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Burn injuries often require complex interdisciplinary care. Despite potential benefits, consultation with specialist palliative care typically occurs in 2% of burn admissions, due largely to lack of availability and misconceptions concerning palliative care. Criteria to guide consultation with specialist palliative care have been developed at this institution. The purpose of this study was to quantify the sensitivity and specificity of these criteria, and then optimize them. Retrospective examination of 388 admissions over 15 months at this adult and pediatric Burn Center were conducted. Chi-square or Fisher's exact test for categorical variables and Wilcoxon Rank Sum test for continuous variables were used to test for between-group differences in demographic and clinical characteristics. Logistic regression model was built to determine modified Baux cut-off score using Youden index (J) value. Criteria were sensitive (0.96) and specific (0.90), though with a low positive predictive value (0.43). Persons with lengths of stay greater than one week, advanced directives, Allow Natural Death orders, and/or deterioration events were significantly more likely to have had palliative care consulted. There were significant between-group differences (with/without palliative care consultation) based on burn surface area, modified Baux score, and mortality risk. Potential criteria revisions are proposed. Prospective adherence to revised criteria could provide useful guidance to providers and benefit to patients and families. [ABSTRACT FROM AUTHOR]

Burns frequently require complex interdisciplinary care. Specialist palliative care (PC) minimizes suffering, aids in decision making, and provides family support in addition to end-of-life care. Specialist PC is a limited resource, best conserved by identifying persons most likely to benefit from a PC referral. Little guidance is available for clinicians on whether and when to refer to PC. This study's purpose was to identify referral criteria using a mixed-methods approach. Data were examined for between-group differences using Fisher's exact, chi-square, or Wilcoxon Rank Sum tests. Qualitative thematic analysis was used to analyze PC provider notes to describe interventions provided. These data formed initial referral criteria, which were reviewed by an expert panel. Significant between-group differences included dying in the burn center; whether multiple patients were transported to the burn center from one event; and ventilator days. Four themes emerged from qualitative analysis. These included managing physical aspects of care; clarifying goals of care; managing end-of-life care; and managing patient/family psychosocial distress. Expert panel input clarified referral criteria language and supplemented the proposed criteria. We present empirically derived referral criteria to guide burn providers in referring persons for specialist PC. Subsequent testing is required to determine their efficacy in improving patient/family outcomes. [ABSTRACT FROM AUTHOR]

A paucity of evidence is available to guide integration of specialist palliative care into burn care. This study's purpose was to develop consensus on referral criteria using a modified Delphi process. Content experts were defined as burn or palliative care providers in locations where the teams have collaborative history; published at least one manuscript or presented nationally on burn and palliative care collaboration; or nomination as having equivalent expertise. N = 202 eligible persons were identified; n = 43 participated in Iteration 1 and Iteration 3 retained 79%. Iteration 1 invited participants to rank published referral criteria on a 9-point Likert-style scale. Consensus was defined as an interquartile range ≤ 2. Consensus items with median scores ≤ 3 were dropped from further consideration. Consensus items with median scores ≥ 7 were considered to be important and excluded in Iteration 2. Iteration 2 which presented non-consensus items with their associated median (interquartile range) and the participant's own ranking from Iteration 1. Iteration 3 presented three models; participants ranked in order of preference and suggested revisions. Consensus was achieved on a final set of criteria for specialist palliative care for persons who sustain burn injuries. Future research should prospectively evaluate the criteria against meaningful outcomes. • Modified Delphi process to develop consensus on palliative care referral for burns. • Consensus was achieved on a final set of criteria for specialist palliative care. • Criteria segregated for mandatory consultation and discretionary consultation. [ABSTRACT FROM AUTHOR]

1. Name 4 areas of palliative care service provided to burn patients and families 2. Name at least 5 criteria for which to consult specialist palliative care Burns often require complex interdisciplinary care. Specialist palliative care (PC) minimizes suffering, aids in decision making, and provides family support in addition to end-of-life (EOL) care. Specialist PC is a limited resource, best conserved by identifying patients most likely to benefit from a PC referral. Little guidance is available for clinicians on whether and when to refer to PC. Identify referral criteria via a mixed-methods approach in our burn center serving adult and pediatric patients. 5-year retrospective review of a matched cohort of patients with and without PC consultation. Qualitative analysis of PC consultation notes was performed to identify indication and services provided. Draft criteria were reviewed by an expert panel. 35 patients had PC consultations; 330 patients were eligible as controls. Propensity scoring found 22 matched pairs; between-group demographics were similar. Average time to PC consultation was 214 hours; mean time from consultation to death was 166 hours. Four themes for consultation were identified: physical symptom management, establishing goals of care, EOL care, and psychosocial management. Consultation criteria identified were EOL anticipated within 7 days, goals of care unarticulated or conflicted, specialist bereavement care indicated, prolonged functional loss, ventilated over 7 days, SCORTEN ≥4, and Baux score ≥ 100. Criteria to prompt consideration for consultation were also identified. PC consultation indications extended well beyond EOL or goals of care. We propose referral criteria for consultation and consideration and will subsequently examine adherence to and outcomes for improvement. As the scope of PC continues to evolve, indications for consultation must balance increasing access with overwhelming capacity. Early PC consultation may be of benefit to adult and pediatric burn patients. Collaboration between PC and burn teams can improve the value proposition for PC and the multidisciplinary approach in complex patients. [ABSTRACT FROM AUTHOR]