Application for Site Visit - American Burn Association

American Burn Association625 N. Michigan Avenue, Ste. 2550 Voice (312) 642-9260 • Fax (312) 642-9130Chicago, IL 60611e-mail: info@ameriburn.orgApplication for Site VisitTo initiate scheduling of a site visit, the hospital should complete the “Application for Site Visit” form and return it withpayment to the ABA Central Office. The verification fee covers ABA administrative costs, plus honoraria and travelcosts to the site for the surveyors. The hospital is responsible for travel costs once the surveyors arrive as well as allcosts related to food and lodging while the surveyors are on-site. When indicating preferred dates for the visit, pleaseinclude a broad range of date parameters to avoid scheduling conflicts. Upon receipt of the application and payment, theABA Central Office will use the visit dates the burn center specified to confirm visitors to the site. Once visitors and avisit date are confirmed, the ABA will notify the burn center via email. Letters pertaining to visit specifics will be sentout one month before the visit. Burn center representatives should communicate with surveyors’ offices regardinglodging, airport pickup and other visit details no less than ten days before the visit.Guidelines for the Operation of Burn CentersThe guidelines, originally published in the 1999 version of Resources for Optimal Care of the Injured Patient, wereupdated in 2006. They describe the organizational structure, personnel qualifications, facilities’ resources and otherrequirements necessary to provide optimal care of burn patients and outline the standards that a burn center must meetin order to achieve verification. Standards that are required for verification are noted with parenthetical references to CD(criterion deficiency). Failure to meet any one of these requirements can result in denial of burn center verification.Burn Resources ChecklistThis document presents in list format the same information as in the Guidelines. Each criterion is followed by a yes orno checkbox to indicate if the center provides this service. This document is intended to serve as an easy reference forsurveyors to quickly assess the level of care a center is capable of providing. The completed checklist should besubmitted with the completed pre-review questionnaire.Pre-Review QuestionnaireBased on the Guidelines for the Operation of Burn Centers, the Pre-Review Questionnaire (PRQ) is designed to gathercomplete information about a burn center. It is made up of general questions pertaining to care provided in the hospitalas well as organizational structure, pre-hospital and emergency care, personnel qualifications and hospital facilities.The PRQ and all related documentation (including appendices and case summaries) should be submitted electronically,either via email or saved on a CD. Completed documentation should be received at the ABA Central Office one monthbefore the visit takes place.Case summaries including: all recent deaths during the previous twelve months, fiscal or calendar year; fiverecent non-fatal complications demonstrating QI and loop closure during the previous twelve months, fiscal orcalendar years; and transfers to other burn care facilities and other acute care facilities for the past threecalendar years should be sent in with the PRQ. A template for these case summaries is included in the packet. Casesummaries which do not follow this template will be rejected. Please ensure that each death and complication patientsummary is limited to 250 words and has clear documentation of the QI process and loop closure.Upon receipt of the PRQ, burn resource checklist and case summaries, you will receive letters including additionalinformation pertaining to the visit. These will include details on the specifics of the visit, i.e., information about the prereviewdinner meeting and review day format as well as necessary attendees, and information about charts, admissions

American Burn Association625 N. Michigan Avenue, Ste. 2550 Voice (312) 642-9260 • Fax (312) 642-9130Chicago, IL 60611e-mail: info@ameriburn.orgdata and other documentation that should be available for reference at the time of the review. Please contact KittyVineyard at the ABA Central Office with any questions.Review AgendaThis document provides an outline of activities on the day of the review as well as a list of items which will need to beavailable at the time of the review.Quality Improvement IndicatorsAs part of a new data collection effort, the ABA VRC asks that at the time of visit centers provide data on four of thefollowing quality improvement indicators as well as two unit-specific indicators of their choosing:Incidence of VAPLine Sepsis RateNutritional Evaluation within 48 hours of AdmitEvaluation and Treatment by Therapy within 24 hours of AdmitLOS/%TBSATime from Admit to Burn Surgeon EvaluationParticipation in this effort is voluntary. Failure to present data will not be considered a CD or otherwiseaffect your review.