- Email: [email protected]
Patient confidentiality and new technologies in burn care
639
burns 41 (2015) 638–647
J.A. Dunne* ST4 Plastic Surgery, St George’s Hospital, Blackshaw Road, London SW17 0QT, UK
Owen Bodger University of Swansea, Singleton Park, Swansea SA2 8PP, United Kingdom
J.M. Rawlins Plastic, Reconstructive and Burns Surgeon, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia
Sarah Hemington Gorse David Williams Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom
*Corresponding author. Tel.: +44 7870987503 E-mail address: [email protected] (J.A. Dunne)
*Corresponding author. Tel.: +44 07949450866 E-mail address: [email protected] (R. Morris)
http://dx.doi.org/10.1016/j.burns.2014.12.019 0305-4179/# 2015 Published by Elsevier Ltd and ISBI.
http://dx.doi.org/10.1016/j.burns.2015.01.019 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
Response to Letter to the Editor
Letter to the Editor
Patient confidentiality and new technologies in burn care
Cost-effective outpatient burn-care for minor burns
We agree with the general concerns raised by Dunne and Rawlins [1] regarding data confidentiality and the use of smartphone cameras in the clinical environment. The apps which we evaluated [2] are simple calculators, requiring input data of age, body weight, burn surface area and time of injury. They do not use any patient identifiable data or take photographs of the patient, and the results of the calculations are not stored or transmitted in any form. We have no interests in promoting either app, but note that both apps studied present less of a threat to patient confidentiality than a handwritten Lund and Browder chart.
Dear Sir,
Funding Nil.
Conflict of interest Nil.
references
[1] Dunne JA, Rawlins JM. Patient confidentiality and new technologies in burn care. Burns 2015;41:638–9. [2] Morris R, Javed M, Bodger O, Hemington Gorse S, Williams D. A comparison of two smartphone applications and the validation of smartphone applications as tools for fluid calculation for burns resuscitation. Burns 2014;40: 826–34.
Rhys Morris* Muhammad Javed Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom
Burn care is known to be expensive. Nowadays, research on burn-related costs is becoming a current subject of debate and a wide variety of methodological approaches and cost prices are found in the literature. The mean total healthcare cost per burn patient in high-income countries is calculated as $88,218 (range $704–$717,306; median $44,024) [1]. According to ‘American Burn Association, National Repository 2013 report’ the estimated number of burns receiving medical treatment is 450,000 and only 40,000 of these cases are hospitalized [2]. These data suggest that majority of burn cases are treated as outpatients and I think that cost-effective outpatient management should be a current issue in modern burn-care approach. This letter intends to discuss the factors which may influence the cost-effectiveness of outpatient burn-care. The goal of outpatient management in burn trauma is to provide the best environment for spontaneous healing in order to prevent scarring and allow normal functions. Infections must be avoided at all costs because it will change the depth of burn and increase scarring with functional losses [3]. In the light of these principles, I think that the primary factor which may influence the cost-effectiveness of outpatient burn-care is the appropriateness of initial treatment for minor burns. Superficial burn wounds result in less damage when compared to deeper ones, hence cautious attempts for protecting the burn wound from deepening should be started in the initial treatment. Immediate cooling of the burn wound with tap water, water-soaked gauze or hydrogel reduces the surface temperature as well as the state of dehydration of a burned zone. By cooling, pain and damage due to perilesional vasodilatation are reduced as well [4,5]. Analgesia with nonsteroid anti inflammatory agents, oral rehydration and appropriate elevation of the affected extremity are other initial therapies which may protect the wound from deepening [6]. Successful management in the acute phase lowers the number of future wound dressings and debridements,
burns 41 (2015) 638–647
J.A. Dunne* ST4 Plastic Surgery, St George’s Hospital, Blackshaw Road, London SW17 0QT, UK
Owen Bodger University of Swansea, Singleton Park, Swansea SA2 8PP, United Kingdom
J.M. Rawlins Plastic, Reconstructive and Burns Surgeon, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia
Sarah Hemington Gorse David Williams Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom
*Corresponding author. Tel.: +44 7870987503 E-mail address: [email protected] (J.A. Dunne)
*Corresponding author. Tel.: +44 07949450866 E-mail address: [email protected] (R. Morris)
http://dx.doi.org/10.1016/j.burns.2014.12.019 0305-4179/# 2015 Published by Elsevier Ltd and ISBI.
http://dx.doi.org/10.1016/j.burns.2015.01.019 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
Response to Letter to the Editor
Letter to the Editor
Patient confidentiality and new technologies in burn care
Cost-effective outpatient burn-care for minor burns
We agree with the general concerns raised by Dunne and Rawlins [1] regarding data confidentiality and the use of smartphone cameras in the clinical environment. The apps which we evaluated [2] are simple calculators, requiring input data of age, body weight, burn surface area and time of injury. They do not use any patient identifiable data or take photographs of the patient, and the results of the calculations are not stored or transmitted in any form. We have no interests in promoting either app, but note that both apps studied present less of a threat to patient confidentiality than a handwritten Lund and Browder chart.
Dear Sir,
Funding Nil.
Conflict of interest Nil.
references
[1] Dunne JA, Rawlins JM. Patient confidentiality and new technologies in burn care. Burns 2015;41:638–9. [2] Morris R, Javed M, Bodger O, Hemington Gorse S, Williams D. A comparison of two smartphone applications and the validation of smartphone applications as tools for fluid calculation for burns resuscitation. Burns 2014;40: 826–34.
Rhys Morris* Muhammad Javed Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom
Burn care is known to be expensive. Nowadays, research on burn-related costs is becoming a current subject of debate and a wide variety of methodological approaches and cost prices are found in the literature. The mean total healthcare cost per burn patient in high-income countries is calculated as $88,218 (range $704–$717,306; median $44,024) [1]. According to ‘American Burn Association, National Repository 2013 report’ the estimated number of burns receiving medical treatment is 450,000 and only 40,000 of these cases are hospitalized [2]. These data suggest that majority of burn cases are treated as outpatients and I think that cost-effective outpatient management should be a current issue in modern burn-care approach. This letter intends to discuss the factors which may influence the cost-effectiveness of outpatient burn-care. The goal of outpatient management in burn trauma is to provide the best environment for spontaneous healing in order to prevent scarring and allow normal functions. Infections must be avoided at all costs because it will change the depth of burn and increase scarring with functional losses [3]. In the light of these principles, I think that the primary factor which may influence the cost-effectiveness of outpatient burn-care is the appropriateness of initial treatment for minor burns. Superficial burn wounds result in less damage when compared to deeper ones, hence cautious attempts for protecting the burn wound from deepening should be started in the initial treatment. Immediate cooling of the burn wound with tap water, water-soaked gauze or hydrogel reduces the surface temperature as well as the state of dehydration of a burned zone. By cooling, pain and damage due to perilesional vasodilatation are reduced as well [4,5]. Analgesia with nonsteroid anti inflammatory agents, oral rehydration and appropriate elevation of the affected extremity are other initial therapies which may protect the wound from deepening [6]. Successful management in the acute phase lowers the number of future wound dressings and debridements,