/policies/,/policies/clinical/,/policies/clinical/uw-health-clinical/,/policies/clinical/uw-health-clinical/gen-care/,/policies/clinical/uw-health-clinical/gen-care/admission-discharge-transfer/,

/policies/clinical/uw-health-clinical/gen-care/admission-discharge-transfer/2116.policy

201710297

page

100

UWHC,UWMF,

Policies,Clinical,UW Health Clinical,General Care and Procedures,Admission, Discharge, Transfer

Admission and Discharge Criteria for the Burn Unit (2.1.16)

Admission and Discharge Criteria for the Burn Unit (2.1.16) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Admission, Discharge, Transfer

2.1.16


UW HEALTH CLINICAL POLICY 1
Policy Title: Admission and Discharge Criteria for the Burn Unit
Policy Number: 2.1.16
Category: UW Health
Type: Inpatient
Effective Date: October 20, 2017

I. PURPOSE

To ensure appropriate use of the Burn Unit and to outline guidelines for admission and discharge from the
Burn Unit.

II. POLICY ELEMENTS

A. Scope of services.
The Burn Unit serves adults and children who have sustained burn injury or have pathologies that result in
skin loss or soft tissue damage. The patient in the Burn Unit requires the expertise of the interdisciplinary
burn team. All levels of patient acuity are accommodated in the Burn Unit. The goal is for the patient to
remain in the Burn Unit from the day of admission to the day of discharge, unless specialized rehabilitation is
required. All children admitted to the Burn Unit that are 10 years of age and under will have a pediatric
consultation.
B. Typical burn service populations include adults and children with:
i. Thermal and chemical burns
ii. Electrical burns and injuries
iii. Inhalation injury
iv. Cold injuries: Frostbite and hypothermia
v. Dermatologic conditions: Steven-Johnson Syndrome and TENS (Toxic Epidermal Necrolysis
Syndrome)
vi. Soft tissue conditions: Degloving injuries, extensive wounds, purpura fulminans and necrotizing
fasciitis
vii. Reconstructive surgery:
As consistent with UW Health Clinical Policy #2.1.27, Triage of Critically Ill Patients, patients
requiring intensive care services will take priority for admission. During periods of ICU bed
shortages, burn center patients not requiring ICU level care may need to be transferred to non-ICU
nursing units and arrangements made to ensure continuity of services outside the burn unit.

III. PROCEDURE FOR ADULT PATIENTS

A. Criteria and mechanisms for the admission and discharge of patients to and from the Burn Unit.
i. Class I priority is a burn service patient who meets one or more of the following criteria:
a. Hemodynamic instability that requires continuous assessment and intervention for fluid
shifts.
b. Hemodynamic and/or respiratory status requires complex, invasive monitoring equipment
to provide information regarding multiple parameters (i.e., pulmonary and systemic
vascular pressures, cardiac output).
c. Hemodynamic status requires administration, monitoring and titration of vasoactive drug
infusions at constant or frequent intervals (four hours or less).
d. Respiratory status requires mechanical ventilation, a secured airway, or constant to
frequent assessment and intervention for potential airway obstruction due to facial
burns/fluid resuscitation.
e. Carbon monoxide poisoning with a carbon monoxide level greater than or equal to 15%.
f. Cardiac status requiring continuous monitoring and possible intervention.
g. Circumferential burn(s) requiring assessment of peripheral pulses frequently (every two
hours or less).
h. TBSA (total body surface area) skin loss greater than 20% in an adult.
i. Electrical injuries with need to monitor extremities for compartment syndrome.
ii. Class II priority is a burn service patient who meets one or more of the following criteria:
a. Carbon monoxide poisoning with a carbon monoxide level less than 15%.
b. Circumferential burn(s) requiring frequent assessment of peripheral pulses (greater than
every two hours).
c. Significant skin loss but less than 20% TBSA in an adult.



UW HEALTH CLINICAL POLICY 2
Policy Title: Admission and Discharge Criteria for the Burn Unit
Policy Number: 2.1.16

d. Extensive or specialized wound care requiring burn team expertise (i.e., hydrotherapy,
debridement, skin graft care).
e. Reconstructive surgery requiring burn team expertise for post operative care.
B. Admission procedure and assignment of service.
i. Burn service patient: The Graduate Medical Education (GME) trainee and the attending physician
for the burn service identify the patient's need for placement in the Burn Unit. A burn service patient
can be directly admitted upon physician determination.
ii. Burn service consultation patient: A patient may require the care of the burn team and placement in
the Burn Unit. The patient may remain on the service of origin with burn service consultation upon
approval of the Burn Unit's attending physician. Orders and treatment may then occur within both
services.
iii. Non-burn service patient:
a. A patient would benefit from wound care performed by the Burn Unit nursing staff. The
patient remains on their primary service and is accommodated if burn service census
permits. Requests are made through the Nursing Coordinator.
b. A patient requires intensive care and burn service census permits (may include triage of
non-ICU burn service patients to general care unit). Placement is determined by the
Nursing Coordinator in consultation with the Burn Unit's attending physician.
c. A patient requires intermediate care and burn service census permits.
iv. An intermediate care patient may be placed by the Nursing Coordinator at the request of the
admitting MD. The patient remains on the service requesting the intermediate care status. All
orders and treatments are the responsibility of the patient's primary service.
C. Transfer criteria and priority.
i. A burn service patient may transfer when the Burn Unit is full and there is:
a. Class I admission;
b. Class II admission with greater acuity and/or more complex wound care needs than the
transferring patient;
c. Non-burn service patient requiring intensive care services and a shortage of ICU beds
exist.
ii. A transferring patient remaining on the burn service may have their wound care provided by the
Burn Unit nursing staff if requested by the burn service physicians.
iii. A burn service patient may transfer when the patient requires the expertise of a different service.
This patient has less than 5% TBSA unhealed injury and simple wound care.
iv. A non-burn service patient may be transferred from the Burn Unit when the patient has resolution
or reduction of the problem requiring the expertise of the burn team or wound care by the Burn Unit
nursing staff, resolution or reduction of the problem requiring intensive or intermediate care, or burn
service admissions occur.
a. All patients transferring to an intermediate care area must fall within the admission criteria
of the respective unit.
b. All patients transferring to general care units no longer require invasive monitoring
devices, mechanical ventilation, a secured airway or vasoactive drug therapy; patients
have stabilized physiologically (i.e., cardiovascular, respiratory, etc.) to the extent that
intensive or intermediate care is not required.
c. Patients continuing to need specialized care are transferred to another intensive or
intermediate care arranged by the appropriate GME trainee and the Nursing Coordinator.
D. Transfer Procedure
i. The GME trainee and the attending physician for the patient identify the need or advisability of
transfer to another unit and/or service. Arrangements for the transfer of the patient to the
appropriate unit and/or service are made by the GME trainee and the Nursing Coordinator.
ii. In the event the transfer of a non-burn service patient is necessary due to a burn service
admission, the Burn Unit nursing staff will notify the Nursing Coordinator. Arrangements for the
transfer of the patient are made by the appropriate GME trainee and the Nursing Coordinator.
iii. All patients transferring out of the Burn Unit are in accordance with UW Health Clinical policies
2.1.6, Patient Transfers and 2.1.22, Patient Belongings and Valuables, and Nursing Patient Care
policy 14.17, Transfer of the Patient.
E. Discharge criteria.
i. A burn service patient and/or home caregiver or staff in an alternative care facility must be able to
perform all aspects of wound care, perform occupational and/or physical therapy exercises, and



UW HEALTH CLINICAL POLICY 3
Policy Title: Admission and Discharge Criteria for the Burn Unit
Policy Number: 2.1.16

demonstrate knowledge of medications (including food and drug interactions) and nutrition.
ii. A non-burn service patient and/or home care giver must be able to perform all aspects of care
specific to the patient's condition and demonstrate knowledge of medications (including food and
drug interactions) and nutrition.
F. Discharge procedure.
i. The GME trainee and the attending physician for the burn service, in collaboration with the nurse,
determine the patient's date of discharge.
ii. The GME trainee and the attending physician for a non-burn service patient determine the date of
discharge.
iii. All patients discharged from the Burn Unit are in accordance with UW Health Clinical policies
2.1.25, Discharge Planning Process, 2.1.22, Patient Belongings and Valuables, and Nursing
Patient Care policy 14.19, Preparing a Continuity of Care Referral.

IV. PROCEDURE FOR PEDIATRIC PATIENTS

A. Criteria and mechanisms for the admission and discharge of patients to and from the Burn Unit.
i. Class I priority is a burn service patient who meets one or more of the following criteria:
a. Hemodynamic instability that requires continuous assessment and intervention for fluid
shifts.
b. Hemodynamic and/or respiratory status requires complex, invasive monitoring equipment
to provide information regarding multiple parameters (i.e., pulmonary and systemic
vascular pressures, cardiac output).
c. Hemodynamic status requires administration, monitoring, and titration of vasoactive drug
infusions at constant or frequent intervals (four hours or less).
d. Respiratory status requires mechanical ventilation, a secured airway, or constant to
frequent assessment and intervention for potential airway obstruction due to facial
burns/fluid resuscitation.
e. Carbon monoxide poisoning with a carbon monoxide level greater than 15%.
f. Cardiac status requiring continuous monitoring and possible intervention.
g. Circumferential burn(s) requiring assessment of peripheral pulses frequently (every two
hours or less).
h. TBSA (total body surface area) skin loss greater than 10% in a child under age 17.
i. Electrical injuries with need to monitor extremities for compartment syndrome.
ii. Class II priority is a burn service patient who meets one or more of the following criteria:
a. Carbon monoxide poisoning with a carbon monoxide level less than 15%.
b. Circumferential burn(s) requiring frequent assessment of peripheral pulses (greater than
every two hours).
c. Significant skin loss but less than 10% in a child under age 17.
d. Extensive or specialized wound care requiring burn team expertise (i.e., hydrotherapy,
debridement, skin graft care).
e. Reconstructive surgery requiring burn team expertise for post operative care.
B. Admission procedure and assignment of service.
i. Burn service patient: The GME trainee and the attending physician for the burn service identify the
patient's need for placement in the Burn Unit. A burn service patient can be directly admitted upon
physician determination.
ii. Burn service consultation patient: A patient may require the care of the burn team and placement in
the Burn Unit. The patient may remain on the service of origin with burn service consultation upon
approval of the Burn Unit's attending physician. Orders and treatment may then occur within both
services.
iii. Non-burn service patient:
a. A patient would benefit from wound care performed by the Burn Unit nursing staff. The
patient remains on their primary service and is accommodated if burn service census
permits. Requests are made through the Nursing Coordinator.
b. A patient requires intensive care and burn service census permits (may include triage of
non-ICU burn service patients to general care unit). Placement is determined by the
Nursing Coordinator in consultation with the Burn Unit's attending physician.
c. A patient requires intermediate care and burn service census permits.
iv. An intermediate care patient may be placed by the Nursing Coordinator at the request of the



UW HEALTH CLINICAL POLICY 4
Policy Title: Admission and Discharge Criteria for the Burn Unit
Policy Number: 2.1.16

admitting MD. The patient remains on the service requesting the intermediate care status. All
orders and treatments are the responsibility of the patient's primary service.
A. Admission of critically ill pediatric patients.
i. Critically ill and intubated pediatric patients less than 17 years of age with thermal injuries will be
admitted to the PICU by the burn service. All others will be admitted to the Burn Unit. Any pediatric
patient can be admitted to the PICU after direct communication between the burn and PICU
attending determining the most appropriate placement for the patient. Admission to the PICU will
require a consultation to the PICU team and there will be close collaboration between the Burn and
PICU teams.
ii. The burn unit nurses will be responsible for wound care and treatment at the bedside in the PICU.
This will be done in close collaboration with the PICU nurses.
B. Transfer criteria and priority.
i. A burn service patient may transfer when the Burn Unit is full and there is:
a. Class I admission;
b. Class II admission with greater acuity and/or more complex wound care needs than the
transferring patient;
c. Non-burn service patient requiring intensive care services and a shortage of ICU beds
exist.
ii. A transferring patient remaining on the burn service may have their wound care provided by the
Burn Unit nursing staff if requested by the burn service physicians.
iii. A burn service patient may transfer when the patient requires the expertise of a different service.
This patient has less than 5% TBSA unhealed injury and simple wound care.
iv. A non-burn service patient may be transferred from the Burn Unit when the patient has resolution
or reduction of the problem requiring the expertise of the burn team or wound care by the Burn Unit
nursing staff, resolution or reduction of the problem requiring intensive or intermediate care, or burn
service admissions occur.
a. All patients transferring to an intermediate care area must fall within the admission criteria
of the respective unit.
b. All patients transferring to general care units no longer require invasive monitoring
devices, mechanical ventilation, a secured airway or vasoactive drug therapy; patients
have stabilized physiologically (i.e., cardiovascular, respiratory, etc.) to the extent that
intensive or intermediate care is not required.
c. Patients continuing to need specialized care are transferred to another intensive or
intermediate care arranged by the appropriate GME trainee and the Nursing Coordinator.
C. Transfer Procedure
i. The GME trainee and the attending physician for the patient identify the need or advisability of
transfer to another unit and/or service. Arrangements for the transfer of the patient to the
appropriate unit and/or service are made by the GME trainee and the Nursing Coordinator.
ii. In the event the transfer of a non-burn service patient is necessary due to a burn service
admission, the Burn Unit nursing staff will notify the Nursing Coordinator. Arrangements for the
transfer of the patient are made by the appropriate GME trainee and the Nursing Coordinator.
iii. All patients transferring out of the Burn Unit are in accordance with UW Health Clinical policies
2.1.6, Patient Transfers and 2.1.22, Patient Belongings and Valuables, and Nursing Patient Care
policy 14.17, Transfer of the Patient.
D. Discharge criteria.
i. A burn service patient and/or home caregiver or staff in an alternative care facility must be able to
perform all aspects of wound care, perform occupational and/or physical therapy exercises, and
demonstrate knowledge of medications (including food and drug interactions) and nutrition.
ii. A non-burn service patient and/or home care giver must be able to perform all aspects of care
specific to the patient's condition and demonstrate knowledge of medications (including food and
drug interactions) and nutrition.
E. Discharge procedure.
i. The GME trainee and the attending physician for the burn service, in collaboration with the nurse,
determine the patient's date of discharge.
ii. The GME trainee and the attending physician for a non-burn service patient determine the date of
discharge.
iii. All patients discharged from the Burn Unit are in accordance with UW Health Clinical policies
2.1.25, Discharge Planning Process, 2.1.22, Patient Belongings and Valuables, and Nursing



UW HEALTH CLINICAL POLICY 5
Policy Title: Admission and Discharge Criteria for the Burn Unit
Policy Number: 2.1.16

Patient Care policy 14.19, Preparing a Continuity of Care Referral.

V. COORDINATION

Author(s): Nurse Manager, Burn Unit; Medical Director, Burn Unit
Senior Management Sponsor: SVP/Chief Nurse Executive
Approval committees: UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: September 20, 2017

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VI. APPROVAL

Peter Newcomer, MD
Chief Clinical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VII. REFERENCES

UW Health Clinical Policy #2.1.27, Triage of Critically Ill Patients
UW Health Clinical Policy #2.1.6, Patient Transfers
UW Health Clinical Policy #2.1.25, Discharge Planning Process
UW Health Clinical Policy #2.1.22, Patient Belongings and Valuables
Nursing Patient Care policy #14.17, Transfer of the Patient
Nursing Patient Care policy #14.19, Preparing a Continuity of Care Referral

VIII. REVIEW DETAILS
Version: Revision
Last Full Review: May 17, 2016
Next Revision Due: May 2019
Formerly Known as: Hospital Administrative policy #7.23