The Introduction of Standard Operating Procedures to Improve Burn Care in the United Kingdom.
United Kingdom (UK) burn units face substantial new obstacles in delivering high quality care because of the advent of full-shift working patterns, cross-specialty cover arrangements, and increased trainee turnover. Junior trainees rely heavily on senior colleagues, who may not be readily accessible. The authors therefore proposed the introduction of standard operating procedures (SOPs), detailed written instructions used to achieve uniformity in performance and to improve outcomes. After undertaking a preliminary strength, weaknesses, opportunities, and threats analysis of their use locally and nationally, the authors set out to systematically develop burn-specific SOPs. The authors first mapped our existing local SOPs to the newly introduced UK national burn care pathway to specify gaps in coverage. The authors then administered a questionnaire to other UK burn units to identify SOPs already used elsewhere. Finally, the authors developed and piloted a robust pathway for the development, introduction, and auditing of new SOPs. The strength, weaknesses, opportunities, and threats analysis identified significant benefits and minimal risks. The mapping exercise identified specific deficiencies in our coverage of the national pathway. All 26 UK burn units responded to our questionnaire; only 12 had one or more SOPs (mean, 2.1). These covered initial assessment, inhalational injuries, drug prescribing, wound care, and gastric protection; none were audited. Locally, the authors have begun to develop the additional SOPs required. SOPs have not been instituted widely in the UK, despite the shift toward a standardized national care pathway and their association with improved outcomes. The authors hope that the systematic approach to their development and implementation demonstrates the feasibility of their wider use within UK regional burn centers and beyond.