A Practice Model to Integrate Mental Health Care at an Outpatient Burn Clinic

Background: The Center for Disease Control and Prevention (CDC) reports that more than 350,000 individuals sought medical treatment for burn injuries in 2020. Over half of those individuals will experience a mental health disorder within one year. Despite the known link between mental health disorders and their impact on patient clinical outcomes, evidence suggests that only fifty percent of burn patients will receive mental health screening or support. Mental health integration has been highly studied, modeled, and successfully implemented in primary care settings. This project aimed to identify and assess the clinical need for integrated mental health in the outpatient burn setting and then to develop and propose a psychiatric nurse practitioner-led model to address those needs. Local Problem: The University of Utah Burn Center is the only American Burn Association (ABA) accredited burn center in a five-state region capable of Level 1 Trauma services; the outpatient burn clinic serves over 4,000 patients yearly. To address the mental health needs of burn patients, the outpatient burn clinic follows the current standard of embedded psychological support using a Licensed Clinical Social Worker (LCSW) as needed to initiate referrals to community psychiatry services. This current model lacks timely, comprehensive mental health delivery. Methods: In this needs assessment/program development project, the mental health clinical gap was assessed by identifying current clinical practices in an outpatient burn clinic associated with a large academic health center. The current clinical practices were compared to those used in a second burn unit structured similarly. A literature review was conducted to identify evidence-based best practice recommendations for addressing mental health in general outpatient clinics, burn outpatient clinics, and the general burn patient population. Project data then guided the development of a psychiatric nurse practitioner-led evidence-based care model for mental health integration. An executive summary proposed the model to key healthcare partners for feedback. The provided response was incorporated into the care model resulting in a strategic plan for mental health integration at a local burn center. Results: Current practices to address mental health at a local outpatient burn clinic include utilizing LCSW screenings, standardized questionnaire screenings, and referral to psychiatric specialty. A review of the literature and ABA recommendations shows the need to address mental health in burn patients, with no clear specific guidelines. The synthesized result of gathered data is a psychiatric nurse practitioner-led evidence-based care model for mental health integration. Feedback on the care model showed a high willingness to implement and feasibility when expanded to include the inpatient service. Conclusion: There is clear evidence to support the need to address mental health in the burn population. Utilizing the psychiatric nurse practitioner to integrate mental health into the burn center can improve patient outcomes, generate cost savings, and may be more effective than traditional care models.