Transcript
DEPTT OF NEUROSURGERY
JPN APEX TRAUMA CENTRE
AUDITJAN 2011- DECEMBER 2011
JPN APEX TRAUMA CENTRE
Clinical workload
0
1000
2000
3000
4000
5000
6000 2008200920102011
2008 3615 1916 1369 60
2009 4488 1978 1070 56
2010 5245 2073 1535 54
2011 5343 1882 1407 54
OPD Admissions Surgery Beds
Total Admns from Jan2011-Dec2011
0
500
1000
1500
2000
Neurosx orthopedics surgeryAdmission 1882 1444 1875
Bed strength 54 48 48
OPERATIONS
Operated cases in NS OT
SURGICAL LOAD
• Total cases Operated in OT:1407
Cranial Spinal Shunt BPI Cranioplasty Others Open Tracheostomy
753 353 82 63 118 51 105
Open Vs Percutaneous Tracheostomy
67
236
105
205
0
50
100
150
200
250
Open tracheostomy (OT) PC Tracheostomy (ICU)
2010
2011
Open Vs Percutaneous ICP monitoring
8
231
5
268
0
50
100
150
200
250
300
Open ICP Montiring (OT) PC ICP Montiring (ICU)
2010
2011
HEAD INJURIES
Age fractional classification
0
500
1000
1500
2000
2500
0-5 6-12- 13-18 19-30 31-40 41-50 51-60 >60
no
of p
atie
nts
age limit
male patients with head injury
(male)
Age fractional classification
050
100150200250300350400450500
0-5 6-12. 13-18 19-30 31-40 41-50 51-60 >60
no
of p
atie
nts
age limit
females with head injury
females with head …
HEAD INJURIES- 2011
Total Cases Mortality %
Minor HI 10501 17 0.16
Mod HI 254 21 8.26
Severe HI 990 206 20.8
Overall 11745 244 2.07
Data of Head Injury Patients
Total Cases admissions Operated Death (%) NonOperated
Death (%)
Minor HI 10501 408 230 9(3.9%) 178 8(4.49%)
Mod HI 254 170 118 13(11%) 52 8(15.38%)
Severe HI 990 990 547 104(19%) 443 102(23%)
Severe HI mortality in age groups
<12 13-18 18-59 60-80 >80
27 31 111 35 2
32 0.56
0.16
1512
7.98.26
3536
29.9
20.8
23 22
5.7
2.07
0
5
10
15
20
25
30
35
40
Minor HI Mod HI Severe HI Overall
2008
2009
2010
2011
OUTCOME: MORTALITY (%)
SPINE INJURIES
Age fractional classification
0
20
40
60
80
100
120
140
1-5. 6-12. 13-18. 19-30. 31-40 41-50 51-60 >60
no
of
pat
ien
ts
age limit
males with spinal injury
males with spinal injury
Age fractional classification
0
5
10
15
20
25
age limit 0-5 6-12. 13-18 19-30 31-40 41-50 51-60 >60
no o
f p
atie
nts
females with spinal injury
females with spinal injury
Cervical Spine Injury (2011)
Total admission Operated Death(%) Non-Operated Death(%)
268 200 159 29(18%) 109 17(15%)
Cervical Spine Injury (2011)
Total complete incomplete Death(%)
268 81 187 47(17%)
Cervical Spine Injury
161
195
268
0
50
100
150
200
250
300
Cervical
2009
2010
2011
Follow up
• Mean Follow up:209.02 daysRange (75-428 days)
Dorsolumbar Spine Injuries
162
109
0
20
40
60
80
100
120
140
160
180
DL Spine Inj
2010
2011
Dorsolumbar Spine Injuries
Total Complete Incomplete Operated Death(%)
109 64 45 87 6 (5.5%)
Follow up
• Mean Follow up:220.47 days(Range 55-415 days)
Brachial Plexus injuries
7276
63
0
10
20
30
40
50
60
70
80
2009 2010 2011
EQUIPMENT
Equipment Audit
Mobile CT• Started functioning; 18 July 2009
• Total No of MCT’s done in 2011: 2086
• Average of 173 MCT/ month or 5 MCT/day• Total MCTs till date:5482
Equipment Audit
Mobile CT• Audit paper accepted in Neurology India
(Pubmed Indexed)
Equipment Audit
O-arm• First case on 14 April
2010• 70 cases in 2010• 120 cases in 2011• 202cases till date
Equipment Audit
O-arm• Audit paper accepted in Neurology India
TEG:ThromboElastoGraphy
• Started functioning on 8th April 2011• Total No of TEG`s done in 2011:977• Average of 102 TEG/month or 3 /day
Nursing informatics specialist
• Started on 1 Feb 2011• Posted round the clock in ED• Link between medical and IT professionals
CPRS Compliance in various departments in ED
0%10%20%30%40%50%60%70%80%90%
% OF CPRS ENTRY
OCT NOV DEC
MONTHS
NEURO
ORTHO
SURG
Computerised store compliance
ED OT TC-1 TC-2 TC-3 TC-4 TC-5 TC-6 TC-70%
20%
40%
60%
80%
100%
120%
1st half (MAY,JUN,JUL,AUG)
2nd half (SEPT,OCT,NOV,DEC
WARDS
PE
RC
EN
TA
GE
Patient display system
Patient display system
• Total No of HI in Red area in 2011:3064 • Average disposition time from Red area: 8hrs• No of HI patients who stayed >24hrs in red
area in 2011 :74• Out of 74-retriaged and then discharged :5 -tr.out:12 -admission:13 -ED death:44
E-MLC:launched on 11 Oct 2011
e-Death forms
HIS-Cashering
Pneumatic tube system
• Reduce sample sending time .(average time 1-2mts)
E-blood requisition
Bar code print label
• Accurate & precise data of the patients for labeling.
Awards won by our doctors
• Dr.Avijit Sarkari:Best paper award at NEUROTRAUMA 2011 at Ranchi for minimally invasive spine surgery in acute dorsolumbar trauma.
• Dr.Avijit Sarkari:Best poster award for decompressive craniectomy in paediatric minor head injuries.
Awards cont…
• Dr.Saurabh Sharma:2nd prize in quiz competition in DNACON .
• Dr.Avijit Sarkari & Dr.Kawaljeet Garg:1st prize in quiz competition in DNACON
Awards won by our nurses
• Shiny thomas-First prize in oral presentation DNACON : Effectiveness of mechanical vibrator for chest physiotherapy in ventilated head injury and spinal injury patient
• Shallu chauhan-2nd prize in oral presentation at DNACON:Initial Experience with Mobile CT in Neurosurgery ICU in a level 1 Trauma Centre in India
Awards cont…• Christina Varghese:2nd in quiz
competition at DNACON• Shiny Varghese:best poster at
DNACON• Martin jose:2nd best poster at
DNACON• Anu Antony:2nd in oral presentation at
SINNCON at Bangalore,2nd in quiz competition.
Awards cont…
• Metilda Robin:Best presentation in nursing at ISPN ,Goa
• Anu Susan Mathew :Best presentation in nursing at ISPN ,Goa and best poster in CEUTEH 2011
• Anita george: 2nd in quiz competition in SINNCON at Bangalore and 2nd best poster in CEUTEH 2011
Awards cont…• Yuvaraja:2nd in oral presentation in
CEUTEH2011 for role of empirical antibiotics on clinical infection under culture negative pts. In neurosurgery ICU
• Christina Varghese :3rd in oral presentation in CEUTEH 2011 for concordance between the result of tracheal aspirate using mucus extractor method and by modified non-bronchoscopic BAL techniques
Awards cont…
• Shiny Thomas :3rd in oral presentation in CEUTEH 2011 for effectiveness of mechanical vibrator for chest physiotherapy in ventilated head injury and spinal injury patient
PUBLICATIONS: PUBMED INDEXED• P Ailawadhi,D Agrawal,Ssahoo,GDS,D Gupta,S
Sinha,MC Misra. Use of O-arm for spinal surgery in academic institution in India:experience from JPNATC; Neurol India:2011,4,590-593
• Deepak agrawal,siddhartha sahoo,GD Sathyarthee,Deepak Gupta,Sumit Sinha,MC Misra. Initial experience with mobile CT in neurosurgery ICU in a level 1 trauma center in India. Neurol India 2011/vol59/issue:5/page:739-742
PUBMED INDEX ED
• S P Josua,D Agrawal,BS Sharma,AK Mahapatra:papilloedema as a non invasive marker for raised ICP following decompressive craniectomy for severe head injury
THE INDIAN JOURNAL OF NEUROTRAUMA
• SA Borker,S Sinha,DAgrawal,GD Satyarthee,D Gupta,AK Mahaptra:severe head injury in elderly:risk factor assessment& outcome analysis in a series of 100 consecutive pts in a level 1 trauma centre
• K Garg,D Gupta,N Basheer,AK Mahaptra,GD Satyarthee,Dagrawal,S Sinha:risk factor prognosticating single centre outcome study of cervicodorsal fracture dislocations
THE INDIAN JOURNAL OF NEUROTRAUMA
• Asarkari,Dgupta,S Sinha,AK Mahaptra:minimally invasive spine surgery in acute dorsolumbar trauma:an experience of 14 cases
• SP Josua,D Agrawal,GD Satyarthee,D Gupta,S Sinha:cranioplasty as surrogate marker for excellent outcome in severe head injury
THE INDIAN JOURNAL OF NEUROTRAUMA
• S Ahmed,D Agrawal,SS Kale,AK Mahaptra:a comparitive study of treatment of chronic subdural hematoma-burr hole drainage versus continuous closed drainage
• A Singh,N Goyal,D Gupta,AK Mahaptra:an overview of spinal injuries in children:series of 122 cases
THE INDIAN JOURNAL OF NEUROTRAUMA
• S Sahoo,D Gupta,AK Mahaptra:traumatic paraplegia-outcome study at an apex trauma center
• A Sarkari,D Gupta,S Sinha,SS Kale,AK Mahaptra:post traumatic hydrocephalus-presentation ,management & outcome:an apex trauma centre experience
THANK YOU
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