Global Hospital Infrastructure and Pediatric Burns.

Low-income regions carry the highest mortality burden of pediatric burns and attention to remedy these inequities has shifted from isolated mission trips toward building infrastructure for lasting improvements in surgical care. This study aims to investigate disparities in pediatric burn care infrastructure and their impact on mortality outcomes. The multinational Global Burn Registry was queried for all burn cases between January 2018 and August 2021. Burn cases and mortality rates were analyzed by chi-square and multinomial regression. There were a total of 8537 cases of which 3492 (40.9%) were pediatric. Significantly lower mortality rates were found in facilities with sophisticated nutritional supplementation (P < .001), permanent internet connectivity (P < .001), critical care access (P < .001), burn OR access (P = .003), dedicated burn unit (P < .001), and advanced plastic and reconstructive skills (P = .003). Significant disparities were found in the availability of these resources between high- and low-income countries, as well granular information within low-income regions. In a multinomial logistic regression controlling for TBSA, the most significant predictive factors for mortality were limited critical care availability (OR 15.18, P < .001) and sophisticated nutritional access (OR 0.40, P = .024). This is the first quantitative analysis of disparities in global burn infrastructure. The identification of nutritional support as an independent and significant protective factor suggests that low-cost interventions in hospital nutrition infrastructure may realize significant gains in global burn care. Granular information in the variability of regional needs will begin to direct targeted infrastructure initiatives rather than a one-size-fits-all approach in developing nations.

Making Patient Safety Event Data Actionable: Understanding Patient Safety Analyst Needs.

OBJECTIVES: The increase in patient safety reporting systems has led to the challenge of effectively analyzing these data to identify and mitigate safety hazards. Patient safety analysts, who manage reports, may be ill-equipped to make sense of report data. We sought to understand the cognitive needs of patient safety analysts as they work to leverage patient safety reports to mitigate risk and improve patient care. METHODS: Semistructured interviews were conducted with 21 analysts, from 11 hospitals across 3 healthcare systems. Data were parsed into utterances and coded to extract major themes. RESULTS: From 21 interviews, 516 unique utterances were identified and categorized into the following 4 stages of data analysis: input (15.1% of utterances), transformation (14.1%), extrapolation (30%), and output (14%). Input utterances centered on the source (35.9% of inputs) and preprocessing of data. Transformation utterances centered on recategorizing patient safety events (57.5% of transformations) or integrating external data sources (42.5% of transformations). The focus of interviews was on extrapolation and trending data (56.1% of extrapolations); alarmingly, 16.1% of trend utterances explicitly mentioned a reliance on memory. The output was either a report (56.9% of outputs) or an action (43.1% of outputs). CONCLUSIONS: Major gaps in the analysis of patient safety report data were identified. Despite software to support reporting, many reports come from other sources. Transforming data are burdensome because of recategorization of events and integration with other data sources, processes that can be automated. Surprisingly, trend identification was mostly based on patient analyst memory, highlighting a need for new tools that better support analysts.