Elsevier

Burns

Volume 44, Issue 7, November 2018, Pages 1759-1766
Burns

Qualitative analysis of clinician experience in utilising the BuRN Tool (Burns Risk assessment for Neglect or abuse Tool) in clinical practice

https://doi.org/10.1016/j.burns.2018.03.013Get rights and content

Highlights

  • Qualitative analysis of clinician experience in utilising the BuRN Tool.

  • BuRN-Tool an acceptable aid in identifying child maltreatment in patients with burns.

  • The greatest perceived benefit is for junior staff and those that do not regularly work in paediatrics.

Abstract

Introduction

The BuRN-Tool (Burns Risk assessment for Neglect or abuse Tool) is a clinical prediction tool (CPT) aiding the identification of child maltreatment in children with burn injuries. The tool has been derived from systematic reviews and epidemiological studies, validated and is under-going an implementation evaluation. Clinician opinion on the use of this CPT is a key part of its evaluation.

Objectives

To explore the experience of emergency clinicians use of the BuRN-Tool in an emergency department (ED).

Methods

Three focus groups were conducted over a six-week period by the research team in the ED in the University Hospital of Wales; 25 emergency clinicians attended. A semi-structured approach was taken with pre-determined open-ended questions asked followed by a series of case vignettes to which the CPT was applied. The focus groups were recorded and transcribed verbatim. Thematic analysis was conducted for identification of pre-set and emergent themes. All data were double-coded.

Results

All participants said that it was acceptable to use the BuRN-Tool to aid in the decision-making process surrounding child maltreatment. All participants said that the BuRN-Tool was helpful and straight forward to use. All participants said that the tool was clinically beneficial, particularly for junior staff and those who do not always work in a paediatric environment.

The clinical vignettes identified subjectivity in interpretation questions around adequate supervision, previous social care involvement and full thickness burns. This resulted in some variation in scoring.

Conclusions

This study confirms that the BuRN-Tool is acceptable in an ED setting. The focus groups demonstrated a homogenous and positive attitude regarding the layout, benefits and use of the BuRN-Tool. The subjective interpretation of some variables accounts for the non-uniformity in the scores generated. Clarification of questions will be made.

Introduction

Approximately 50–60,000 children attend emergency departments each year as a result of burns [1]. Evidence suggests that the proportion to child maltreatment ranges from 1 to 24% (1% Cornwall, UK; 24% USA) [2], [3]. One of the most current UK figures quoted estimate that 10% are a result of maltreatment with the ratio of physical abuse to neglect 9:1 [4].

The identification of burns due to maltreatment is complex but is an essential step in safeguarding children. For those discharged without recognition of the signs of maltreatment, there is an increased risk of future neglect or abuse [5], [6].

Members of the Children’s Burns Research Network have developed a clinical prediction tool (CPT). The BuRN-Tool (Burns Risk assessment for Neglect or abuse Tool) generates a simple score based around seven routinely collected demographic, historical and clinical features (Supplementary Appendix 1). Possible scores range from 0 to 12. A score of three or more acts as the threshold above which maltreatment is suspected [7]. The variables in the tool were identified following a systematic review and an epidemiological study [8], [9]. Data collection for these studies utilised a proforma called the BaSAT (Burns and Scalds Assessment Template – Supplementary Appendix 2). As well as its role as a research template, the BaSAT acts as a clinical record, aiding the identification of key features of maltreatment and works in synergy with the BuRN-Tool which has been prospectively validated [7]. The next stage in the development of a CPT is to undertake an implementation study to ensure that the CPT has the desired effect in the clinical setting [10].

As an initial stage in the process evaluation, we have undertaken a qualitative study to explore clinician opinion on the acceptability of the BuRN-Tool during the implementation study. In a previous study, the acceptability of the CPT was assessed, noting that clinicians were willing to use the BuRN-Tool [11]. This analysis occurred before the tool was in clinical use with the BuRN-Tool undergoing considerable revisions since.

In the study site, the BuRN-Tool is incorporated into the BaSAT in the ED. The ED was chosen as the BuRN-Tool was derived from an ED population and is designed to be used in this environment.

Section snippets

Design

Focus group methodology is a recognized means of collecting qualitative data. The method allows for extrapolation of the data collected, and further interpretation and refinement of results [12], [13]. It can be a particularly useful to explore knowledge and experiences [14].

A key advantage of focus groups is the ability to involve multiple participants in one session, allowing for data to be gathered from numerous candidates without the need for several interviews [13]. It facilitates

Results

The following results are presented by sub-theme. Quotes presented represent illustrative examples of the identified themes. Insertions to clarify topic content are denoted by square brackets. The characteristics of each participant are presented in brackets after each quote.

Discussion

The focus groups demonstrated a homogenous and positive attitude regarding the layout, benefits and use of the BuRN-Tool. The perceived benefits crossed all levels of staff experience, training and specialities. Participants commented that those from a non-paediatric background and junior level benefited the most, while also acknowledging a role for the BuRN-Tool for experienced consultants. The ease of use and interpretation allows a consistent approach in the clinical use of the BuRN-Tool.

Limitations

The study limitations include the fact that the lead researchers conducted the focus groups, potentially introducing bias. The middle grade focus group was comprised of four participants, the lower end of the recommended number for a focus group and may have impacted the discussion.

The site was chosen due to its current involvement in the implementation study and the results obtained may not be generalizable to other ED’s. Further focus groups will be conducted in other emergency departments as

Conclusion

This study offers an insight into clinician opinion on using CPT in an ED setting. All levels of clinician seniority supported its use. Assessing child maltreatment cases can be challenging, often involving the piecing together of small fragments of information to draw overall conclusions. The results support the hypothesis that adding a numerical score to a clinical assessment can make a subjective interpretation more objective.

Conflict of interest

The authors declare that they have no conflict of interest.

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