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

Horrigan makes an important point with respect to clinical protocols that are implemented in an excessively rigid manner. However, as stated in our article,1 the data provided by the Burns Registry of Australia and New Zealand (BRANZ) indicate only that there is a need for an ongoing analysis of data that identifies relevant factors contributing to improved outcomes, and for the implementation of a quality improvement program to disseminate such practices.

Fundamental questions, such as which patients will benefit from the use of skin substitutes, how and when to use antibiotics, timing of skin grafting, and wound management strategies, are at present, in many instances, matters for judgement. While judgement must always be used in decision making, it should be recognised that judgement informed by evidence will lead to more appropriate treatment for individual patients.

The process of developing evidence-based clinical indicators for the BRANZ identified a significant absence of evidence for many burn treatments.2 Therefore, in the first instance, there is an urgent need for clinicians to document their care pathways, rather than for directive treatment protocols. Protocols or guidelines should be designed to ensure that key decision points in the care pathway are specifically addressed and documented, in order to direct clinical attention to factors that are thought likely to influence patient outcomes.3

The complexity of burn care is such that relevant potential influences on outcomes may be missed, unless they are specifically identified prospectively through the use of protocols and also when collecting data for the clinical quality registry.

The Burns Quality Improvement Program has been developed to provide a structure for examining the practices of high performing units — identified by BRANZ data — with the intention of recognising the factors that lead to improved outcomes. Only when these have been identified and established as clinically plausible associations will it be possible to make specific recommendations regarding standards of care relating to an array of treatments.