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DEPTT OF NEUROSURGERY
  JPN APEX TRAUMA CENTRE




             AUDIT
   JAN 2011- DECEMBER 2011
Clinical workload
6000                                  2008
5000                                  2009
                                      2010
4000                                  2011
3000
2000
1000
  0     OPD    Admissions   Surgery    Beds
 2008   3615     1916        1369       60
 2009   4488     1978        1070       56
 2010   5245     2073        1535       54
 2011   5343     1882        1407       54
2000
   1500
   1000
     500
        0
               Neurosx   orthopedics   surgery
Admission       1882        1444        1875
Bed strength     54          48          48
OPERATIONS
Operated cases in NS OT
SURGICAL LOAD
• Total cases Operated in OT:1407

                                                                Open
  Cranial   Spinal    Shunt   BPI   Cranioplasty   Others
                                                            Tracheostomy



   753       353       82     63        118         51          105
Open Vs Percutaneous Tracheostomy

250                                   236
                                              205
200                            2010

                               2011
150

               105
100
       67
50


 0
      Open tracheostomy (OT)          PC Tracheostomy (ICU)
Open Vs Percutaneous ICP monitoring

300
                                                268
250                             2010    231

200                             2011

150

100

50
        8       5
 0
      Open ICP Montiring (OT)          PC ICP Montiring (ICU)
HEAD INJURIES
Age fractional classification

                                 male patients with head injury

                 2500
no of patients




                 2000
                 1500
                                                                        (male)
                 1000
                 500
                   0
                        0-5   6-12- 13-18 19-30 31-40 41-50 51-60 >60
                                           age limit
Age fractional classification

                                      f emales with head injury

           500
           450
           400
no of patients




           350
           300
           250                                                          females with head…
           200
           150
           100
            50
             0
                 0-5   6-12. 13-18 19-30 31-40 41-50 51-60        >60
                                     age limit
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 (%)   NonOperat   Death (%)
                                                          ed
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
OUTCOME: MORTALITY (%)
40                                              36
                                           35
35
                                                     29.9
30
                                                               23 22
25                                                                                  2008
                                                        20.8
20                                                                                  2009
                       15
15                          12                                                      2010
                                 7.98.26                                            2011
10
                                                                       5.7
      3
5         2 0.56                                                             2.07
                0.16
0
     Minor HI          Mod HI Severe HI Overall
SPINE INJURIES
Age fractional classification
                                                    males with spinal injury



                 140

                 120
no of patients




                 100

                 80
                                                                                             males with spinal injury
                 60

                 40

                 20

                  0
                       1-5.   6-12.   13-18.   19-30.     31-40      41-50     51-60   >60

                                                 age limit
Age fractional classification
                                                        females with spinal injury



                 25


                 20
no of patients




                 15
                                                                                               f emales with spinal injury

                 10


                  5


                  0
                      age limit   0-5   6-12.   13-18   19-30   31-40    41-50   51-60   >60
Cervical Spine Injury (2011)



        admissio
Total              Operated   Death(%)   Non-Operated   Death(%)
           n




268       200        159      29(18%)        109        17(15%)
Cervical Spine Injury (2011)



Total      complete   incomplete   Death(%)




268          81          187       47(17%)
Cervical Spine Injury

300                        268
250
                   195
200
          161
                                 2009
150
                                 2010
100                              2011

50

 0
                Cervical
Follow up
• Mean Follow up:209.02 days
         Range (75-428 days)
Dorsolumbar Spine Injuries

180     162
160
140
120                109
100                      2010
 80                      2011
 60
 40
 20
  0
        DL Spine Inj
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

80               76
        72
70                        63
60
50
40
30
20
10
0
       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

           90%
           80%
           70%
           60%
 % OF CPRS 50%                        NEURO
   ENTRY 40%                          ORTHO
           30%
                                      SURG
           20%
           10%
            0%
                 OCT    NOV     DEC
                       MONTHS
Computerised store compliance

  120%



  100%



        80%
PERCENTAGE




                                                                             1st half
                                                                             (MAY,JUN,JUL,AUG)
        60%
                                                                             2nd half
                                                                             (SEPT,OCT,NOV,DEC

        40%



        20%



             0%
                   ED   OT   TC-1   TC-2   TC-3  TC-4   TC-5   TC-6   TC-7
                                           WARDS
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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Neurosurgery 2011

  • 1. DEPTT OF NEUROSURGERY JPN APEX TRAUMA CENTRE AUDIT JAN 2011- DECEMBER 2011
  • 2. Clinical workload 6000 2008 5000 2009 2010 4000 2011 3000 2000 1000 0 OPD Admissions Surgery Beds 2008 3615 1916 1369 60 2009 4488 1978 1070 56 2010 5245 2073 1535 54 2011 5343 1882 1407 54
  • 3. 2000 1500 1000 500 0 Neurosx orthopedics surgery Admission 1882 1444 1875 Bed strength 54 48 48
  • 6. SURGICAL LOAD • Total cases Operated in OT:1407 Open Cranial Spinal Shunt BPI Cranioplasty Others Tracheostomy 753 353 82 63 118 51 105
  • 7. Open Vs Percutaneous Tracheostomy 250 236 205 200 2010 2011 150 105 100 67 50 0 Open tracheostomy (OT) PC Tracheostomy (ICU)
  • 8. Open Vs Percutaneous ICP monitoring 300 268 250 2010 231 200 2011 150 100 50 8 5 0 Open ICP Montiring (OT) PC ICP Montiring (ICU)
  • 10. Age fractional classification male patients with head injury 2500 no of patients 2000 1500 (male) 1000 500 0 0-5 6-12- 13-18 19-30 31-40 41-50 51-60 >60 age limit
  • 11. Age fractional classification f emales with head injury 500 450 400 no of patients 350 300 250 females with head… 200 150 100 50 0 0-5 6-12. 13-18 19-30 31-40 41-50 51-60 >60 age limit
  • 12. 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
  • 13. Data of Head Injury Patients Total Cases admissions Operated Death (%) NonOperat Death (%) ed 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%)
  • 14. Severe HI mortality in age groups <12 13-18 18-59 60-80 >80 27 31 111 35 2
  • 15. OUTCOME: MORTALITY (%) 40 36 35 35 29.9 30 23 22 25 2008 20.8 20 2009 15 15 12 2010 7.98.26 2011 10 5.7 3 5 2 0.56 2.07 0.16 0 Minor HI Mod HI Severe HI Overall
  • 17. Age fractional classification males with spinal injury 140 120 no of patients 100 80 males with spinal injury 60 40 20 0 1-5. 6-12. 13-18. 19-30. 31-40 41-50 51-60 >60 age limit
  • 18. Age fractional classification females with spinal injury 25 20 no of patients 15 f emales with spinal injury 10 5 0 age limit 0-5 6-12. 13-18 19-30 31-40 41-50 51-60 >60
  • 19. Cervical Spine Injury (2011) admissio Total Operated Death(%) Non-Operated Death(%) n 268 200 159 29(18%) 109 17(15%)
  • 20. Cervical Spine Injury (2011) Total complete incomplete Death(%) 268 81 187 47(17%)
  • 21. Cervical Spine Injury 300 268 250 195 200 161 2009 150 2010 100 2011 50 0 Cervical
  • 22. Follow up • Mean Follow up:209.02 days Range (75-428 days)
  • 23. Dorsolumbar Spine Injuries 180 162 160 140 120 109 100 2010 80 2011 60 40 20 0 DL Spine Inj
  • 24. Dorsolumbar Spine Injuries Total Complete Incomplete Operated Death(%) 109 64 45 87 6 (5.5%)
  • 25. Follow up • Mean Follow up:220.47 days (Range 55-415 days)
  • 26. Brachial Plexus injuries 80 76 72 70 63 60 50 40 30 20 10 0 2009 2010 2011
  • 28. 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
  • 29. Equipment Audit Mobile CT • Audit paper accepted in Neurology India (Pubmed Indexed)
  • 30. Equipment Audit O-arm • First case on 14 April 2010 • 70 cases in 2010 • 120 cases in 2011 • 202cases till date
  • 31. Equipment Audit O-arm • Audit paper accepted in Neurology India
  • 32. 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
  • 33. Nursing informatics specialist • Started on 1 Feb 2011 • Posted round the clock in ED • Link between medical and IT professionals
  • 34. CPRS Compliance in various departments in ED 90% 80% 70% 60% % OF CPRS 50% NEURO ENTRY 40% ORTHO 30% SURG 20% 10% 0% OCT NOV DEC MONTHS
  • 35. Computerised store compliance 120% 100% 80% PERCENTAGE 1st half (MAY,JUN,JUL,AUG) 60% 2nd half (SEPT,OCT,NOV,DEC 40% 20% 0% ED OT TC-1 TC-2 TC-3 TC-4 TC-5 TC-6 TC-7 WARDS
  • 37. 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
  • 38.
  • 39.
  • 40.
  • 44. Pneumatic tube system • Reduce sample sending time .(average time 1- 2mts)
  • 46. Bar code print label • Accurate & precise data of the patients for labeling.
  • 47. 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.
  • 48. 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
  • 49. 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
  • 50. 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.
  • 51. 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
  • 52. 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
  • 53. 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
  • 54. 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
  • 55. 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
  • 56. 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
  • 57. 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
  • 58. 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
  • 59. 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