8 Apr 2016

Building the evidence base for burns care with BRANZ

Miss Heather Cleland with a patient. She is Director of the
Victorian Adult Burns Service at Alfred Health.
The Burns Registry of Australia and New Zealand (BRANZ) is providing crucial data to burn units across the region, improving practice and outcomes for patients, according to research published in the Medical Journal of Australia (MJA) on the first four years of data from BRANZ.

BRANZ was established in 2009 to monitor and benchmark quality of care in specialist burn units in the two countries; and in 2013 the Australian and New Zealand Burn Association (ANZBA) launched the Burns Quality Improvement Program to develop evidence-based standards of care and to provide a quality improvement framework for improving care.

Dr Heather Cleland is Director of the Victorian Adult Burns Service, the Skin Tissue Culture Laboratory in the Central Clinical School and an adjunct senior lecturer in the School of Public Health and Preventive Medicine. She is the lead author of the MJA article, which analysed the first four years of data from the BRANZ. It revealed significant variation in treatments and outcomes between specialised burns unit across the country.

Accompanying the paper was an MJA ‘InSight’ article, video and podcast. In these, Dr Cleland discusses the vital need for such data, given the evidence of variations in practice and outcomes that were identified.

“We have significant differences - not only in inputs and outcomes - and we really need to get a better understanding of what the influences for these are,” Dr Cleland said.

The researchers examined four basic features of burn care in Australia and New Zealand from July 2010 to June 2014: two management items, rates of admission to intensive care units and rates of skin grafting; and two outcome measures, length of hospital stay and mortality.

The authors found that despite the highly centralised delivery of care to patients with severe or complex burn injuries there was considerable variation in practice. The study also provided evidence of significant variations in outcomes that are not explained by simple differences in casemix alone.

“It is highly likely that some aspects of the treatment that we deliver to burns patients are not as good as other aspects,” Dr Cleland said.

Nearly three-quarters (74 per cent) of patients underwent at least one surgical procedure, the authors found. However, there were significant differences between units in skin grafting rates. Surgical management impacts on long term scarring outcomes and the study indicated that the rates of grafting differ between units.

“The information provided by BRANZ provides a unique opportunity for significantly improving the quality of care for burns patients in Australia and New Zealand,” the authors concluded.

To date, use of the BRANZ registry has successfully resulted in improved burns service planning, along with driving changes to community awareness and burns prevention campaigns. Dr Cleland said that the registry has been vital in advancing and improving burns treatment, but it could go further in providing crucial evidence-based standards of care for all burns units in the region.

Reference: Heather Cleland, John E Greenwood, Fiona M Wood, David J Read, Richard Wong She, Peter Maitz, Andrew Castley, John G Vandervord, Jeremy Simcock, Christopher D Adams and Belinda J Gabbe.The Burns Registry of Australia and New Zealand: progressing the evidence base for burn care. Med J Aust 2016; 204(5), pp.195.
doi: 10.5694/mja15.00989.

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