Orthopedics audit 2016
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Orthopedics audit 2016
- 1. Census– 2016 (01/01/16 ---- 31/12/16) JPNATC,AIIMS
- 3. ED - Ortho Consultations 3 TOTAL PATIENTS IN E/D ORTHO CONSULT RED AREA YELLOW AREA GREEN AREA 2015 67044 25337 3624 11612 49677 2016 69551 26376 3929 15677 46998 0 10000 20000 30000 40000 50000 60000 70000 80000 Patients 38%
- 4. Emergency Department 0 5000 10000 15000 20000 25000 30000 ORTHO CONSULT DISCHARGES TRANSFER OUT 2014 24970 23645 1325 2015 25337 24323 1014 2016 26376 24878 1498 2014 2015 2016
- 5. Admissions-2013-16 0 20 40 60 80 100 120 140 160 180 2013 (N=1546) 2014(N= 1555) 2015(N=1418) 2016 (N=1417) 2016 118/month 27/week
- 6. Admission/Discharges/Death 2013 2014 2015 2016 ADMISSIONS 1546 1555 1418 1417 DISCHARGES 1564 1543 1363 1349 DEATH 18 12 8 7 0 200 400 600 800 1000 1200 1400 1600 1800 ADMISSIONS DISCHARGES DEATH
- 7. Bed Occupancy - 2016 • Total bed occupancy rate: 95% (Days of Care/Beds*days X100) • Open fractures: mean 21 days • Spine: mean 14 days • Pelvis & Acetabulum : mean 9 days • Peri articular fractures: mean 6 days • Diaphyseal fractures: mean 3 days • Upper limb fractures: mean 3 days
- 9. Critical Care Admissions-2016 MULTIPLE LONG BONE # WITH CHEST/ABD TRAUMA PELVIS & CHEST/ABD TRAUMA SPINE GERIATRIC COMPLICATIONS 2013 (N=56) 21 4 14 17 2014 (N=40) 21 8 4 7 2015 (N=45) 18 4 15 8 2016 (N=43) 19 5 13 6 21 4 14 17 21 8 4 7 18 4 15 8 19 5 13 6 0 5 10 15 20 25
- 10. Critical Care Admissions-2016 DEATH =6(14%) SHIFTED TO WARD=37(86%) ORTHO ADMISSIONS=43
- 12. Follow-up OPD Census- 2016 ORTHOPEDICS, 20451, 50% SURG + NSx, 20143, 50% TOTAL ORTHO OPD REGISTRATIONS 2016 (N=20451)
- 13. Follow-up OPD Census 2014-16 0 5000 10000 15000 20000 25000 ORTHO GEN SURG NEURO 2014 18372 8074 6236 2015 19640 9703 7206 2016 20451 11145 8998 2014 2015 2016
- 14. Opd…timings..? 9 am –registration? 11 am-patient rush 2 pm-waiting patients Increase opd timings Opd rooms
- 15. OPD Registrations:2013-16 15 NEW REGISTRATIONS OLD REGISTRATIONS 2013 (N=18475) 8419 10056 2014 (N=18711) 8372 10339 2015 (N=19640) 8623 11017 2016 (N=20451) 8886 11565 0 2000 4000 6000 8000 10000 12000 14000 2013 (N=18475) 2014 (N=18711) 2015 (N=19640) 2016 (N=20451)
- 16. OPD Procedures(minor) 16 2013 (N=12328) 2014 (N=12751) 2015 (N =12849) 2016 (N=11123) DRESSING 2929 3245 3308 2862 SUTURE REMOVAL 2147 1551 1602 1496 EX FIX REMOVAL 72 48 63 69 K WIRE REMOVAL 104 110 130 127 DEBRIDEMENT 17 72 89 23 OTHERS 342 442 466 328 POP PROCEDURES 6717 7283 7380 6128
- 17. Surgeries Monthly Calendar : 2014-16
- 18. Operated Cases -2016 ROUTINE , 951, 54% EMERGENCY (inc LOCAL) 794, 46% N=1745 ROUTINE EMERGENCY
- 19. Routine/Emergency Cases-2014- 16 0 200 400 600 800 1000 1200 1400 2014(N=2075) 2015(N=1826) 2016 (N=1745) ROUTINE CASES 1265 1022 951 EMERGENCY CASES 810 804 794 1265 1022 951 810 804 794
- 20. Sex Distribution - 2016 MALES , 1367, 78% FEMALE, 378, 22% SEX DISTRIBUTION (N=1745)
- 21. Surgeries - over all review 2014(N=1891) 2014(N=184) AXIAL SKELETON APPENDICULAR SKELETON 2012(N=219) 2012 (N=1978) 2013(N=231) 2013(N=1895) 2015(N=1665) 2015(N=161) 2016(N=212) 2016(N=1533) 12% 88%
- 22. Spine
- 23. Spine Surgeries : 2015-16 CERVICAL DORSOLUMAR TOTAL 2015(N=83) 11 72 83 2016 (N=95) 12 83 95 0 10 20 30 40 50 60 70 80 90 100
- 25. Pelvi-acetabular Fractures : 2015-16 0100 #REF! Emergency external fixation Combined approaches Percutaneous fixation Total hip replacements for post-traumatic arthritis 117 surgeries
- 26. Long Bone - Femur
- 27. Femur Surgeries : 2015-16 27 PROX FEMUR SHAFT FEMUR DISTAL FEMUR HRA/THR 2015 (N=416) 196 152 42 26 2016 (N=478) 214 166 55 44 196 152 42 26 214 166 55 44 0 50 100 150 200 250
- 28. Leg Bones
- 29. Leg And Foot : 2013-16 PROX TIBIA(I/A) BB LEG DISTAL TIBIA & ANKLE TALUS CALCANEUM 2013 (N=395) 88 112 142 13 40 2014 (N=335) 102 100 109 8 20 2015(N=362) 112 98 124 6 22 2016 (N=359) 105 104 92 9 15 0 20 40 60 80 100 120 140 160
- 31. Upper Limb Trauma : 2014-16 31 PROX HUMERUS SHAFT HUMERUS DISTAL HUMERUS FOREARM DISTAL RADIUS 2014(N=374) 46 62 93 108 65 2015(N=320) 33 68 63 84 72 2016 (N=360) 52 48 89 97 74 46 62 93 108 65 33 68 63 84 72 52 48 89 97 74 0 20 40 60 80 100 120
- 32. Compound Fracture Procedures-2014 TO 16 32 DEBRIDEMENT & EX. FIX AMPUTATION DEBRIDEMENT & DEFINITIVE FIXATION 2014 (N=194) 147 42 5 2015 (N=108) 85 19 4 2016 (N=169) 143 9 17 147 42 5 85 19 4 143 9 17 0 20 40 60 80 100 120 140 160
- 33. Arthroscopy
- 34. Arthroscopy : 2012-16 KNEE SHOULDER ANKLE 2012 (N=45) 35 10 0 2013 (N=41) 37 4 1 2014 (N=33) 32 1 1 2015 (N=25) 22 3 0 2016 (N=37) 25 11 1 35 10 0 37 4 1 32 1 1 22 3 0 25 11 1 0 5 10 15 20 25 30 35 40
- 35. Other Procedures -2013 TO 16 0 20 40 60 80 100 120 140 2013 (N=254) 2014 (N=283) 2015 (N=155) 2016 (N=155)
- 36. Liaison Services FRAGILITY FRACTURE CLINIC Over 200 patients registered in 2016 Retrospective follow-up of over 1000 patients Research and project work SPINE TRAUMA CLINIC Every Monday morning Increasing number of spine trauma patients
- 37. Achievements… 37 HIGHEST NUMBER OF PELVI- ACETABULAR SURGERIES IN INDIA COMPLEX INTRA-ARTICULAR FRACTURES 35% OF TOTAL SURGERIES 17 INDEXED PUBLICATIONS IN 2016 FROM ORTHOPAEDICS TEAM AT JPNATC SUCCESSFULLY CONDUCTED REGIONAL AND NATIONAL CONFERENCES TEAM ORTHO
- 38. Challenges Ahead ….. GERIATRIC PATIENTS : SILENT EPIDEMIC ON THE RISE! -- Establishment of geriatric trauma ward -- Managing medical co-morbidities NEED TO INCREASE BED CAPACITY IN WARDS --Regretted patients (1498) DEDICATED 24 HOURS EMERGENCY ORTHO OT -- Routine(54%)/emergency(46%) TO INCREASE THE OPD TIMINGS/OPD ROOMS --51% of total OPD patients ORTHO REGISTRY -trained staff for the registry documentation
Editor's Notes
- Good afternoon. On behalf of the Department of Orthopaedics, I will be presenting an audit of our work in the last calender year
- We will first start with the Emergency services provided by the department
- The Trauma Centre Casualty saw an annual footfall of 69551 patients of which 26376 patients constituting 38% of the total received an ORTHO consultation. Most of these patients were triaged into the Green area of the Casualty. Both of these figures show an increase compared to the previous year.
- We had to transfer out or regret as many as 1498 patients due to lack of availability of beds
- We have had in excess of 1000 admissions in each of the last 4 years. This year we had an average of 118 admissions per month and about 27 consultations per week.
- Thanks to the help of our Anaesthesia colleagues and the ICU back-up available for spine, pelvis and geriatric patients – our mortality rate has been very low and we had only a mortality of only 7 patients
- Total bed occupancy rate for 2016 was 95%. Open fractures and spine fractures have longer admission periods.
- Coming next to the Critical care admissions in 2016
- Most of our ICU patients are not primary admissions but rather shifted to ICU post-operatively or due to medical complications. Last year 43 of our patients were admitted in ICU with 19 polytrauma patients, 5 patients with pelvic fractures, 13 spine patients and 6 patients who belonged to the geraitric age group.
- Of the 43 admissions, 7 died and 36 were shifted back to the ward.
- Next we Come to the OPD part….
- In the last year, we had over 20000 OPD visits which include both new registrations and re-visits accounting for just over 50% of the total OPD load at trauma centre. At present we do not have a walk-in OPD so all of these patients are follow-up patients initially seen in casualty or patients discharged from the ward.
- The number of patients attending ORTHO OPD has been on a steady rise in the last three years, with 2016 seeing a footfall of over 20000 patients
- These pictures tell us a story we see on every OPD day…even at 2pm we have patients waiting to be seen and this is also the time for the next OPD. The solution to this could be to increase the OPD timings or the number of OPD rooms.
- In 2016, of the 20000 odd patients that we saw, 8886 were new registrations and 11565 were revisits.
- In 2016, over 11000 office procedures which includes dressing, suture removal and plster of paris application were carried out. Amost 50% of these procedures were plaster applications because of the high number of patients following up from the casualty. This brings out the need for having 1-2 skilled plaster technicians in the OPD
- In 2016, we performed 1745 surgeries – 1680 major, 65 minor – 5 surgeries per day. 15 surgeries per day performed in trauma centre overall [5437]. The monthwise distribution of surgeries shows a slight dip between May to July which are the months when some of the consultants are on vacation.
- 951 cases amounting to 54% were routine cases, 794 46% were emergency cases which included local procedures done in OT.
- Both our routine and emergency cases number has been high over the last 3 years.
- In concordance with the epidemiological trends, males account for 78% of the surgeries done.
- If we categroize these surgeries into axial and appendicular portions of the skeleton, spine and pelviacetabular fractures accoutned for 212 surgeries. [12%]
- A total of 95 spine surgeries were done in 2016 – of which xx were cervical spine, xx were dorsal spine and xx were lumbar spine. 15 discectomies were also done.
- Our centre records the maximum number of pelvis and acetabulum surgeries in india.
- 117 pelvi-acetabular surgeries were done in 2016 – which includes definitive fixation and emergency pelvic fixators or C-clamp applictions.
- Consistent with the increasing prevalence of geriatric trauma and osteoporosis, we saw an increase in the number of proximal femur fractures that were operated by either intra-meduallary, extra-meduallry fixation or hemi replacement or total hip arthroplasties.
- Coming to leg bones, we saw high numbers of complex peri-articular fractures being operated – 105 proximal tibia and over 90 dital tibia and malleolar fractures. Even signoficant numbers of rare fractures like talus and calcaneum were operated.
- Upper limb trauma is fairly common and we saw high numbers of complex peri-articular fractures being operated. Modern implants and surgical techniques have been developed for distal radius fractures and are being used by us.
- Most of the debridement and fixator are less . May be with help of surgeons go to surgery department