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The Burns Registry of Australia and New Zealand: progressing the evidence base for burn care

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
Med J Aust 2016; 204 (5): 195. || doi: 10.5694/mja15.00989

Summary

Objective: Analysis of data from the Burns Registry of Australia and New Zealand (BRANZ) to determine the extent of variation between participating units in treatment and in specific outcomes during the first 4 years of its operation.

Design: BRANZ, an initiative of the Australian and New Zealand Burn Association, is a clinical quality registry developed in accordance with the Australian Commission on Safety and Quality in Healthcare national operating principles.

Setting: Patients with burn injury who fulfil pre-defined criteria are transferred to and managed in designated burn units. There are 17 adult and paediatric units in Australia and New Zealand that manage almost all patients with significant burn injury. Twelve of these units treat adult patients.

Participants: Data on 7184 adult cases were contributed by ten acute adult burn units to the registry between July 2010 and June 2014.

Major outcomes: In-hospital mortality, hospital length of stay, skin grafting rates, and rates of admission to intensive care units.

Results: Considerable variations in unit profiles (including numbers of patients treated), in treatment and in outcomes were identified.

Conclusions: Despite the highly centralised delivery of care to patients with severe or complex burn injury, and the relatively small number of specialist burn units, we found significant variation between units in clinical management and in outcomes. BRANZ data from its first 4 years of operation support its feasibility and the value of further development of the registry. Based on these results, the focus of ongoing research is to improve understanding of the reasons for variations in practice and of their effect on outcomes for patients, and to develop evidence-informed clinical guidelines for burn management in Australia and New Zealand.

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  • Heather Cleland1
  • John E Greenwood2,3
  • Fiona M Wood4
  • David J Read5
  • Richard Wong She6,7
  • Peter Maitz8,9
  • Andrew Castley1
  • John G Vandervord11
  • Jeremy Simcock12,13
  • Christopher D Adams14,15
  • Belinda J Gabbe16

  • 1 Alfred Hospital, Melbourne, VIC
  • 2 Royal Adelaide Hospital, Adelaide, SA
  • 3 Hanson Institute, Adelaide, SA
  • 4 Royal Perth Hospital, Perth, WA
  • 5 National Critical Care and Trauma Response Centre, Royal Darwin Hospital, Darwin, NT
  • 6 Auckland Regional Centre for Plastic Reconstructive and Hand Surgery, Auckland, New Zealand
  • 7 New Zealand National Burn Centre, Middlemore Hospital, Auckland, New Zealand
  • 8 Concord Hospital, Sydney, NSW
  • 9 University of Sydney, Sydney, NSW
  • 10 Royal Hobart Hospital, Hobart, TAS
  • 11 Royal North Shore Hospital, Sydney, NSW
  • 12 Christchurch Hospital, Christchurch, New Zealand
  • 13 University of Otago, Christchurch, New Zealand
  • 14 Hutt Hospital, Wellington, New Zealand
  • 15 Wellington Plastic Surgery Institute, Wellington, New Zealand
  • 16 Monash University, Melbourne, VIC

Correspondence: h.cleland@alfred.org.au

Acknowledgements: 

Funding for this project was provided by the Australian Commission on Safety and Quality in Health Care. In addition, the BRANZ is an initiative of the Australian and New Zealand Burn Association (ANZBA) with additional funding received from the Julian Burton Burns Trust (2008-2013), the Australian Commission on Safety and Quality in Health Care (2008-09), the Helen Macpherson Smith Trust (2010-2012), the Thyne Reid Foundation (2011-2013), the New Zealand Accident Compensation Corporation (2013-2014) and the Australasian Foundation for Plastic Surgery (2013-2014). Individual burn centres have also contributed to co-funding the registry to ensure the ongoing sustainability of BRANZ. We thank the BRANZ Steering Committee for supporting the project and providing data to the project. Belinda Gabbe was supported by a National Health and Medical Research Council Career Development Fellowship (GNT1048731) during the preparation of this manuscript.

Competing interests:

No relevant disclosures.

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