A pediatric acute wound service: a novel approach in wound management.
BACKGROUND
In 2001, in response to an overwhelming increase in patient visits for various pediatric abscesses, burns, and other wounds, an ambulatory burn and procedural sedation program (Pediatric Acute Wound Service, or PAWS) was developed to minimize operating room utilization. The purpose of this study is to report our initial 7-year experience with the PAWS program.


METHODS
The hospital records of all children managed through PAWS from 2001 to 2007 were reviewed. Outcomes measured include patient demographics, number and location of visits per patient, procedure information, cause of wounds, and reimbursement. chi(2) test and linear regression were performed using GraphPad Prism (GraphPad Software Inc, San Diego, CA).


RESULTS
Overall, 7620 children (age 0-18 years) received wound care through PAWS from 2001 to 2007. There were no differences in patient age, race, and sex during this time period. Between 2001 and 2007, the percentage of patients seen as outpatients increased from 51% to 68% (P < .05), and the average number of visits per patient decreased from 3.9 to 2.4 (P = .05). In, 2007, 46% of the children required only 1 visit. In 2007, 74% of the visits were for management of wound and soft tissue infections, compared with only 9% in 2001 (P < .05). The contribution margin of a PAWS visit and total contribution margin in 2007 were $1052 and $4.0 million, respectively.


CONCLUSIONS
The creation of PAWS has allowed for the transition in management of most pediatric skin and soft tissue wounds and infections to an independent ambulatory setting, alleviating the need for operating room resources, while functioning at a profitable cost margin for the hospital.
Bucher
B T
BT
Division of Pediatric Surgery, St. Louis Children's Hospital, Washington University, School of Medicine, St. Louis, MO, USA.
Seigel
J
J
Rosenblum
E
E
Nesslein
C
C
Keswani
S
S
Foglia
R P
RP
Dillon
P A
PA
Warner
B W
BW
Keller
Martin S
MS
D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D062109:Dermatologic Surgical Procedures; D004322:Drainage / Q000191:economics* / Q000379:methods; D019538:Health Care Surveys / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006753:Hospital Records / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D012867:Skin / Q000293:injuries; D018461:Soft Tissue Infections / Q000191:economics / Q000601:surgery; D017695:Soft Tissue Injuries / Q000191:economics / Q000601:surgery; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000191:economics* / Q000601:surgery*