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Patient Safety Authority
333 Market Street
Lobby Level
Harrisburg, PA 17120


Phone: 717-346-0469
Fax: 717-346-1090


 
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Data Snapshot: Iatrogenic Burn Injuries
Pa Patient Saf Advis 2009 Mar;6(1):36. 
 

A recent article in the Wall Street Journal1 led Pennsylvania Patient Safety Authority analysts to query the PA-PSRS database for burn reports submitted in 2007.* The search was designed to yield reports of actual or proximal harm to the patient by burns, singes, or sparks occurring in the healthcare facility that reported the burn. Reports involving events before the patient received care at the reporting facility were not considered. Also excluded were reports of events involving cigarettes, candles, and other flammable items not usually found in a healthcare setting.

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* 2007 was selected for comparison against data obtained from the Pennsylvania Health Care Cost Containment Council, for which 2007 was the last full year of available admission data at the time of publication.
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There were 224 reports of burns, two-thirds of which were thermal in nature. More than half the submitted burns were reported to have been caused by instruments or devices used in procedures, including cautery units, light sources, and cords for these devices. Nine percent of the reported burns were attributed to therapeutic heat sources, such as heating pads or hot packs; a further 5% were reported following magnetic resonance imaging procedures. Almost 14% of reported burns were attributed to food preparation or distribution. These reports include hot liquid spills and handling hot containers.

 Table. Causes and Types of Burns Submitted to the Authority in 2007
  Table. Causes and Types of Burns Submitted to the Authority in 2007

 

 

Overall, reports of burns account for 0.11% of all reports submitted to the Authority in 2007. Based on additional figures from the Pennsylvania Health Care Cost Containment Council, an estimated 11.9 burns occur per 100,000 admissions in Pennsylvania.2

Notes

  1. Landro L. In just a flash, simple surgery can turn deadly Wall St J [online]. 2009 Feb 18 [cited 2009 Feb 18]. Available from Internet: http://online.wsj.com/article/
    SB123491688329704423.html
    .
  2. Pennsylvania Health Care Cost Containment Council. Statewide report [20071-20074 online]. [cited 2009 Feb 18]. Available from Internet: http://www.phc4.org/countyprofiles/
    CountyProfileResults.aspx?CID=0&B=20071&E=20074
    .
 
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THE PENNSYLVANIA PATIENT SAFETY AUTHORITY AND ITS CONTRACTORS  
PSA LOGO The Pennsylvania Patient Safety Authority is an independent state agency created by Act 13 of 2002, the Medical Care Availability and Reduction of Error (“Mcare”) Act. Consistent with Act 13, ECRI Institute, as contractor for the Authority, is issuing this publication to advise medical facilities of immediate changes that can be instituted to reduce Serious Events and Incidents. For more information about the Pennsylvania Patient Safety Authority, see the Authority’s Web site at www.patientsafetyauthority.org .      
ECRI LOGO ECRI Institute, a nonprofit organization, dedicates itself to bringing the discipline of applied scientific research in healthcare to uncover the best approaches to improving patient care. As pioneers in this science for nearly 40 years, ECRI Institute marries experience and independence with the objectivity of evidence-based research. More than 5,000 healthcare organizations worldwide rely on ECRI Institute’s expertise in patient safety improvement, risk and quality management, and healthcare processes, devices, procedures and drug technology.      

ISMP Logo The Institute for Safe Medication Practices (ISMP) is an independent, nonprofit organization dedicated solely to medication error prevention and safe medication use. ISMP provides recommendations for the safe use of medications to the healthcare community including healthcare professionals, government agencies, accrediting organizations, and consumers. ISMP’s efforts are built on a nonpunitive approach and systems-based solutions.      
 
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