extent. The average % TBSA was computed for the time periods before and after the creation of the coordinator position. The left panel shows the trends by year for average TBSA of patients referred to The Burn Center at MWHC and the right panel shows averages before and after the inception of the outreach education coordinator program. The average TBSA of patients referred decreased from 10.8 ± 1.7 to 6.9 ± 2.6, which was statistically significant with a p value of 0.007. Error bars represent standard deviations of the mean. Values represented as triangles correspond to years prior to the inception of the coordinator position. Circles represent data from years since the creation of the position.

Fig. 3. Increased operative procedure volume. The number of operative cases and procedures were queried from hospital financial records for each fiscal year. The left panel shows the trends by year for number of operative procedures at The Burn Center at MWHC and the right panel shows averages before and after the inception of the outreach education coordinator program. The average number of yearly operative procedures increased from 298 ± 24 to 484 ± 99, which was statistically significant with a p value of 0.0006. Error bars represent standard deviations of the mean. Values represented as triangles correspond to years prior to the inception of the coordinator position. Circles represent data from years since the creation of the position.

Fig. 4. Decreased length of stay. Average LOS for each fiscal year was computed. The left panel shows the trends by year for average length of ICU and hospital stay at The Burn Center at MWHC and the right panel shows averages before and after the inception of the outreach education coordinator program. The average ICU length of stay decreased from 3.8 ± 0.7 to 2.1 ± 0.7 days, which was statistically significant with a p value of 0.004. The average total hospital length of stay decreased from 12.2 ± 1.9 to 8.0 ± 1.5 days, which was also statistically significant with a p value of 0.003. Error bars represent standard deviations of the mean. Values represented as triangles correspond to years prior to the inception of the coordinator position. Circles represent data from years since the creation of the position.

Fig. 5. Payor mix improvement. Financial data were collected and averaged from the time periods before coordinator position creation (left panel), and after (right panel). The proportion of patients covered by private insurance and Medicare increased, decreasing the proportion of patients presenting with Medicaid or “Self-Insurance.”

Fig. 6. Travel costs. Mileage and fuel usage logs were tabulated from 1999 to 2008. A second order polynomial nonlinear regression was used to display the overall trends of increase in miles traveled and gasoline expenses.

Fig. 7. Marketing costs.Overall costs of purchases made for marketing purposes were calculated for the years 2001 to 2008. Linear regression was used to display the overall trend of increase.

Fig. 8. Charitable donations. Annual charitable donations were tabulated. The left panel shows the trends by year for amount of charitable donations to The Burn Center at MWHC and the right panel shows averages before and after the inception of the outreach education coordinator program. The average amount of yearly charitable donations increased from $27,506 ± 19911 to $183,386 ± 54,432, which was statistically significant with a p value less than 0.0001. Error bars represent standard deviations of the mean. Values represented as triangles correspond to years prior to the inception of the coordinator position. Circles represent data from years since the creation of the position.

Fig. 9. Outreach and education activities. The daily activity log of the coordinator was tabulated. The left panel shows the trends by year for number of outreach and education activities sponsored by The Burn Center at MWHC and the right panel shows averages before and after the inception of the outreach education coordinator program. The average number of yearly activities increased from 10 ± 13 to 115 ± 16, which was statistically significant with a p value less than 0.0001. Error bars represent standard deviations of the mean. Values represented as triangles correspond to years prior to the inception of the coordinator position. Circles represent data from years since the creation of the position.

Fig. 10. ABLS courses. The number of courses offered annually from 2001 to 2008 were totaled. Linear regression was used to display the overall trend of increase.