Search

Staffing models should promote shared care between burn and critical care teams, as this may improve safety.⁵⁶

Any sedation service should be age appropriate, with general anaesthesia an option available for some cases.^{29,49,53,57,58}

Patients requiring burn or plastic surgery procedures should be managed by anaesthetists who have an appropriate level of training in this field. They should have a regular commitment to the burn and plastic surgery specialty and should have acquired the relevant knowledge and skills needed to care for these patients.

To maintain the necessary repertoire of skills, anaesthetists providing a burn and plastic surgery anaesthesia service should have a regular commitment to the specialty, and adequate time must be made for them to participate in a range of relevant CPD activities.

Because burn care is a small specialty with relatively few anaesthetists able to participate in burn care during training, each service should have plans in place to establish and maintain an appropriate anaesthesia workforce.⁵⁹

A small number of centres perform burn surgery. These centres should offer external training opportunities for anaesthetists, nursing staff, physiotherapists and other members of the multidisciplinary team.⁶⁰

Anaesthetists who provide emergency care outside burn services should be trained in the initial management of the patient with severe burns, including timely emergency assessment, resuscitation and transfer to a burns service.⁶¹

Anaesthesia for burn and plastic surgery should be included in regular anaesthesia department mortality and morbidity meetings, audit meetings and quality improvement programmes. Burns services should actively participate in the network and in national mortality meetings.

Multidisciplinary audit meetings involving surgical teams should be encouraged where mortality and morbidity should be discussed alongside all serious untoward incidents related to the service.

Anaesthesia departments should be integrated into the overall clinical audit and governance structure of the hospital. Each anaesthesia department undertaking anaesthesia for burn and plastic surgery should have a system in place for the routine audit of important areas such as:

• perioperative temperature
• optimisation of perioperative blood transfusions⁴²
• management of perioperative pain and quality of analgesia⁸¹
• management of...