title: Reduced length of stay in hospital for burn patients following a change in practice guidelines:  financial implications.
abstract: The objective of this study was to analyze the financial implications of the implementation of new institutional practice guidelines including greater outpatient care and earlier operative intervention in a provincial burn center. A retrospective review was performed including all patients admitted to the Burn Unit with burns up to 20% TBSA between August 2005 and July 2009, including 2 years before and after the new guidelines were introduced. Daily costs for the burn unit were used to calculate this portion of cost. Length of stay (LOS) was based on actual data and representative clinical scenarios. Two hundred sixty-four patients were included. Mean LOS decreased from 10.3 to 3.9 (P < .01) and 21.0 to 13.3 (P > .05) for nonoperative burns 0 to 10% and 10 to 20% TBSA, respectively. Mean LOS for operative burns decreased from 16.6 to 12.9 and 32.3 to 29.8 days for 0 to 10% and 10 to 20% TBSA, respectively (P > .05). Burn patient management requires significant financial resources, and LOS has a large impact on cost. Given per diem rates of Can$1,663, scenario analysis shows potential cost savings of Can$19,956 per patient for operative and nonoperative burns <20% TBSA. With an average of 66 such patients treated each year, potential annual cost savings are Can$1.3 million. If outcomes are not compromised, earlier operative management and greater outpatient care can translate into significant cost savings. A prospective analysis capturing all costs and patient quality of life is required for further assessment.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada.
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Jansen
authors.forename: Sally L
authors.initials: SL
authors.lastname: Hynes
authors.forename: Sheina A
authors.initials: SA
authors.lastname: Macadam
authors.forename: Anthony
authors.initials: A
authors.lastname: Papp
mesh_terms: D001955:British Columbia; D002053:Burn Units / Q000191:economics*; D002056:Burns / Q000191:economics* / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects