ISBI Burn Center Audit Pilot Program

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30 January 2024 (Updated 8 Feb 2024)

The ISBI is pleased to announce a new initiative called the ISBI Burn Center Audit Program which we hope will improve burn care in low- and middle-income countries (LMIC).  This program will increase the engagement of the ISBI in these countries and is consistent with the ISBI’s mission.  

The Program:  This program will visit burn centers, assess their resources and structures, and provide a roadmap for the center to improve the care their patients receive. It is hoped that the ISBI will have many partners in this initiative who are already engaged around the world in burn care. The audit process will be very inclusive, and it is hoped that all centers will be able to join the ISBI Burn Audit program on an ongoing basis (Full details of the program are on page 3-4 of this document).  The cost of travel and lodging for these trips would be borne by the ISBI.

Who should apply:  The program will accept applications for participation from all ISBI members who are in the fields of rehabilitation, nursing and physicians.  If you are an ISBI member and know a non-member who would like to participate in this program you should encourage them to apply for ISBI membership ( Join the Society | International Society for Burns Injuries (worldburn.org) )

ISBI Burn Center Audit Program

Background

Burn practitioners in low and middle resource countries often face a shortfall between the care they would like to provide their burn patients and the care they actually deliver due to a shortage of resources and/or personnel.  They are also hindered due to the lack of ability to close this gap because they are oftentimes a single voice who is advocating to their hospital administration and governmental Departments of Health. Their advocacy might be strengthened if they could reference an external international standard of care and have an international partner.  

The ISBI is in a unique position to provide partnership and this external international standard of burn care to guide local burn centers in their efforts to improve care and develop a broad quality program.  The 4 parts of a Quality Program are 1) Setting Standards 2) Building Infrastructure 3) Data Collection and 4) Confirmation of Compliance with standards/peer review.  The ISBI has already taken a first step to create worldwide burn Quality Process by the publication in 2007 of the “One World, One Standard” document. This standard of care document could be the catalyst for the next steps of building infrastructure, data collection, and peer review in low and middle resource countries through a process of Burn Center Audits. While these audits are an extension outside of the ISBI’s traditional educational role, this proposal is consistent with the ISBI’s mission of improving the care of burn injured patient world-wide. This pilot project would last 6 years and would hopefully visit and audit burn centers in up to 8 countries. 

Process

The ISBI would call for partnerships with national burn associations, burn centers, and local in-country NGOs to facilitate a process whereby Burn Center Audit process would occur in the country.  The applications would be vetted by an ISBI subcommittee and candidate(s) for partnership chosen during a three-year Burn Center Audit (BCA) cycle. There may be more than one sponsor in each country.  Each application cycle would choose up to 12 centers.  These 12 centers could be within one or two countries. The first year of the 3-year cycle would be submission of applications, selection of sites for audit and arrangement of travel.  The next two years of the cycle would be the site visits with the visits arranged over a 10–12-day period. The ISBI would visit the selected sites and would be accompanied on these visits with the in-country national burn association partner(s). When fully mature there would be 3 cycles engaged at any one time with two of the cycles having Burn Center Audit visits:

The process would be very inclusive and would take into account the burn center’s and the country’s resources.  The BCA process would offer 3 levels of participation:

• Level 3 Burn Center (Participant Level) – the center is compliant with 10% of the criterion laid out in the One World One Standard document.
• Level 2 Burn Center (Qualified Level) – the center is compliant with 11-50% of the criterion laid out in the One World One Standard document.
• Level 1 Burn Center (Master Level) – the center is compliant with >50% of the criterion laid out in the One World One Standard document.

Each January the ISBI would post on the website that applications for the ISBI BCAP were open.  Deadline for application submission would be 1 July.  The winning application would be announced on 1 September to allow time for the sponsoring associations to put finishing touches on the Burn Center Audit schedule which would start in January.

The application would ask for:

• current state of burn center auditing/verification in the country
• number of burn centers that would be sponsored – name, location, number of beds, annual admissions
• proposed travel schedule – with 5 burn centers per 10-12 day period, how many weeks of travel needed
• statement of financial support for this process

ISBI Personnel

The ISBI Guidelines/Outcomes Workforce would be the entity responsible for vetting the applications, would provide the site auditors and would finalize the site reviewer’s preliminary report.  To facilitate this pilot Burn Center Audit program would need to have 6 physicians, 6 nurses and 6 rehabilitation therapists from the Guidelines/Outcomes Workforce. Since the pilot program envisions 1-2 trips a year during the 6-year pilot this would be no more than one 10–12 day trip for each member of the committee each year.

Site Visit

Each hospital would be visited for 24 hours. The visit would start at noon on the first day where the reviewers would review the PRQ with the host burn center leadership.  The reviewers would also review 5 mortalities and 5 morbidities case summaries that occurred over the last 12 months before the site visit which had been prepared by the host burn center.  The evening would have a small working dinner with reviewers and burn center and hospital leadership in attendance.  The following morning, from 7-10 or 8-11, the ISBI team would deliver three lectures – one each by the MD, nurse and rehabilitation therapist (OT or PT).  This would be followed by multi-disciplinary rounds with the host burn team and the reviewers and a tour of the burn center and hospital.  The late morning/noontime would allow an hour for the reviewers to prepare their summary report and at 2 PM they would report their preliminary findings to the burn center and hospital leadership. 

Report

A final report with level of verification and recommendations for improvement will be sent to the burn center and sponsoring society/association in 2 months.

Follow-up of the Burn Center Audit

ZOOM call:  The ISBI would arrange a ZOOM call with the ISBI reviewers and the burn center leadership at 6-8 months after delivery of the final Burn Center Audit visit to check in on progress and offer advice into implementation of recommendations, and to solicit from the burn center their opinion as to the value of the Burn Center Audit program.

ISBI website content:  This is still a work in progress, but as the ISBI develops content and/or an ISBI listserve (on-line community) the center’s participating in the ISBI Burn Center Audit program would receive 1 year of free access to these features.

Re-visit:  For this pilot Burn Center Audit program there are no plans for revisiting burn centers.  If this pilot is found to be successful, the ISBI will consider offering re-visits to centers that have previously be visited on a 5-year cycle.

Deadline for applications:  25 March 2024, 5PM CST US

Apply Here

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