Title
Qualitative analysis of clinician experience in using the BuRN Tool in clinical practice

Objectives
The BuRN Tool (Burns Recognition of Neglect and Maltreatment) is a clinical prediction tool acting as an aid in identifying burns in which child maltreatment is present. As part of a larger evaluation of the use of the tool, focus groups were conducted with the objective of exploring the views of clinicians on the feasibility, acceptability and impact of the tool in clinical practice.

Methods
Three focus groups were conducted (n = 25) in the Emergency Department (ED) in the University Hospital Wales, Cardiff. Focus groups were tiered by clinician seniority to facilitate open and honest discussion between peers. Thematic analysis was conducted. 100% of data were double-coded. 

Results
Feasibility and acceptability of the use of the BuRN Tool was high across all participants and tiers. Participants consistently associated acceptability with ease of use of the tool and ease of interpretation of the results and their associated actions. All participants commented that the BuRN Tool was clinically beneficial, especially for those of a more junior tier or those who do not consistently work in paediatrics. Those with a paediatric specialism placed importance on the ‘gut feeling’ of the clinician, and expressed how this interacts with clinical examinations and incident history in making a decision for the appropriate next step. 
 
Discussion
The support from participants that the BuRN Tool was clinically beneficial might suggest that the tool could have high clinical impact in the ED setting. Participants advocated the importance of experience which plays a significant factor in confidence of clinicians when confronted with maltreatment situations. Data suggest that the BuRN Tool helps to increase the confidence of those lacking experience. Results from the focus group suggest that clinicians appreciate the benefit of a clinical prediction tool in aiding the assessment of child maltreatment in burns.

Qualitative analysis of clinician experience when using the BuRN-Tool in clinical practice