Where to from here? A quality improvement project investigating burns treatment and rehabilitation practices in India
Jagnoor et al. BMC Res Notes
Where to from here? A quality improvement project investigating burns treatment and rehabilitation practices in India
J. Jagnoor 0 2 3
C. Lukaszyk 0 3
A. Christou 0 3 4
T. Potokar 1
S. Chamania 6
R. Ivers 0 2 3 5
0 The George Institute for Global Health, University of New South Wales , Level 5, 1 King Street Newtown, Sydney 2042 , Australia
1 Human and Health Sciences Central, Swansea University , Swansea, Wales , UK
2 Sydney Medical School, University of Sydney , Sydney , Australia
3 The George Institute for Global Health, University of New South Wales , Level
4 Sydney School of Public Health, The University of Sydney , Sydney , Australia
5 Southgate Institute, Flinders University , Adelaide , Australia
6 Choithram Hospital and Research Centre , Indore , India
Objective: To describe the capacity of the Indian healthcare system in providing appropriate and effective burns treatment and rehabilitation services. Results: Health professionals involved in burns treatment or rehabilitation at seven hospitals from four states in India were invited to participate in consultative meetings. Existing treatment and rehabilitation strategies, barriers and enablers to patient flow across the continuum of care and details on inpatient and outpatient rehabilitation were discussed during the meetings. Seventeen health professionals from various clinical backgrounds were involved in the consultation process. Key themes highlighted (a) a lack of awareness on burn first aid at the community level, (b) a lack of human resource to treat burn injuries in hospital settings, (c) a gap in burn care training for medical staff, (d) poor hospital infrastructure and (e) a variation in treatment practices and rehabilitation services available between hospitals. A number of opportunities exist to improve burns treatment and rehabilitation in India. Improvements would most effectively be achieved through promoting multidisciplinary care across a number of facilities and service providers. Further research is required to develop context-specific burn care models, determining how these can be integrated into the Indian healthcare system.
Burns care; Burns rehabilitation; India; Health services; Health systems; Health professionals
Introduction
Approximately seven million people sustain burns every
year in India [
1
] with over 61,000 deaths attributed to
exposure to fire, heat or hot substances in 2015 [
2
]. Ten
percent of hospitalised burns cases require prolonged
hospital treatment lasting over 3 months, with half of
surviving patients acquiring permanent disability [
3
]. The
risk factors associated with burns are well known and
within India, these include a scarcity of safe fuels, high
population density, and additional risk factors associated
with intentional burns [
4
].
Burn care is often poorly organised and
underresourced in low- and middle-income countries (LMICs),
exacerbated by the already inadequate health care
facilities and fragmented health systems that exist in
many of these settings [
5
]. Potentially damaging local
traditional first aid practices provided to patients prior to
attaining definitive medical care, such as applying urine,
mud, or cow dung directly to a burn wound, may
compound burn care further [
6
]. Burns have the highest
average direct medical costs of all injury types in LMICs [
7
]
due to lengthy periods of hospitalization, operative costs,
and costs associated with diagnostic tests, dressings,
medications and need for long rehabilitation [
8–10
]. In
many LMICs, a large proportion of these costs are borne
by the patient. In Vietnam, the average out-of-pocket
cost per burn injury hospitalization is over US$270 [
10
].
It is therefore important to understand the context of
available resources and local health system structure
when making recommendations for the management and
delivery of burns care services.
The aim of this project was to document current
practices for burns care in India, particularly for care after
the acute phase of injury and for rehabilitation services
provided post-discharge. This information was used to
inform further research questions and guided the
development of topic guides for additional large-scale
qualitative work.
existing burns treatment and rehabilitation strategies. No
statistical analysis was performed due to the qualitative
nature of the data collected for this project. Co-authors
discussed the output until consensus was reached upon
the major themes identified by health professionals.
Main text
Methods
This project was initiated in 2015 as part of a broader suit
of work investigating the availability, acceptability and
effectiveness of services providing burns care in India.
Seven secondary and tertiary medical facilities in
TierII and Tier-III metropolitan cities across four states in
India were selected for inclusion in the study (Table 1).
Purposive sampling was used to identify government and
non-governme (...truncated)