Non-ICU Hospital Care

Massachusetts General Hospital provides expert clinical care in the management of burn patients from all of New England. The Mass General philosophy is to provide quality care to all people who are in need. The Burn Service, in particular, combines its specialized services and clinical expertise to ensure that the needs of both burn patients and their families are met. This portion of the website describes the burn program and the services patients may receive during their hospital stay.

The Burns Service is made up of a large number of personnel responsible for providing services throughout all phases of burn care. In most cases, the Burn Attending Physician (a general surgeon with expertise in the management of burn patients) will be responsible for a patient's overall clinical management. The surgeon works closely with a team of surgical residents, Burn Nurse Practitioners, and registered nurses, in organizing daily medical care. Depending on a patient's individual needs, other specialists and their teams may be involved in a person's care.

The Burn Service incorporates a team approach to the care of burn patients and their families. Additional hospital services often involved in providing burn care include:

Occupational Therapy Services
Occupational therapists provide a complete evaluation that identifies limitations in the areas of physical strength and thinking. All treatment programs are established with the burn team and, if possible, a patient's personal goals.

Physical Therapy Services
Physical therapists provide services to patients with a wide variety of physical limitations and disabilities. Following evaluation, a treatment plan is created to restore an individual to the highest level of function.

Speech-Language Pathology Department
The speech pathologist evaluates thinking, speaking, and swallowing functions. Treatment programs are designed to meet a patient's special needs.

Social Service
Social workers can help the team, patient, and family, solve and try to work out problems that affect good patient care.

Case Manager
The case manager is a registered nurse who works with doctors, nurses, and therapists to help with plans for discharge. Please note that a discharge plan may include transfer to a Rehabilitation Hospital.

Family-Centered Care
For the family's convenience, visiting hours are extremely flexible. We encourage family members to come and sit and, if they would like, to assist with some of the aspects of care. Team members are always available for counseling and support.

Pain Control
Pain and discomfort are expected after a major injury, but we try hard to minimize patients’ pain and make them feel comfortable. With the treatments now available, pain can be reduced to a tolerable level.

Physical Therapy
Participation in physical therapy and normal daily activities helps to prevent complications associated with an injury or surgery. The most common complications after a burn include pneumonia, blood clots in the legs (DVT), and general weakness, which may delay recovery.

Patients can get out of bed when the team feels it is safe. Patients might initially have some activity restrictions. The physical therapist can show the patient exercises that help prevent problems associated with immobility. Nursing and physical therapy personnel can provide any assistance.

Coughing, Deep Breathing
Burn patients should cough and deep breathe at least every two hours to prevent pneumonia and help the lungs expand. Patients are shown how to use an incentive spirometer that should be used at least once every hour (10-15 times in a row).

Eating and Drinking
A patient's ability to eat or drink depends on several things, including the type of surgery or injury, types of medicines required for the patient, presence of nausea, and how well the stomach and bowels are working after surgery. When eating and drinking are allowed, patients are encouraged to start slowly and follow the doctor's recommendations.

Medications
In addition to pain medication, burn patients often receive antibiotics to help prevent infection. Injections of heparin or lovenox, or oral coumadin, help prevent the formation of blood clots in the legs.

A stool softener may be given to the patient once he/she is able to take food by mouth to prevent constipation or bowel straining. If the patient does not move his/her bowels, please let the nurse know. It is not unusual for bowel function to slow down from anesthesia, bedrest, or pain medications.

Urinary Catheter
Immediately following a burn, urination may be difficult for some patients. For the first few days after burn, the patient may have a catheter in place to drain urine. The catheter is usually placed while the patient is in the Emergency Department or Operating Room. Some patients may feel an urge to urinate even though the catheter is draining urine. This feeling is normal, but the patient is encouraged to discuss it with the nurse.

Pneumo/Air Boots
Pneumoboots are made of soft plastic material that wrap around the legs to prevent blood clots. The boots automatically inflate and deflate to help the circulation. Patients may also wear support stockings to help the circulation in their legs.

Realizing the profound impact a burn injury can have on the entire family, the MGH Burn Service has a strong supportive service component. Social service, psychiatry and nursing play key roles in providing support to families in crisis. Burn nurse practitioners play an especially important role, ensuring continuity across the continuum of care. Nurse practitioners become the family's principal point of contact and relay information from operating room progress to transitioning to home. At the appropriate time, the case manager takes a leadership role in working with the team and family in identifying support services and resources near the patient's home, including arranging rehabilitation and visiting nurse services as necessary.