Effective: 8-24-93

59C-1.043 Burn Units

(1) Agency Intent. This rule implements the provision of paragraph 408.036(1)(k) F.S., which requires the agency to review the establishment of burn unit services under the Certificate of Need Program. Applications for specialized burn units shall be reviewed in accordance with all applicable statutory and rule criteria. This rule defines the minimum staffing, equipment, and physical plant requirements for burn unit services, and includes criteria for determining the need for additional burn units or beds. Specialized burn units shall be distinguished from non-specialized hospitals settings in which burn care is provided. A certificate of need for the establishment of a burn unit or the addition of burn unit beds, shall not normally be approved unless the applicant meets the applicable review criteria in section 408.035, F.S., and the standards and need determination criteria set forth in this rule.

(2) Definitions.

(a) Burn Unit. A burn unit is a discrete unit within a hospital which occupies designated physical space separate from other areas of the hospital. A burn unit shall have a minimum of five dedicated burn beds and shall be equipped and staffed to provide specialized care solely for severely burned persons.

(b) Burn Team. A burn team consists of, at a minimum, the burn care physician, nursing staff, and burn care therapy staff.

(c) Service Planning Areas. Planning for specialized burn care shall be done on a regionalized basis. Certificate of need applications shall be competitively reviewed within each of the four service planning areas delineated below.

1. Service planning area 1 includes districts 1, 2, 3 and 4.

2. Service planning area 2 includes districts 5, 6, and 8.

3. Service planning area 3 includes district 7.

4. Service planning area 4 includes districts 9, 10, and 11.

(3) Coordination of Services.

(a) A hospital with a designated burn unit shall ensure that appropriate aftercare services are available to the burn care patients in order to ensure a continuum between hospitalization and the rehabilitation phase. These services include, at a minimum, social services consultation, vocational counseling, and physical rehabilitation services.

(b) A hospital with a designated burn unit shall provide a public burn prevention program. This requirement may be met by assuring that such programs are made available through other organizations in the service delivery area.

(4) Accessibility of Services

(a) Each service planning area should have at least one burn unit.

(b) Burn unit services shall be available as needed on a 24-hour basis.

(5) Service Quality.

(a) Staffing. Any applicant proposing to establish a burn unit, or the addition of beds to an existing burn unit, must document that properly trained personnel shall be available. An applicant shall document that the following staff are available:

1. A medical director, board-certified or board eligible in general or plastic surgery with at least two years of experience in the management of burn patients.

2. One full-time registered nurse with two years intensive care or equivalent experience.

3. One full-time physical therapist with training in the management of burn patients.

4. Surgical support personnel shall be available for consultation as needed in the surgical specialities listed below:

a. Cardiothoracic

b. Neurologic

c. Obstetrics-Gynecologic

d. Ophthalmic

e. Oral

f. Orthopaedic

g. Otorhinolaryngologic

h. Pediatric

i. Plastic

j. Urologic

5. The following non-surgical support personnel should be available as needed for consultation in the specialties listed below.

a. Anesthesiology

b. Cardiology

c. Gastroenterology

d. Hematology

e. Infectious Disease

f. Internal Medicine

g. Nephrology

h. Neurology

i. Nutrition

j. Occupational Therapy

k. Pathology

l. Pediatrics

m. Psychiatry or psychology

n. Pulmonary

o. Radiology

p. Respiratory therapy

(b) Equipment. The following equipment shall be available in designated burn units:

1. Burn unit beds which are designated as intensive care beds within the burn unit shall be equipped with monitoring devices which allow nurses at the nursing station to monitor the patient 24 hours around-the-clock. Each intensive care bed shall accommodate a ventilator.

2. A tub, tank, or table for the cleaning of burn wounds shall be located in an area of the burn unit which is separate from the general patient care area.

3. Temperature control equipment which allows for independent temperature control of each patient room.

(6) Need Determination.

(a) The agency shall not normally approve an application for the establishment of a new burn unit or the addition of beds within the same service planning area unless the average occupancy rate for the 12 months ending not later than three months prior to the application deadline, of all designated burn units, was at or exceeded 80 percent.

(b) An applicant for burn unit beds shall justify the request for additional beds based on the projected bed need for the applicable planning horizon. The applicable planning horizon is the calendar year when the burn unit, or the number of additional beds requested, are expected to become operational. The applicant's projection of a bed need shall be based on the number of burn patient days for the 12 months ending not later than 3 months in the same service planning area prior to the application deadline; the projected population growth in the service planning area, and documented factors which in the applicant's judgment impact on the number of projected patient days for specialized burn care.

(c) Preference shall be given to applicants which propose to convert existing medical and surgical beds to burn unit beds. A certificate of need for the construction of new burn unit beds shall not normally be given unless the applicant demonstrates that the occupancy rate for all medical and surgical beds in the applicant's facility was at or exceeded an occupancy rate of 75 percent for the most recent calendar year prior to the application deadline.

(7) Data Reporting Requirement. All burn units in the state shall provide the agency with burn patient-related data for health planning purposes which shall include: total patient days, total number of patients by age, average length of stay, gross revenue per adjusted admission, gross revenue per adjusted patient day, number of patients served and patient days by payor source including Medicare, Medicaid, private pay, and charity care. The data shall be submitted to the agency or its designee once a year on February 1, for the preceding calendar year.

(8) Any health care facility which operated a specialized burn unit as of October 1, 1987 shall be given a reasonable time, not to exceed 1 year from the effective date of this rule, within which to comply with these rule requirements.