680 Utilizing a Quality Audit Tool to Mitigate Over-Resuscitation Incidence

TL;DR

A quality audit tool helped reduce over-resuscitation in burn patients, leading to fewer complications and lower mortality rates.

Contribution

A quality audit tool was developed and implemented to reduce over-resuscitation in burn patients through data-driven insights.

Findings

Over-resuscitation incidence decreased by 62.5% in one year and was eliminated in three years.

Mortality rates of resuscitated patients decreased by 34% over three years.

Streamlined communication and educational initiatives were key to reducing over-resuscitation.

Abstract

Data analysis during the acute care phase of fluid resuscitation for severely burned patients can mitigate complications associated with over-resuscitation and reduce mortality rates. The development and implementation of an audit tool by a burn quality team facilitated data analysis and identification of key factors influencing over-resuscitation in this critically injured population.

At the studied institution, fluid resuscitation is administered to patients with greater than or equal to 20% total body surface area burned (TBSA). Over-resuscitation is defined as a fluid administration rate of greater than or equal to 5 ml per kg per TBSA per hour during the resuscitation phase, accompanied by associated complications. A quality audit tool was developed and applied to all fluid resuscitations over a three-year period to identify contributing factors to over-resuscitation. The tool allowed for hour-by-hour analysis of patient data, including vital signs, hemodynamic measurements, urine output, laboratory values, resuscitation rates, and cumulative fluid intake. Each hour during the first 24 hours post-injury was analyzed using this tool, enabling the quality team to identify trends in pre-hospital treatment interventions and inpatient resuscitation that predisposed patients to negative outcomes, as well as to implement strategies to mitigate these outcomes.

Within the defined population, the incidence of over-resuscitation decreased by 62.5% within one year post-implementation and was eliminated entirely within three years. Additionally, the incidence of abdominal compartment syndrome was zero, and the mortality rate of resuscitated patients decreased by 34% over the same three-year period. Key opportunities identified in this study included streamlined inter-departmental communication, focused educational initiatives, improved staff retention, and the addition of a dedicated burn educator to the burn center.

The implementation of a quality audit tool to evaluate fluid resuscitation can effectively decrease the incidence of over-resuscitation in burn centers. Continued efforts in data analysis may further identify essential treatment interventions for critically injured burn patients.

Focused burn quality department efforts in data capture and analysis can lead to the identification of key opportunities in clinical intervention and targeted educational initiatives for clinicians.

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