Burn Center Verification Frequently Asked Questions

Our hospital doesn’t conduct morbidity and mortality conferences. How can we do a peer review conference in this setting?
That’s a serious problem. Failure to conduct peer-reviewed conferences of complications and deaths is a criterion deficiency. Be imaginative and be the first in your hospital to establish an M & M conference; others will soon be jealous.

Our hospital has a rule that the pulmonary/anesthesia/critical care doctors control the ventilators and write the orders. Is that okay?
No. Burn patients must have a single identifiable physician responsible for all aspects of care. That physician or his/her designee (eg., a surgery resident, another burn attending) should write ALL orders. Others should act as consultants and, with very few exceptions, shouldn’t independently write orders.

Can our burn unit be verified if we don’t participate in the Advanced Burn Life Support (ABLS) Course?
Yes. ABLS is recommended, not required. However, the unit must have some continuing education program for its staff, whether by ABLS or some other mechanism.

Our burn unit doesn’t use the TRACS® Burn Registry. Are other patient database systems okay to use?
Yes, as long as data from your registry can be exported annually in a readable fashion to the ABA National Burn Repository (NBR); a tab delimited text file containing the minimal data set should work. The NBR Policy and Procedure Manual under development by the ABA will include more detailed user information.

We just recruited a new head nurse. She is experienced but lacks burn-specific experience. Can our nurse educator make up for that or do we have to wait six months or a year for verification?
Tough question. Each case would have to be individualized based on the qualifications of your new head nurse and the nurse educator.

We use the burn ICU for other patients when we’re not full. Is this okay?
Yes. Nearly all burn centers do so to keep their staff during times of lower census. It would be best if the "patient borders" had an emphasis on wounds and surgical issues. Burn patients must always have priority if someone has to be "bumped."

For the Pre-Review Questionnaire that must be completed as part of our application for verification, can we use a program other than MS Word?
No. All word processing programs should have the ability to translate the document into at least an ASCII text file. Translation to MS Word is the easiest and most efficient for the site surveyors.

We never had peer-reviewed burn conferences before. Do we really need them now?
Yes—they are essential to appropriate Quality Assurance. A conference with candid, critical discussion can only take place with "uninvolved" physicians not under the authority of the burn director. You don’t need whole troops of such individuals, but at least one knowledgeable physician must be present.

Does the pharmacy need to be open for business 24 hours a day and seven days a week?
If "open for business" means supplying any and all drugs in the pharmacy to the burn patient 24 hours a day, then the answer is yes.

Can we be verified with only one burn physician attending in the center?
Yes, if he/she is available all the time with few exceptions—and can designate an appropriate substitute for those exceptions.

How often must a burn center undergo re-verification?
The cycle is three years. An experiment was done several years ago with verified centers in a three-year cycle—with all centers verified in 1995 undergoing re-verification in 1998-1999. All of the institutions that underwent re-verification felt it was quite valuable to keep the center in the forefront with administration, and that the process was worthwhile.

How do we become re-verified?
Call the American Burn Association (312-642-9260) and ask for a Re-verification Packet or email vineyard@ameriburn.org. The pre-review questionnaire is simplified and emphasizes only changes from the time of the last verification visit. In addition, you should highlight what has been done in the "areas of improvement" identified at the last visit. During the surveyors visit, they will also emphasize changes since the last visit, and will not likely require an extensive tour of the facility unless changes have occurred.

Thanks to David M. Heimbach, MD, FACS for his responses to the Frequently Asked Questions about Burn Center Verification. Dr. Heimbach is a past Chair of the ABA Verification Committee.