107A Quality Improvement Process for Donning Custom Garments for the Burn Patients

Abstract Introduction Long term sequela of burn injuries include the development of scars leading to psychological, emotional, functional, and physical disabilities. There are multiple modalities for scar management including compression garments, topical silicone, orthotics, laser therapy, surgical releases, and medical treatment for symptom management. Multiple studies have found custom garments are a viable option to aid in improvement of range of motion, scar pliability, vascularity, color, height of scar, and improvement in appearance. Timing of garments is critical to the success of the treatment. The purpose of this quality improvement project is to develop an effective and efficient process to improve time to burn garment application. Methods At one verified ABA Burn Center, a retrospective chart review included adult burn patients, to compare the time for donning custom garments in the outpatient setting pre- and post-process improvement project. Pre-process improvement data was collected between October 1, 2018 and June 30, 2019. Post-process data collection carried from November 1, 2019 to August 31, 2020. A group including burn therapists, program manager, providers, and clinic staff met to identify the current practice and develop an improved workflow. An excel spreadsheet was developed to track key data points for continued improvement. Results A total of 33 patients were included in the initial pre-process improvement group (27 initial orders, 6 reorders) and 39 in the post-process group (24 initial orders, 15 reorders). The mean number of days for patients to receive their initial garment order was 98 days (range 19- 280) pre-process and 45.6 days (range 15 – 106) post-process (p = 0.0001). For reorders, mean days for receiving the garment was 37.3 days (range 19–70) preprocess and post process was 19.5 days (range 9–15) p = 0.039. Pre-process delays were related to packets not sent to vendor in a timely manner, necessary paperwork missing when sent to the vendor, lack of follow up for the status of the garment, insurance coverage, and staff being unaware of garment arrival. The major reason for delays with receiving garments in the post-process period was issues with insurance payments. Conclusions A defined, stepwise process may improve time to garment donning by patients. Support from insurance billing may further help improve this process.