Merits and challenges in the development of a dedicated burn service at a regional hospital in South Africa Nikki L. Allorto *, Damian L. Clarke Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-Zulu Natal, South Africa 1. Introduction We know that burns are common in South Africa and affect the vulnerable sector of our population [1–3]. It is estimated that 3.2% of the South African population is burnt annually, 90% of those are minor burns but 0.2% (270 people per month) sustain a burn that needs specialised burn care and half of those need intensive care. Burns are the most common external cause of death in children less than 4 years old and mortality from burns in South Africa is 8.5 in 100 000 compared to the world average of 5 in 100 000 [4–6]. Many South African authors have described this high burden of injury [11–13] however little has been done to address the training of surgeons in the field of burns or towards the development of a sustainable and practical system of burn care. Burns are predominantly treated by general surgeons in Kwa-Zulu Natal, largely due to the greater number of general surgeons compared to plastic surgeons. Although expected to manage burns, there is not adequate training during registrar or fellowship years. Rotation through a burn unit or centre is not compulsory for trainees and the majority of qualified general surgeons have not had exposure to burn management. A single 1-hour seminar every two years on the management of burns is the only formal burn teaching in the surgical curriculum [3]. Even subspecialist trauma training has limited exposure to burn care. This results in a paucity of burn specialists and general surgeons with the appropriate skills to manage burns. b u r n s x x x ( 2 0 1 4 ) x x x – x x x * Corresponding author. Tel.: +27 836557660; fax: +27 314670545. E-mail address: nikkiallorto@gmail.com (N.L. Allorto). a r t i c l e i n f o Article history: Accepted 28 July 2014 Keywords: Burn Developing world a b s t r a c t Introduction: The Edendale Hospital Burn Service was initiated in 2011 to improve the quality of burn care at a regional hospital. This audit reviews the merits and challenges in developing such a service and identifies areas on which to focus quality improvement initiatives. Methodology: The burn admission records were retrospectively interrogated for the years 2012–2013. Results: This audit covers an 18-month period in which 490 patients were admitted. Admitted days per percentage burn were 2.6 days per percentage total body surface area burnt. The mortality rate was 13%. Fourteen percent of patients met the criteria for referral to the provincial burn centre but for a variety of logistical reasons only 3% were transferred. Conclusion: We have redesigned the process of care without alteration of resources. Out- comes of burns less than 30% total body surface area are not acceptable which we believe reflects the lack of infrastructure and systems development. This audit has revealed a number of areas, which are suitable for dedicated quality improvement initiatives. # 2014 Elsevier Ltd and ISBI. All rights reserved. JBUR-4428; No. of Pages 8 Please cite this article in press as: Allorto NL, Clarke DL. Merits and challenges in the development of a dedicated burn service at a regional hospital in South Africa. Burns (2014), http://dx.doi.org/10.1016/j.burns.2014.07.021 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/burns http://dx.doi.org/10.1016/j.burns.2014.07.021 0305-4179/# 2014 Elsevier Ltd and ISBI. All rights reserved.