GALVESTON BURN HOSPITAL
The first Shriners Burns Hospital for Children opened its doors in 1966 in Galveston, Texas. Dr. Truman Blocker and Mr. Harvey Beffa worked with the Shrine philanthropy to establish hospitals to treat burned children and support burn related research. Shriners Hospitals for Children also had many hospitals that cared for children with orthopedic disabilities. With their four burn hospitals, Shriners cares for children with burn injuries from the time of acute injury through rehabilitation and individual reconstructive needs throughout their childhood.
Shriners Hospitals for Children at Galveston is a 30 bed hospital. It has an ICU with 15 acute beds, a reconstruction and plastic surgery unit with 15 reconstructive beds, three operating rooms, a multi-bed recovery room, clinics and a large outpatient population. The Galveston Shriners Hospital has treated patients from around the country and around the world. Shriners Hospital for Children at Galveston received their first certification from the Joint Commission for the Accreditation of Hospital Organizations in 19?? and received their most recent certification in 2004. Shriners Hospital in Galveston became Verified as a Burn Center from the American College of Surgery first in 19?? and most recently in 2001. We have recently received certification from the ACGME as a Burn and Critical Care Fellowship provider in 2003.
Shriners Hospitals for Children at Galveston is well suited as a model system of comprehensive burn care and rehabilitation. For more than 27 years, through the philanthropy of the Shriners of North America and in affiliation with the University of Texas Medical Branch, the faculty and staff of this institute have successfully endeavored to develop methods and techniques to improve the outcomes of burned children.
Rehabilitation after severe burn injury remains problematic both in terms of maximizing function and providing psychosocial adaptation. This situation becomes even more complex in the setting of pediatric injury where consideration must be given to the growth and development of the patients, cognitive development and differing motivations at each period, and the longer life span over which rehabilitation interventions are likely to affect outcome. Mechanisms are currently in place for the interdisciplinary comprehensive rehabilitation and follow up of the over 250 acutely burned children referred to our institute each year. Patients are cared for in our system from the time of injury until age 18; consequently our comprehensive treatment plans are directed toward long-term outcomes. Existing programs include longitudinal outcome assessments, outreach clinics to rural areas and investigations into techniques to improve functional outcomes.
This institute is well suited to evaluate the benefits, costs and outcomes of rehabilitation therapies for burned children because of our collected experience, patient load and expertise in evaluating data as evidenced by our preliminary data and by our publications. We are particularly adapted to assess the costs of these varying techniques because all our care is free through philanthropy of the Shriners of North America, and thus only true costs are incurred.
Probably because the staff and faculty are responsible for the burn care and burn sequelae over such a long span of each patient's life, there has historically been a great concern for the long-term success of the patients. The interdisciplinary team who follow the children through their physical growth and psychological development are continuously striving to meet the challenges of complex burn-related problems for the growing child and developing adolescent, as well as for the families of children so injured.
| Child Life | Occupational/Physical Therapy |
* TEAM WORK IS VITAL FOR GOOD PATIENT CARE *
Objectives:
A. Present philosophy of Child Life Department.
B. Family-centered care.
C. Continuing emotional/developmental growth of hospitalized children.
D. Increase coping skills through play and music.
E. Provide emotional support.
F. Normalize the hospital experience.
Responsibilities of Child Life Staff:
A. Playroom.
B. Pre-op teaching.
C. Make-up program guidelines.
D. School re-entry guidelines for videos and/or re-entry visits.
E. Bedside interventions.
F. Emotional support provided by Child Life Specialist and Music Therapist.
Communications:
A. Multidisciplinary discharge planning meetings.
B. Chart notes.
C. School/Staff referrals.
Customer Service Area:
A. Customer work request filled out by Graphic Arts personnel.
B. Service performed per posted turn-around schedule.
Medical Photography:
- Patient photography (Acute & Reconstructive)
- (See Patient Rights, Section PR.013)
A. Admissions
B. Dressing changes as per medical/paramedical staff.
C. Operating room as per medical/paramedical staff.
D. Clinical as requested by medical/paramedical staff.
E. Discharge of patient.
F. Clinic as per medical/paramedical staff via photography request form.
G. Outreach clinic as per photography request form located with patient's clinic forms.
H. Autopsy.
Other In-House Services:
A. Slide Duplicates - legal and teaching.
B. Film Processing - color slide E-6 process, black & white film developing.
C. Passports - for official use only.
D. Public Relations - as directed by Administration/Public Relations.
E. Color, Black & White Slides from Books, X-rays, etc. - In-house teaching, medical/scientific meetings.
F. Displays/Exhibits - Public relations, medical/scientific.
G. Photographic Printing includes publications, public relations, or as needed by hospital.
Medical Illustrations:
A. Poster Exhibits - Medical/scientific staff, public relations, and teaching.
B. Produce & Design Forms - Medical and administrative.
C. Framing & Matting - Photographs, certificates.
D. Produce & Design Certificates - Medical/scientific staff, administrative.
E. Charts, Graphs, Color Slides - Computer generated in PowerPoint.
Department Services:
A. Silicone rubber face masks.
B. U-vex face masks.
C. Silicone rubber conformers of various types.
D. Mouth splints.
E. Ear and nose conformers.
F. Hair pieces.
G. Ear and nose prosthesis.
H. Supply conformers for scheduled outreach clinics.
Educational:
A. Open and ongoing communication and problem-solving with all members of the health care teams. Encouraged and followed-through as needed.
B. Available for tours of facility by outside groups, i.e. Shriners and Medical Staff.
C. Available for informational in-services as needed, or upon request.
Occupational/Physical Therapy
The rehab philosophy is to assist the patient to reach the highest level of function possible. This requires efforts of the entire interdisciplinary team. Our therapists are cross-trained and there is not a difference in patient care between the 2 disciplines.
Evaluations/Assessments:
A. Initial - Evaluation requires physician signature for performance.
B. Ongoing - Physicians' orders reflect rehabilitative care throughout hospitalization.
C. Discharge - Referral for outpatient therapy requires physician signature.
D. Return to Clinic - Outpatient Summary requires physician signature.
Parent/Patient Education:
A. Bandage wrapping and splint application classes are Monday and Wednesday at 13:30 (staff invited to classes)
B. Educational slide programs are Friday at 13:30. The program stresses the importance of pressure, splints, activity, exercises, and positioning. Patients are included in this formal training at age 9 and above. The primary therapist assigned to the patient provides one-on-one training on exercises.
Communication:
A. Tuesday - Interdisciplinary D/C Planning Meeting.
B. Thursday - Grand Rounds.
C. Monday, Wednesday, Friday - Unit rounds on a daily basis at bedside with team, 7:00a.m.
D. Saturday, Sunday & Holidays - Unit rounds at 9:30a.m. (or as the attending physician schedules).
E. Weekend Treatment - Therapists provide priority treatments only. Only 2 therapists are present on weekends and holidays.
Rehabilitation Referrals:
A. Referral process and paperwork.
Outpatient/Outreach Clinics:
A. All above procedures are tracked and continued in terms of the patient and family meeting their rehabilitation goals. Outpatient summaries are updated and provided to patient family and referral source. Our department participates in outreach clinics to provide follow-up treatments to patients in their community or surrounding areas. During these clinics we proved priority therapy needs, i.e. splinting and pressure therapy, and we make recommendations for the next level of rehab care.
School Re-entries:
A. The department assists with school re-entries so the children's return to school may be a smooth transition.
Shriners Burns Hospital has a staff of mental health experts who follow every child and family from the time of admission to eventual discharge from the Shriners system - i.e. through the acute admission, as outpatients during clinic visits, and through subsequent admissions until the child is 21 years old or no longer needs our services.
Clinical Services
2 part-time Child Psychiatrists
2 Psychologists
1 Psychology Post-Doctoral Fellow
We also have 1 or more psychology residents at any given time. A full-time school teacher provides schooling for every school-aged child as soon as they are able to participate, either at bedside or in the classroom on the 4th floor. Additionally, a professional counselor works mostly with clinical research, but will occasionally be involved clinically with a patient or family.
Much consideration must be given to a program of rehabilitation for the burn patient, and every patient needs an individually tailored plan of care. There are 4 principles for the rehabilitation of the burn patient:
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