Mr Stuart Andrews1, Dr Allyson Browne2, Professor Fiona Wood1, Ms Marian Jenkins3
1Fiona Stanley Hospital – WA State Adult Burns Unit, Murdoch, Australia, 2University of Western Australia, Pharmacology, Pharmacy and Anaesthesiology Unit. , Crawley, Australia, 3Curtin Univiersity, School of Psychology , Bentley, Australia
Psychological consequences of sustaining a burn injury are well documented with 30-50% of adult patients experiencing moderate to severe psychological distress. Access to psychological services falls short of patient need in burns settings. There is no internationally accepted standard for burns-specific psychological screening, hence the development of a valid and reliable screening model to maximise the efficiency of this limited clinical service is a priority.
The aim of this project was twofold: (1) develop a burns-specific psychological screening tool; (2) determine the feasibility and clinical utility of routine screening for every burns admission.
A screening tool was developed based on published evidence from burns populations and the broader trauma population, that assessed level of distress post burn injury (e.g., flashbacks and low mood), risk for depression and/or post-traumatic stress disorder, coping style, alcohol and drug use, perceived social support, and treatment-related anxiety.
Pilot data revealed that 29 patients (66% of admissions) completed the screen over two months at least 48 hours post admission (Female=31%; M Age=45.62 years; M TBSA=3.31%). Sixty-two percent (n=19) of those patients screened required referral to Clinical Psychology, however only 11 received further inpatient psychological assessments. Every one of these patients met DSM5 diagnostic criteria for at least one mental health disorder, with Acute Stress Disorder (n=6) and Depression (n=4) being the most common.
Barriers to screening included short-stay admissions, inability to capture all patients admitted with part-time Clinical Psychology service, and prolonged ICU stay. Current efforts are being directed towards improving screening efficiency and service capacity.
Stuart Andrews is the Senior Clinical Psychologist on the WA State Adult Burns Unit at Fiona Stanley Hospital. Stuart has a keen interest in the assessment and treatment of psychological trauma. Since being employed on the WA State Adult Burns Unit in 2015, he has been focused on embedding psychological services aimed at improving the assessment, management and treatment of patients who sustain a burn injury.