The development of a regional system for care of the burn-injured patients.
BACKGROUND
In the mid-20th century, it was recognized that patients with major burn injury required a dedicated, multidisciplinary team approach to receive optimal care. In the subsequent years, regionalized systems of care were developed to provide this level of care to the entire populations. There have been no reports on how an individual regional system evolved and the impact it had on the delivery of care for burn-injured patients.


METHODS
The number, distribution of patients, and mortality rates of patients who sustained burn injury from the years 1985-2006 were assessed using administrative hospital data obtained from the New York State Department of Health. Data were also obtained from the archives and registry of the first dedicated burn care facility in the region, the Shires Burn Service, from 1976 through 2008. The incidence of fires occurring by year during this period was assessed from data obtained from the Fire Department of New York City.


RESULTS
During the period from 1985 through 2006, there were 26,606,463 discharges from hospitals in New York City. Of these, 57,547 patients had a primary diagnosis of burn injury and 33,058 were cared for in designated burn care facilities. Since the inception of regionalized care there appears to be a 43% decrease in hospital admissions for burn injury. In the last year of study, 77.3% of the burn-injured patients were cared for in burn centers. The mortality rate has decreased from 3.8% in 1985 to 2% in 2006. In 1975 there were 137,237 fires in the region, which decreased to 44,054 in 2008.


CONCLUSIONS
Although there has been a significant decrease in the number of patients requiring hospitalization for burn injuries, there are still a large number of patients who suffer these injuries. Regionalization of burn care has been associated with care for patients in designated facilities in over 75% of the cases and a reduction in mortality by almost 50%.
Yurt
Roger W
RW
The William Randolph Hearst Burn Center, New York Presbyterian Weill Cornell Medical Center, New York, New York 10065, USA. ryurt@med.cornell.edu
Bessey
Palmer Q
PQ
D002053:Burn Units / Q000706:statistics & numerical data*; D002056:Burns / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D005390:Fires / Q000706:statistics & numerical data; D006801:Humans; D009519:New York City / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D016730:Program Development / Q000379:methods / Q000592:standards; D012040:Regional Health Planning; D014505:Urban Population