Therapeutic and financial outcomes using a pulsating low-air-loss surface for patients surviving severe posterior burns.

Patients with posterior burns require extensive stays in the intensive care unit for recovery. The authors hypothesized that pulsating low-air-loss therapy would decrease the intensive care unit length of stay for burn patients, resulting in a potentially significant reduction in charges to payors. Eighty-one posterior burn patients enrolled in the primary study were randomly assigned to a pulsating low-air-loss surface (study group) or a nonpulsating low-air-loss surface (control group). The 54 survivors in this analysis (the secondary study) were well matched for age, pre-existing conditions, and total body surface area burned. Average intensive care unit length of stay was less for the study patients compared with the control patients--40 days versus 64 days (P < .05). Control patients used specialty surfaces for 49 days and study patients used them for 38 days. Based on a daily intensive care unit charge of $1,000 and the average daily specialty surface rental charge, the study patients averaged potential charges of under $44,000 in comparison to more than $67,000 for control patients. These data suggest that treatment of posterior burns with pulsating low-air-loss therapy may be of great clinical and financial benefit, decreasing the intensive care unit length of stay and potentially contributing to reduced charges to payors.

The Jehovah's Witness orthopaedic trauma patient: an ethical challenge.

Members of the Jehovah's Witness faith believe that they are biblically prohibited from accepting blood transfusions even in cases of severe anemia that could lead to death. The refusal to accept blood is an ethical challenge for the health care team when managing an unstable Witness patient. The Jehovah's Witness patient has a right to refuse blood, and the health care team is obligated to abstain from providing transfusions. It is important that the health care team is proactive in becoming educated on the principles of the Jehovah's Witness faith and how to manage the patient without the administration of blood and blood products. The health care team is also encouraged to network with resources to provide support for the patient and family.

Developing the trauma nurse case manager role.

The case manager serves as the coordinator of all care for a specific caseload of patients throughout an episode of illness. This role includes management, clinical, consultation, education, and research roles. Case management is especially important to implement for trauma patients who otherwise have wide variations in outcomes because of the trauma and concomitant social problems. This author describes how the case management role can be implemented, includes a sample job description of the multiple-responsibilities, and provides a case study demonstrating the case manager's role.