The document discusses gaps in burn care identified between services in NSW, Australia and the UK. It outlines a study visit to burn units and networks in the UK to identify differences and best practices. Key gaps identified included lack of outreach programs, reintegration support, and standardized care pathways. The document also outlines steps taken in NSW to address gaps such as establishing telehealth support, developing rehabilitation programs, and investing in technology like laser scar treatment. The visit helped identify both similarities and areas for improvement between the two systems to better support burn patients.

1. HARC Scholarship
Burn Injury- Post acute
care: filling the gaps
Anne Darton
Manager
ACI Statewide Burn Injury Service NetworkApril 2015
“Achieving international best practice in post acute care and inpatient
rehabilitation for severe burn injured people; what are the gaps in care
for NSW burn injured people?”

2. Opportunity identified 
 Gap in current Burn services identified
 International conference
 Application
▲ Identify potential people/places to visit
▲ Brief literature review
▲ Work plan

3. “Achieving international best practice in post acute care and
inpatient rehabilitation for severe burn injured people; what are the
gaps in care for NSW burn injured people?”
 Burn rehab and post acute community
reintegration identified
 ISBI conference in Edinburgh (hosting same in
Sydney 2 years later)
 UK reviewed their burn services
 Similarity to NSW/Australian system

4. Conference Edinburgh
Visited 3 Burn Care Networks (many sites):
▲ Newcastle on Tyne Royal Victoria Infirmary Burn Unit
▲ Whiston Hospital burn unit Liverpool
▲ Pinderfields Hospital burns unit, Wakefield
Northern Burn Care Network Manager, Sheffield
▲ Sheffield Children’s Hospital Burns Unit
Midland Burn Care Network Manager, Nottingham
▲ University Hospitals Leicester Burn Facility
▲ Birmingham Children’s Hospital Burn Centre
▲ University Hospital Birmingham Burn Centre
Midland Burn Care Network Board Meeting, Nottingham
▲ St Andrew’s Burn Centre, Chelmsford
▲ Chelsea and Westminster Hospital London burns unit
▲ Queen Victoria Hospital East Grinstead
▲ Defence Medical Rehabilitation Centre, Headley Court

5. Findings

6. Gaps in our service (or what they do that we don’t)
 Post acute care
▲ Outreach services/clinics/home visits – variety of set ups
● Home based
● Clinics in peripheral centres
● Nurse only
● MDT
▲ Reintegration programs -
● adult program in partnership with a charity
● paediatric formalised reintegration school program
▲ Scar review clinics inclusive of MDT
▲ Scar Management
● All scar management products e.g. silicone gel sheets, custom made garments etc.
prescribed by GP on recommendation of the burn therapist and paid for by the NHS
system.
● In-house pressure garment production instead of private company production at one site
● Camouflage make-up - routine part of rehabilitation

7. Gaps in our service (or what they do that we don’t)
 System
▲ Online care pathways as per Northern Burn Care Network
▲ Tiered designation system for burn care services with standardised assessment
and validation
 Technology
▲ Laser treatment for scars
▲ Burns assessment app for smart phone and other devices
▲ Telehealth clinical psychology follow up
 Other
▲ Extensive use of clinical psychologists
▲ Burns Link nurses
▲ Burn case management
▲ Printed handout materials for patient information all aspects of burn care acute and
rehab, scar management etc.
▲ ‘Step-down’ flats for ongoing independence training with support of the burn
specialty MDT
▲ Ventilated beds on Burn Unit

8. Filling the Gaps (or what could we do in NSW/Australia?)
 Establishing multidisciplinary outreach teams combined with Telehealth
options
 Focused reintegration of back to work, community and school programs
including psychosocial supports
 Case management positions/roles to coordinate discharge and ongoing
services and care.
 Agreed standards of burn care service validated/accredited and be applicable
for the burn services across Australia and New Zealand through ANZBA
(Australian & New Zealand Burn Association)
 Adopting camouflage make- up as an adjunct to therapy for patients with
potential to improve self-esteem and psychological well being
 Exploring the use of Laser treatment for scars in the public health setting

9. What we have done so far
 Establishing multidisciplinary outreach teams combined with Telehealth options
Burn Telehealth project - in diagnostic phase
 Focused reintegration of back to work, community and school programs including psychosocial
supports
Burn Hub proposal led by our consumer/burn survivor representative
 Case management positions/roles to coordinate discharge and ongoing services and
care. Currently this only occurs with compensable work insurance cases.
Proposal being developed for a trial of “care navigator” for major burns
 Agreed standards of burn care service validated/accredited and be applicable for the
burn services across Australia and New Zealand through ANZBA (Australian & New
Zealand Burn Association)
Burns Quality Improvement Program BQIP (ANZBA) commenced
 Adopting camouflage make- up as an adjunct to therapy for patients with potential to
improve self-esteem and psychological well being
Resources for camouflage make-up explored and now made available to patients
 Exploring the use of Laser treatment for scars in the public health setting
Ultra Pulse Laser machines now purchased at CRGH & CHW (from trust funds)

10. What we have done so far
 Establishing multidisciplinary outreach teams combined with Telehealth options
Burn Telehealth project - in diagnostic phase
 Focused reintegration of back to work, community and school programs including psychosocial
supports
Burn Hub proposal led by our consumer/burn survivor representative
 Case management positions/roles to coordinate discharge and ongoing services and
care. Currently this only occurs with compensable work insurance cases.
Proposal being developed for a trial of “care navigator” for major burns
 Agreed standards of burn care service validated/accredited and be applicable for the
burn services across Australia and New Zealand through ANZBA (Australian & New
Zealand Burn Association)
Burns Quality Improvement Program BQIP (ANZBA) commenced
 Adopting camouflage make- up as an adjunct to therapy for patients with potential to
improve self-esteem and psychological well being
Resources for camouflage make-up explored and now made available to patients
 Exploring the use of Laser treatment for scars in the public health setting
Ultra Pulse Laser machines now purchased at CRGH & CHW (from trust funds)

11. What we have done so far
 Establishing multidisciplinary outreach teams combined with Telehealth options
Burn Telehealth project - in diagnostic phase
 Focused reintegration of back to work, community and school programs including psychosocial
supports
Burn Hub proposal led by our consumer/burn survivor representative
 Case management positions/roles to coordinate discharge and ongoing services and
care. Currently this only occurs with compensable work insurance cases.
Proposal being developed for a trial of “care navigator” for major burns
 Agreed standards of burn care service validated/accredited and be applicable for the
burn services across Australia and New Zealand through ANZBA (Australian & New
Zealand Burn Association)
Burns Quality Improvement Program BQIP (ANZBA) commenced
 Adopting camouflage make- up as an adjunct to therapy for patients with potential to
improve self-esteem and psychological well being
Resources for camouflage make-up explored and now made available to patients
 Exploring the use of Laser treatment for scars in the public health setting
Ultra Pulse Laser machines now purchased at CRGH & CHW (from trust funds)

12. What we have done so far
 Establishing multidisciplinary outreach teams combined with Telehealth options
Burn Telehealth project - in diagnostic phase
 Focused reintegration of back to work, community and school programs including psychosocial
supports
Burn Hub proposal led by our consumer/burn survivor representative
 Case management positions/roles to coordinate discharge and ongoing services and
care. Currently this only occurs with compensable work insurance cases.
Proposal being developed for a trial of “care navigator” for major burns
 Agreed standards of burn care service validated/accredited and be applicable for the
burn services across Australia and New Zealand through ANZBA (Australian & New
Zealand Burn Association)
Burns Quality Improvement Program BQIP (ANZBA) commenced
 Adopting camouflage make- up as an adjunct to therapy for patients with potential to
improve self-esteem and psychological well being
Resources for camouflage make-up explored and now made available to patients
 Exploring the use of Laser treatment for scars in the public health setting
Ultra Pulse Laser machines now purchased at CRGH & CHW (from trust funds)

13. What we have done so far
 Establishing multidisciplinary outreach teams combined with Telehealth options
Burn Telehealth project - in diagnostic phase
 Focused reintegration of back to work, community and school programs including psychosocial
supports
Burn Hub proposal led by our consumer/burn survivor representative
 Case management positions/roles to coordinate discharge and ongoing services and
care. Currently this only occurs with compensable work insurance cases.
Proposal being developed for a trial of “care navigator” for major burns
 Agreed standards of burn care service validated/accredited and be applicable for the
burn services across Australia and New Zealand through ANZBA (Australian & New
Zealand Burn Association)
Burns Quality Improvement Program BQIP (ANZBA) commenced
 Adopting camouflage make- up as an adjunct to therapy for patients with potential to
improve self-esteem and psychological well being
Resources for camouflage make-up explored and now made available to patients
 Exploring the use of Laser treatment for scars in the public health setting
Ultra Pulse Laser machines now purchased at CRGH & CHW (from trust funds)

14. What we have done so far
 Establishing multidisciplinary outreach teams combined with Telehealth options
Burn Telehealth project - in diagnostic phase
 Focused reintegration of back to work, community and school programs including psychosocial
supports
Burn Hub proposal led by our consumer/burn survivor representative
 Case management positions/roles to coordinate discharge and ongoing services and
care. Currently this only occurs with compensable work insurance cases.
Proposal being developed for a trial of “care navigator” for major burns
 Agreed standards of burn care service validated/accredited and be applicable for the
burn services across Australia and New Zealand through ANZBA (Australian & New
Zealand Burn Association)
Burns Quality Improvement Program BQIP (ANZBA) commenced
 Adopting camouflage make- up as an adjunct to therapy for patients with potential to
improve self-esteem and psychological well being
Resources for camouflage make-up explored and now made available to patients
 Exploring the use of Laser treatment for scars in the public health setting
Ultra Pulse Laser machines now purchased at CRGH & CHW (from trust funds)

15. Overall …….
 Learnt about not just post acute care but all aspects of burn care in UK
 There were elements in all the facilities visited that had something that was
different to NSW burns care and showed positive outcomes for patients
 Established ongoing connections with colleagues in the UK and share the
NSW experience.
 Similarities in the burn care services in the UK and those currently delivered
in NSW.
 No single service that was visited in the UK had an ideal model of post-acute
care.

16. Level 4, Sage Building
67 Albert Avenue, Chatswood NSW 2067
PO Box 699
Chatswood NSW 2057
T + 61 2 9464 4666
F + 61 2 9464 4728
info@aci.health.nsw.gov.au
www.aci.health.nsw.gov.au