WEBB FELLOW: Promoting Psychosocial Recovery, Resiliency and Re-integration in Burn Patients in the Inpatient and Outpatient Setting

Background:



Development of depression and trauma-related symptoms is common in burn patients post injury which can lead to poor outcomes and decreased quality of life during the long-term phase of recovery. Large burn centers often have an embedded psychiatrist that provides expert inpatient consultation but there is no standard for identifying patients that may be at risk for psychological distress or mechanism for referring patients for psychiatric and psychosocial aftercare. In order to promote psychosocial recovery, resiliency and social re-integration, it is critical to 1) identify patients at risk for developing depressive and trauma-related symptoms after injury and 2) provide appropriate resources.



Methods:



BWH Burn Resiliency and Recovery workflow was developed at Brigham and Women’s Hospital, a large 793-bed tertiary academic medical center. Patients who had been admitted to BWH Burn service over 2 years underwent screening for depressive and PTSD symptoms during post-burn outpatient follow-up appointment using the PHQ-2 and PC-PTSD-5. Positive screens were combined with subjective data to identify patients who would benefit from outpatient psychiatric or psychological follow-up based on consensus of psychiatrist and clinically licensed social worker. Patients who screen positive are referred to Patient Service Navigator for referrals in the community.



Results:



We are currently analyzing our results. Data that will be presented includes number of burn patients admitted, number of patients with a positive screen, number of patents who accepted referrals and number of patients with successful referrals. Preliminary results showed high rates of depressive and trauma-related symptoms in burn patients post-injury during inpatient hospitalization and at outpatient follow-up. 73.3% of patient with positive screens accepted referrals for post-injury psychological support. Our data shows also shows 45.5% success rate for referral contact.



Discussion/Conclusions:



The BWH Burn Resiliency and Recovery workflow has been shown to successfully identify patients who are at risk for developing depressive and trauma-related symptoms. The findings from this QI project have important management implications for burn patients post-injury. C-L psychiatrist will continue to be called on to assist in promoting resiliency and post-injury integration for survivors of burn injury. Developing mechanisms for identifying patients at risk for developing depressive and trauma-related symptoms early in the course is important for overall quality of life, developing resiliency and post-traumatic growth.



References:
1. Palmu R, Suominen K, Vuola J, et al. Mental disorders after burn injury: a prospective study. Burns. 2011;37(4):601-609.
2. Sveen J, Ekselius L, Gerdin B, et al. A prospective longitudinal study of posttraumatic stress disorder symptom trajectories after burn injury. J Trauma. 2011;71(6):1808-1815.
3. Tedstone JE, Tarrier N. An investigation of the prevalence of psychological morbidity in burn-injured patients. Burns. 1997; 23(7-8):550-554.