The ACTUATE-CBC Study: ACcelerating The UptAke of TelemedicinE for Crisis Burn Care
Abstract
A person with a serious burn injury needs access to a clinician (i.e., a nurse, physician, or therapist) that has expertise in caring for people with burns. Unfortunately, the number of burn clinicians is limited. Only 1% of clinicians and 2% of hospitals have burn care expertise in the United States, which means that if a crisis like a terrorist attack or large building fire occurs, many of the burn-injured persons will have to receive care from clinicians without burn expertise. It is possible, based on recent estimates, that during a crisis scenario, patients with relatively large burns would have to remain in care facilities without burn expertise for as long as 5 days. This long period of time is significant, because studies show that when a patient receives care from a burn expert, they have better outcomes. The longer they remain without access to a burn expert s care, the more likely they are to experience complications, including death. Telemedicine technologies, such as real-time video and the electronic sharing of pictures, is an effective means of connecting a patient with a burn injury to a burn care expert. Telemedicine can also be used for clinician-to-clinician consultation, where the burn expert provides teleconsultation to the local care provider without burn expertise to provide guidance for burn care. Because burn clinician resources are limited, it is a good idea to use telemedicine technologies to link burn care experts with people that do not have that expertise in any location where a patient may need to receive care. Under all circumstances, telemedicine technology is readily available but is not used as often as it should be. Outside of the military, about 34% of all new burn injury consultations with burn experts currently use telemedicine technology. In a recent military practice exercise, despite telemedicine technology being available and recommended, it was only used 11% of the time. When a practice, such as telemedicine for burn consultation, is supported by science and shown to be effective but people still don t use it, implementation science can help us determine why, and help design strategies that make it easier for people to follow the recommended practice. This study seeks to accelerate the use of telemedicine consultation for burn patients by determining all the factors that are currently affecting its use during a crisis and under usual circumstances, and designing and evaluating a toolkit that will enable the use of burn teleconsultation by clinicians in any setting. The military situation of prolonged field care (PFC) occurs when a Warfighter is injured but must remain in a remote location for their initial burn care for a period of hours or days because evacuation is not possible or safe. If that Warfighter has a burn injury, it is unlikely that a burn expert will be present in the remote location. This study directly aligns with FY20 MBRP Focus Area 2 - Burn care solutions for use by the medical first responder in the pre-hospital setting (not necessarily in a PFC scenario). The military personnel that must provide initial and ongoing burn care are similar to a clinician in a hospital or field hospital without burn expertise that must provide burn care during a civilian crisis. Both lack the experience to handle it alone and need to be able to connect the patient to a burn expert regardless of the patient s location to enhance the potential for better long-term outcomes. This study will help military and non-military patients with burn injuries have access to a burn expert that can guide their care regardless of their location. Our results will fill the knowledge gap about why clinicians currently do not use burn teleconsultation and provide a new understanding of the most effective way to leverage telemedicine for use during a civilian crisis, which also applies to the military PFC situation. The subjects of our study will be clinicians that work in r
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110422
Entities
People
- Amanda Bettencourt
Organizations
- United States Army
- University of Pennsylvania