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Ortho Audit 2013
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  • WHAT IS THE RED COLOUR DENOTING NOT THE HIGHEST
  • THIS INCLUDE BOTH LONG AND SHORT ADMISSIONS
  • WHY RED COLOUR
  • DISCHARGES INCLUDE THOSE TRANSFERRED IN FROM SURGERY AND NS AND SHARED ADMISSIONS <br />
  • HOW WAS IT CALCULATED
  • INCREASED LOAD SO EITHER TO INCREASE THE OPD ROOMS/OPD TIMINGS/ <br /> HAS TO BE STRESSED. <br /> IF NOT THE DAYS AT ELAST THE TIMINGS CAN BE BETTER UTILIZED . <br /> SHOW THE FOTO AT 8.50 AM IN THE MORNING AT OPD counter. No person there. Starts at 9 registration by 9.30-45 then see patients.
  • INCREASE OF POP PROCEDURES BECAUSE OF INCREASE OF DISCHARGES FROM ED IN GREEN AREA, WE NEED QUALIFIED TRAINED PLASTER TECHNISIONS
  • DIP
  • These are traumatic discs of cervical spine??
  • INCLUDES ROUTINE FIXATATION PROCEDURES AND EMERGENCY FIXATERS/C CLAMPS..
  • Proximal femur include dhs
  • Most of the debridement and fixator are less . May be with help of surgeons go to surgery department

Ortho Audit 2013 Presentation Transcript

  • 1. JPNATC,AIIMS
  • 2. Orthopedic Team • Consultants : 4 • Senior Residents : 16 • Junior residents : 4+2 • Beds : 46 • Assisted by : Entire Trauma Centre!
  • 3. Emergency Department
  • 4. ED-Ortho Consultations 0 10000 20000 30000 40000 50000 60000 70000 TOTAL PATIENTS IN E/D ORTHO CONSULT RED AREA YELLOW AREA GREEN AREA 2011 2012 2013 24% 33% 16% 6% 4 TOTAL ATTENDENCE ED TOTAL ORTHO CONSULTATIONS RED AREA CONSULTATIONS YELLOW AREA CONSULTATIONS GREEN AREA CONSULTATIONS 2011 42539 34738 2343 3171 29224 2012 55698 42974 2756 4507 35711 2013 58923 30164 1986 9001 19175
  • 5. Emergency Department 0 10000 20000 30000 40000 50000 ORTHO CONSULT DISCHARGES TRANSFER OUT 2011 2012 2013 84% 95% 6% 3% 5% 2011 2012 2013 ORTHO CONSULT 34738 42974 30164 DISCHARGES 29152 35312 28714 TRANSFER-OUT 2124 1458 1450 83%
  • 6. Admissions-2011/13 0 50 100 150 200 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 2011 (N=1301) 2012 (N=1580) 2013(N= 1546) JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 2011 88 65 71 73 61 65 97 118 112 121 111 94 2012 115 111 128 134 154 133 154 139 148 130 121 113 2013 140 145 147 129 117 105 111 139 127 138 113 135
  • 7. Admissions-2011/13 0 200 400 600 800 1000 1200 1400 1600 2011(N=1301) 2012(N=1580) 2013(N= 1546) 1580 (29/WK) 1546 (28/WK) 7 1301 (25/wk)
  • 8. Discharges-2011/13 0 100 200 JAN FEB MAR APRL MAY JUNE JULY AUG SEP OCT NOV DEC 2011 (N=1052) 2012 (N=1566) 2013(N= 1564) JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 2011 63 62 73 76 61 71 101 117 116 114 109 89 2012 106 119 132 127 153 136 149 129 151 122 124 118 2013 144 148 145 139 118 107 118 126 131 133 122 133
  • 9. Discharges-2011/13 0 200 400 600 800 1000 1200 1400 1600 2011 (N=1052) 2012 (N=1566) 2013(N=1564) 1052 (20/WK) 1566 (29/WK) 1564 (29/WK)
  • 10. Admission/Discharges/Death 0 500 1000 1500 2000 2010 2011 2012 2013 972 1076 1580 1546 964 1052 1566 1564 ADMISSIONS DISCHARGES ADMISSIONS DISCHARGES 2010 972 964 2011 1076 1052 2012 1580 1566 2013 1546 1564
  • 11. Bed Occupancy - 2013  Total bed occupancy rate :97% (Days of Care/Beds*days X100)  Open fractures: mean 22 days  Spine: mean 12 days  Pelvis & Acetabulum : mean 8 days  Peri articular fractures: mean 5 days  Diaphyseal fractures: mean 3 days  Upper limb fractures: mean 3 days
  • 12. Critical Care Admissions-2013
  • 13. Critical Care Admissions-2013 10 19 4 4 11 26 19 18 21 4 14 17 0 5 10 15 20 25 30 2011 (N=37) 2012 (N=74) 2013 (N=56) 2011(N=37) 2012(N=74) 2013(N=56) MULTIPLE LONG BONES 10 11 21 PELVIS/CHEST/ABD 19 26 4 SPINE 4 19 14 GERIATRIC 4 18 17
  • 14. Critical Care Admissions-2013 DEATH =32% SHIFTED TO WARD=68% ORTHO ADMISSIONS=56
  • 15. OPD Census-2013 TOTAL OPD REGISTRATIONS 2013(N=32130) ORTHOPEDICS(N=18475) SURGERY(N=7271) NEURO SURGERY(N=6384) 23% 58% 19%
  • 16. OPD Census 2012/13 0 5000 10000 15000 20000 ORTHO GEN SURG NEURO 2012 2013 DEPARTMENT 2012 2013 ORTHO 17912 18475 GEN SURG 7263 7271 NEURO 6131 6384 3%
  • 17. OPD Registrations-2010/13 0 2000 4000 6000 8000 10000 12000 OLD REGISTRATIONS NEW REGISTRATIONS 2010 (N=15933) 2011 (N=12982) 2012 (N=17912) 2013 (N=18475) 2% 18 2010 2011 2012 2013 OLD REG 9645 7235 7622 8419 NEW REG 6294 5747 10290 10056 MON/TUES AVERAGE 101 PATIENTS/OPD WED/THUR AVERAGE 51 PATIENTS/OPD 6%
  • 18. OPD - Minor Procedures
  • 19. OPD Procedures(minor) 0 2000 4000 6000 8000 10000 2011 (N=7259) 2012 (N=12318) 2013 (N=14851) 63% 20 2011 (N=7259) 2012 (N=12318) 2013 (N=14851) DRESSING 1609 2929 3245 SUTURE REMOVAL 1285 2147 1551 EX FIX REMOVAL 64 72 48 K WIRE REMOVAL 84 104 110 DEBRIDEMENT 46 7 172 OTHERS 282 342 442 POP PROCEDURES 3869 6717 9283 55%
  • 20. Operation Theatre
  • 21. Surgeries Monthly Calendar 2011/13 0 50 100 150 200 250 2012 (N=2197) 2011(N=1708) 2013(N=2126)
  • 22. Operated Cases -2013 N=2126 ROUTINE EMERGENCY 33% 67%
  • 23. Routine/Emergency Cases-2011/13 0 200 400 600 800 1000 1200 1400 1600 2011(N=1708) 2012(N=2197) 2013(N=2126) 1221 1576 1421 487 621 705 ROUTINE CASES EMERGENCY CASES 10% 13%
  • 24. Demographic Profile
  • 25. Demographic Profile-2013 15 106 1429 158 20 198 1770 209 31 214 1657 224 0 200 400 600 800 1000 1200 1400 1600 1800 2000 0-3 yrs 4-18 yrs 19-60 yrs > 60 yrs 2011 (N=1708) 2012 (N=2197) 2013 (N=2126) 26
  • 26. Sex Distribution -2013 SEX DISTRIBUTION(N=2126) MALES (N=1625) FEMALE(N=326) 78% 22%
  • 27. Surgeries-over all review AXIAL SKELETON APPENDICULAR SKELETON 2010 (N=163) 2011 (N=191) 2012 (N=219) 2010 (N=1093) 2011 (N=1517) 2012 (N=1978) 2013 (N=231) 2013 (N=1895)
  • 28. Spine
  • 29. Spine Surgeries-2013 15 29 4 29 37 4 12 64 6 34 54 22 0 10 20 30 40 50 60 70 ANTERIOR APPROACH POSTERIOR APPROACH DISCECTOMY 2010 (N=48) 2011 (N=70) 2012 (N=82) 2013 (N=110) 2010(N=48) 2011(N=70) 2012(N=82) 2013(N=110) ANTERIOR APPROACH 15 29 12 34 POSTERIOR APPROACH 29 37 64 54 DISCECTOMY 4 4 6 22
  • 30. Pelvi-acetabular Fractures
  • 31. Pelvi-acetabular Fractures-2010/13 0 20 40 60 80 100 ANTERIOR APPROACH POSTERIOR APPROACH 48 67 83 38 65 72 46 75 2010 (N=115) 2011 (N=121) 2012 (N=137) 2013 (N=121) 2010(N=115) 2011(N=121) 2012(N=137) 2013(N=121) ANTERIOR APPROACH 48 83 65 46 POSTERIOR APPROACH 67 38 72 75
  • 32. Long Bone - Femur
  • 33. Femur Surgeries-2010/13 81 130 87 10 163 118 84 14 322 169 80 33 312 224 93 16 0 50 100 150 200 250 300 350 PROX FEMUR IL NAILING DISTAL FEMUR HRA/THR 2010 (N=308) 2011 (N=379) 2012 (N=604) 2013 (N=645) 34 2010(N=308) 2011(N=379) 2012(N=604) 2013(N=645) PROX FEMUR 81 163 322 312 IL NAILING 130 118 169 224 DISTAL FEMUR 87 84 80 93 HRA/THR 10 14 33 16
  • 34. Leg Bones
  • 35. Leg And Foot -2010/13 0 20 40 60 80 100 120 140 160 2010 (N=191) 2011 (N=253) 2012 (N=268) 2013 (N=395) 2010(N=191) 2011(N=253) 2012 (N=268) 2013(N=395) PROX TIBIA(I/A) 54 78 76 88 NAILING 69 68 79 112 DISTAL TIBIA&ANKLE 43 82 82 142 TALUS 5 4 5 13 CALCANEUM 20 21 26 40
  • 36. Upper Limb Trauma
  • 37. Upper Limb Trauma -2010/13 40 30 41 97 18 42 51 92 90 58 42 38 69 67 47 72 55 73 64 62 0 20 40 60 80 100 120 PROX HUMERUS SHAFT DISTAL HUMERUS FOREARM DISTAL RADIUS 2010 (N=226) 2011 (N=333) 2012 (N=263) 2013 (N=314) 38 2010 (N=226) 2011 (N=333) 2012 (N=263) 2013(N=314) PROX HUMERUS 40 42 42 72 SHAFT 30 51 38 55 DISTAL HUMERUS 41 92 69 73 FOREARM 97 90 67 64 DISTAL RADIUS 18 58 47 62
  • 38. Compound Fractures
  • 39. Compound Fracture Procedures-2010/13 316 75 6 291 71 12 241 77 9 102 49 7 0 50 100 150 200 250 300 350 DEBRIDEMENT & EX. FIX AMPUTATION DEBRIDEMENT & DEFINITIVE FIXATION 2010 (N=397) 2011 (N=374) 2012 (N=327) 2013 (N=178) 40 2010(N=397) 2011(N=374) 2012(N=327) 2013(N=178) DEB+EX FIXATER 316 291 241 102 AMPUTATION 75 71 77 49 DEB+DEFINITIVE FIXATION 6 12 9 7
  • 40. Arthroscopy
  • 41. Arthroscopy -2010/13 0 20 40 60 KNEE SHOULDER 46 8 34 8 35 10 37 4 2010 (N=54) 2011 (N=42) 2012 (N=45) 2013 (N=41) KNEE SHOULDER 2010 46 8 2011 34 8 2012 35 10 2013 37 4
  • 42. Complex Intra-articular Fractures (Excluding Pelvis & Acetabulum)
  • 43. Complex Intraarticular Fractures (Excluding Pelvis & Acetabulum)-2010/13 0 20 40 60 80 100 120 140 160 2010 (N=327) 2011 (N=466) 2012 (N=429) 2013 (N=505) 44 2010(N=327) 2011(N=466) 2012(N=429) 2013(N=505) DISTAL FEMUR 87 84 80 78 PROX TIBIA 69 78 76 88 PROX HUMERUS 40 42 42 72 DISTAL HUMERUS 41 92 69 77 DISTAL RADIUS 18 58 47 72 SCAPULA 4 5 6 -- CALCANEUM AND TALUS 25 25 31 53 DISTAL TIBIA AND ANKLE 43 82 82 142 27%
  • 44. Other Fractures-2010/13 52 37 25 5 44 29 28 4 35 18 48 5 21 13 29 0 0 10 20 30 40 50 60 HAND FOOT PATELLA CLAVICLE 2010 (N=119) 2011 (N=105) 2012 (N=106) 2013 (N=63) 2010(N=119) 2011(N=105) 2012(N=106) 2013(N=63) HAND 52 44 35 21 FOOT 37 29 18 13 PATELLA 25 28 48 29 CLAVICLE 5 4 5 0
  • 45. Other Procedures -2010/13 0 20 40 60 80 100 120 140 160 2010 (N=137) 2011 (N=114) 2012 (N=224) 2013 (N=254) 2010(N=137) 2011(N=114) 2012(N=224) 2013(N=254) IMPLANT REMOVAL 103 65 135 132 BONE GRAFTING 15 18 29 33 ILLIZAROV 12 11 15 18 TENDON REPAIR 5 13 9 7 BM INJECTON 2 7 11 13 PRPP INJECTION 0 0 15 17 VAC APPLICATION 0 0 10 34
  • 46. Achievements….  ONE OF THE HIGHEST NUMBER OF PELVI-ACETABULAR SURGERIES IN INDIA (121 in 2013).  TOTAL OF SURGERIES:  COMPLEX INTRA-ARTICULAR FRACTURES: 43% OF SURGERIES  LATEST PRINCIPLES OF FRACTURE MANAGEMENT.  VARIOUS RESEARCH WORK IN DIFFERENT TOPICS STARTED IN 2013  VARIOUS PRESENTATIONS IN ALL INDIA AND REGIONAL CONFERENCES  13 INDEXED PUBLICATIONS INVOLVING ORTHOPAEDICS TEAM IN 2013 47