PATIENT CARE

THERAPEUTIC SERVICES

It may not always be about what we know, but it’s always about how much we care.

THERAPEUTIC SERVICES

Tata Medical Center

Surgical Oncology

Surgery remains the primary treatment in a number of malignancies. Apart from curative removal of the tumour where possible, surgical expertise is often required for diagnosis, follow-up and symptom palliation. Surgical services in TMC comprise a highly trained team of surgical oncologists, nurses and ancillary staff. The surgical teams aspire to work with the mission of offering high quality evidence-based surgical services. To attain this, and to develop focused centers of excellence, teams will be site-specific. Such organ-centric surgical care helps foster expertise in intricacies of cancer surgery and reconstruction. TMC will also pursue a multidisciplinary approach, wherein clinicians across all specialities will participate in formulating investigative and therapeutic strategies for each patient. Such a holistic approach helps neutralise the instinctive bias that clinicians often possess about the relative superiority of their discipline, be it a surgeon, medical oncologist or a radiation oncologist.

TMC boasts of an integrated surgical suite comprising of 8 general operation theatres, 1 operation theatre for delivery of brachytherapy and a state-of-the-art CSSD. To facilitate high-volume complex cancer surgery and optimise ambient atmosphere, each theatre is fitted with equipment meeting contemporary standards. All the theatres have HEPA filters, which remove practically all traces of microbes in the air, thereby improving levels of asepsis. Facilities are available for minimal access surgery, laser surgery, micro-vascular reconstructions and day-care procedures like biopsies and endoscopic interventions.

Patient care will be further augmented by a Fellowship programme, which will attract talented trainees, who will be supervised by a team of full-time Consultants.

Radiation Therapy

Radiotherapy is a very important treatment modality in cancer. Radiation is used for curative treatment as well as symptom palliation for the majority of patients with cancer.

This department is equipped with two of the highest precision radiation delivery units – the Tomotherapy HiArt and the Varian Novalis Tx linear accelerators. Treatment planning is performed on the Eclipse, Brainlab  and Tomotherapy planning systems. Networking is provided on the ARIA platform. A widebore GE Lightspeed CT simulator is used for 3D image acquisition. A Varian RPM Gating system allows for precise targeting of tumors moving with respiration. These allow the implementation of some of the latest techniques in radiation therapy including Intensity Modulated Radiotherapy (IMRT); Image Guided Radiotherapy (IGRT); stereotactic radiotherapy and respiratory gating. Brachytherapy will be delivered with the VariSource High-dose-rate (HDR) Brachytherapy unit. The use of MRI and PET-CT based treatment planning is performed as indicated.

The Radiation Oncology Team at TMC has an excellent mix of doctors and medical physicists who have practiced in some of the best institutions in India and abroad. There is an emphasis on quality assurance at every level of the radiotherapy planning and treatment process.

Medical Oncology

Medical oncology deals with the use of systemic medications aimed at cancer cell killing and control. The department of Medical Oncology has specialist consultants with interest in the management of solid tumors as well as pediatric (childhood) cancers. The medical oncology team in TMC are experts in the use of systemic treatment including chemotherapy, endocrine therapy, as well as the latest biological and targeted treatments for solid tumors.

In-house treatment protocols are being set at par with international standards and such treatment algorithms will be constantly updated based on the latest research evidence. The medical oncology team aims to provide a comprehensive approach to cancer care with emphasis on careful personalised monitoring of patients during and after treatment. The department works very closely with other specialist departments in the hospital to ensure the highest standards of cancer care for all patients.

A fully equipped medical daycare ward will ensure a supportive and compassionate environment during the patient’s short stay in the hospital whilst undergoing chemotherapy treatment without the need for inpatient admissions.

Emphasis will also be placed on translational research, Phase I/II clinical trials, drug development including the development of gene therapy for cancer cure.

Clinical Hematology

The department of Clinical Hematology in TMC is involved in the treatment of malignant blood disorders (leukemia and lymphoma), bone marrow failure and thalassemia major.

Under the guidance of a team of physicians and nurses led by Dr Mammen Chandy, this unit brings with it the immense expertise and experience of Christian Medical College- Vellore in this field.

TMC possesses a state-of-the-art bone marrow transplant unit with 9 beds, another first for this part of the country. This unit has been built on international standards, with definitive measures for asepsis including HEPA filtered air. The unit is capable of autologous and allogeneic transplants, matched unrelated donor transplants as well as cord blood transplants.

Therapeutic Nuclear Medicine

Therapeutic Nuclear Medicine involves the use of radioactive isotopes administered to the patient for the treatment of cancer or control of cancer symptoms. TMC has a dedicated high dose radioisotope therapy ward where several radiopharmaceuticals will be available for the treatment of thyroid cancers, malignant pheochromocytoma, carcinoids, painful bone metastases etc. This unit is one of the first in eastern India to enable treatment of such cancers.

Anesthesia, ICU and Pain

DEPARTMENT OF ANAESTHESIOLOGY, CRITICAL CARE AND PAIN

As anesthesiologists we are responsible for the safety and well-being of patients before, during and after surgery. This includes placing patients in a state of controlled unconsciousness called “general anesthesia”, the provision of “regional anesthetics” where only a portion of the body is made numb, or administering ‘sedation’ when indicated for the relief of pain or anxiety.

The role of the anaesthesiologist extends beyond the operating room. It starts from preoperative assessment of the patient, which is an evaluation process that carefully considers both the patient’s current state of health and the planned surgical procedure that allows anaesthesiologists to make judgments about the safest anesthesia plan for each individual patient. The anaesthesia care extends to postoperative period while the patient emerges from the effects of anaesthesia.

Critical Care Medicine (CCM) is a specialty that involves the management of patients with life threatening, frequently complex medical and surgical illnesses in a specialized Intensive Care Unit (ICU) or similar facility. A modern ICU represents the pinnacle of any hospital’s approach to highly technological & sophisticated in-patient care. The critical care consultant has the expertise in the evaluation and management of these critically ill patients, who may have dysfunction or failure of one or more organ systems including the cardiac, pulmonary, neurologic, liver, kidney or gastrointestinal systems.

The department also provides acute pain services in the hospital and pain management for chronic cancer related pain on both as outpatient as well as in-patient basis.

ABOUT THE DEPARTMENT

The mission of the Department of Anesthesiology, Critical Care and Pain in Tata Medical Center is to provide state-of-the art anaesthesia services, perioperative care, pain management and life-support for cancer patients in intensive care. The primary objective is centered on patient safety and satisfaction.

The Department of Anesthesiology, Critical Care and Pain has successfully completed five years of existence and is an integral part of the institute that has contributed immensely to the growth of the hospital. Our Department has set up its own high standards in patient care, education and research. The Department boasts of a pool of 11 consultants, 4 clinical associates, 5 postgraduate fellows, 9 medical officers and 13 technologists. The Department provides anaesthesia services for seven onco-surgical sub-specialties. Recently, we have added advanced robotic-anaesthesia into our armamentarium. Our Department provides round-the-clock consultant-based anaesthesia services for emergency surgical patients. We also have a robust ‘Pain Management Unit’ that covers for acute postoperative pain services and outpatient clinics for elective pain management.

STATE-OF–THE-ART- TECHNIQUES

The Department of Anaesthesiology, Critical Care and Pain looks forward and into newer/emerging techniques that propose to improve patient management. The unit is equipped with latest advanced technology/aids to boost up routine clinical anaesthesia management including modern anaesthesia machines, advanced gadgets for difficult airway management, patient safety monitors: specific hemodynamic monitoring for fluid administration, optimization during critical/long surgery (stroke-volume variation), anesthesia-depth monitoring (Bispectral-Index); ventilators, ultrasound etc. amongst many others. Pain medicine: radio-frequency ablation, ultrasound-aided nerve-blocks, alcohol/neurolysis etc.

The Department of Anaesthesiology, Critical and Pain, offers host of clinical services, academic-training and research. Apart from the provision of routine clinical anesthesia, we impart fellowship in Onco-Anesthesia, Critical Care and Cancer Pain management accredited by Indian College of Anaesthesiologists. The process of accreditation for IDCCM and DNB is going on.

KEY SERVICE

Clinical Anesthesia

The presence of a collective anaesthesia practice system in the department has facilitated to undertake 250-300 cancer surgeries in various sub-specialties along with active teaching (operation-theatre technologists, visiting fellows/observers in Anesthesiology, etc.) and related investigator-driven clinical research. All the anesthetic episodes are fully controlled and covered by designated consultants and fellows only. We provide anesthesia care delivery (clinical anesthesia, perioperative intensive care, intensive care to other critically sick patients) to several surgical sub-specialty-areas (GI-onco, gynaec-onco, head-neck, uro-onco, plastic & microvascular, thoracic-onco, breast, paediatric and robotic etc.) for scheduled/emergent surgical intervention.

Intensive Care

Critical care unit presently comprised of 16 beds. It is divided into medical ICU (5 beds), surgical ICU (6 beds) and High Dependency Unit (5 beds). All the medical beds are isolated unit to prevent cross infection. ICU beds are electronically controlled so that head or foot end of the bed can be positioned appropriately as per patient requirement for better patient management. Each bed is associated with an advanced multichannel monitor capable of monitoring patient’s pulse, ECG rhythm, blood pressure (both continuous and intermittent basis), central venous pressure, respiratory rate and pattern etc. The unit is equipped with advanced ventilators containing different modes to support patient’s lung function in different scenario. Besides, the unit is also equipped with advanced haemodynamic monitors, airway adjuncts including fibreoptic bronchoscope, haemodialysis machine etc.  We have dedicated radiology, microbiology and pathology team helping us for better patient management. All the patient related data including laboratory and radiology reports, doctor’s assessment record, and old treatment document (both inpatient and outpatient) are available in our electronic hospital management system (HMS), so that investigation reports are available to the treating doctors without any unnecessary delay, all the data can be accessed from any place inside the hospital and no old data are lost during the treatment course.

Acute Pain Services

The Department of Anesthesiology, Pain and Perioperative Medicine has an active Acute Pain Service (APS) program that caters to all the surgical patients in the postoperative period. A multidisciplinary, nurse (acute pain Nurse) based, anaesthesiologist (consultant & fellows) supervised/ led model of APS (Acute Pain Service), involving all ward nurses (through an organized team approach) provide postoperative analgesia, regardless of the technique used. Acute pain team uses protocol-based management, which involves use of multimodal analgesia including thoracic epidural analgesia (TEA), patient-controlled analgesia (PCA), patient controlled epidural analgesia (PCEA) etc.

Chronic Pain Management

The Department runs a pain clinic for cancer patients. It facilitates evaluation, initial counseling for possible prospective methods of pain-relief, which include pharmacological, non-pharmacological or interventional. This pain may be due to direct tumour invasion of local tissues, metastatic bone pain, visceral obstruction, nerve compression and plexus invasion, ischaemia and inflammatory pain. The post pain-intervention care is responsibly supervised 24×7 by our APS-team.

Non-Operating Room Anaesthesia Services

Nonoperating room anesthaesia (NORA) refers to administration of sedation/anesthaesia outside the operating room to patients undergoing painful or uncomfortable procedures. Common procedures include diagnostic/ thearapeutic procedures in radiology i.e. MRI, CT, PET CT etc, gastrointestinal endoscopic procedures, radiotherapy, interventional radiological procedures in cath lab etc. Anaesthesiologists are frequently asked to provide NORA in these remote locations. We have state-of-the-art facility with anaesthesia machine and monitoring in every area (including MRI compatible machine & monitors) to provide safe anaesthesia to patients.

SPECIALTY CLINIC

We run dedicated anesthesia care delivery clinics with sub-specialty area experts. The following clinics serve the patients in the respective core areas:

1.Pre-Anaesthesia Checkup Clinic (PAC clinic):  Daily PAC Clinic goes on from 09:00 to 17:00 (08:00 hrs) keeping up to the timings of concurrently running surgical OPDs. Here all patients scheduled for surgery are assessed, optimized, counseled, preoperative advise given and consent is taken after thorough explanation and discussion regarding the perioperative plan.

2.Pain Clinic: We actively cater to the chronic pain patients on Saturdays and other days on SOS basis.

OBJECTIVES AND VISION

Overall, we aim to follow a set of serial-objectives that are intricately linked and have a prospective stepladder orientated growth projection. Current objectives are:

  1. Patient-oriented anesthesia services
  2. Newer approaches to consider and address difficult case-scenarios
  3. Bring down internal case-cancellation rate
  4. Active record keeping (anaesthesia-related morbidity, successfully managed critical cases)

The collective efforts towards objectives (as above) are likely to yield solid, inclusive and comprehensive sustainable mechanisms of anaesthesia-specific health care delivery. We aim to deliver consistently on clinical services as well remain sensitive to immediate/long-term need of surgical patient population coming to TMC Kolkata.

RESEARCH-RELATED ENDEAVORS

The Department of Anaesthesia, Critical Care & Pain in TMC has an inclusive clinical research development plan in place. Intensive clinical practice, thesis-oriented research, morbidity meets, active audit system and consultant-based innovative practices have formed the very basis from which research have emanated. In addition, our consultants get actively involved in subspecialty anaesthesiology conferences (National/International) as delegates/presenters (platform, poster)/invited faculty/ lectures).

The unit runs a successful postgraduate TMC fellowship program of 2 years’ duration, Indian College of Anaesthesia (ICA) accredited fellowship program for 1 year duration in onco-anaesthesia, critical care & pain, 1 year postgraduate TMC fellowship program in critical care.  Our Department also administers structured training OR-technicians, observers (anaesthesia, pain-relief services) and guest observes/fellows.

Our Department trains all senior and junior doctors of the hospital on “simulation-based Basic Life support training methods” Importantly, we also have orientation-program for disaster preparedness, infection control and handling mass-casualty situations.

Fellowship programs in Anaesthesia, Critical care & Pain

  • 2 year TMC fellowship in Oncoanaesthesia, Critical Care & Pain
  • 1 year ICA accredited fellowship in Oncoanaesthesia, Critical Care & Pain
  • 1 year TMC fellowship in Onco Critical Care

Palliative Care

The palliative care unit provides symptomatic management and end-of-life care for patients. A team of physicians, palliative care nurses, psychologists and social workers provide hospital based clinical care and emotional support for individuals who need the best of care and compassion.

Transfusion Medicine

Welcome to theTransfusion Medicine Department (Blood Bank) TATA Medical Center, home page. This site  provides information about the facilities available and services offered by the department.

Tata Medical Center(TMC), is one of the leading city hospitals and provides world-class cancer treatment. We have our own Blood Bank with the state-of-the-art facilities. The Blood Bank now operational for more than two years, provides quality blood products at nominal charges. This is one of the few NABH accredited Blood Banks in the country and hence high quality standards are practiced at all times.

At our center, the transfusion services are an integral component of treatment and management of cancer patients. The Blood Bank provides quality blood products to patients by using modern technology for blood collection, processing and testing.  Using modern technology, a single unit of blood donation is split into three to four different blood  components, which can be used for three-four patients. Many patients requiring blood transfusion, need modified blood products. The special needs of such patients is taken care of, by using sophisticated techniques (like blood irradiation and leuco-depletion) and other modern equipment. The department also has a Blood irradiator which modifies the blood products  (minimize adverse transfusion effects) and makes it suitable for immuno-compromised cancer patients. This equipment is the only such machine available in north eastern India.

The department has the following facilities –

  • Entire process  of blood collection, processing, testing and issue is undertaken using a computerized HMS software to ensure error free collection and processing.
  • All blood units are tested by highly sensitive testing protocols for infection markers. This ensures that only safe blood components are transfused.
  • Selective leuco-reduction facilities are also available.
  • To ensure efficiency and reduce the turn-around -time, blood components are transported through the Pneumatic tube system.
  • The department staff also participate in peripheral blood stem cell (PBSC) collection for bone marrow transplant patients.
  • The department has a Blood irradiator (BRIT) to modify the blood components and render them suitable for cancer and bone marrow transplant patients (immuno-compromised).
  • To meet the needs of multi-transfused cancer patients, in-house voluntary blood donation services are also offered.  A voluntary donor registry is maintained to facilitate availability of blood donors as and when required.
  • The department has facilities to provide:
    1. Apheresis (SDP) platelets
    2. Apheresis granulocytes
    3. Buffy coat granulocytes
    4. Donor lymphocyte infusion
    5. Autologous transfusion

NABH Accreditation

Soon after the Blood Bank was established, need for accreditation was felt to ensure that quality standards are practiced. In pursuance of the efforts of the staff along with support from the administration, the Blood Bank acquired the NABH accreditation in 2012. Ours is one of the few Blood Banks in the eastern region which is NABH accredited.

Academic activities

The department has intra and inter departmental academic activities. CME programs are held time to time to apprise the staff of the latest developments in the speciality. In addition the staff also participate in various academic activities organised by other hospitals in the region.

Team Members.

1.     Dr. Sabita Biswas  (Consultant and Head)
2.     Dr. Supriya Dhar  (Fellow, Dept of Transfusion Medicine)
3.     Dr. Suvro Sankha Datta (Fellow, Dept of Transfusion Medicine)

A team of 9 skilled technologists provide round the clock services.

Other Services

General Medicine
An in-house physician is available for general medical needs of patients where it impacts their diagnosis, pre-treatment assessments and ongoing cancer care. There is provision for investigations including ECG, pulmonary function tests, MUGA scan etc. for patient assessment.

Endoscopy
Comprehensive endoscopy facilities including head and neck endoscopy, gastrointestinal endoscopy as well as bronchoscopy are available for diagnostic and certain therapeutic procedures.

Dental Services
Dental care services are available for patients where the disease or treatment affects dental or oral health.

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