Outpatient workload in the NHS: A new challenge for the burn services?

The aim of this study was to evaluate the impact of outpatient care on activities at the Adults' Regional Burns Centre and the Children's Regional Burns Unit, Mid Yorkshire Hospitals NHS Trust UK, where outpatient and inpatient responsibilities are shared between the nursing staff. Data for all inpatient and outpatient interactions (all care related activities with the presence of a Registered Nurse (RN)) was collected prospectively by the attending RN for two consecutive months (October and November 2014). We also retrospectively collected data related to daily RN staffing levels, and Centre/Unit admissions and discharges. We compared our results with the staffing standard recommended by the National Burn Care Review 2001 and the National Burn Care Standards 2013. In the two months analysed we recorded a total number of 1232 interactions: 240 for the adult inpatient service, 385 for the adult outpatient service, 155 for the paediatric inpatient service, 452 for the paediatric outpatient service. Considering this burden and collating it with daily RN staffing levels, we highlighted an understaffing in 42.6% (26/61) of the days for the Adult Regional Burn Centre and in 100% (61/61) of the days and nights for the Children Regional Burn Unit. The impact of outpatients on the activities of a Burns Centre/Unit is a factor that should be taken into account when evaluating staffing needs and planning services. This is a variable not currently considered in any guideline for safe staffing.