===== Neurosurgery On-Call Protocol =====

==== ✅ 1. Standardized On-Call Report Structure ====

Every daily on-call report must include:

=== SURGERIES ===
  * **Patient ID / Age / Referring site**
  * **Diagnosis**
  * **Procedure performed**: technique, laterality, complications
  * **Immediate postoperative status**: GCS, imaging, drains, destination unit

=== ADMISSIONS ===
  * **Reason for admission and working diagnosis**
  * **Neurological exam and baseline status**
  * **Imaging findings**
  * **Clear clinical plan**: observation, scheduled surgery, pending decisions

=== NOT ADMITTED / REDIRECTED ===
  * **Precise clinical justification**
  * **Destination service and accepting physician** (name, department)

=== ICU / CRITICAL PATIENTS ===
  * **Relevant acute events** (e.g. mydriasis, ICP spikes, coma)
  * **Action taken**: medical/surgical response
  * **Follow-up plan**: re-evaluation, imaging, surgical reconsideration

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==== 🧠 2. Supervision and Responsibility ====
  * The **on-call neurosurgeon** must endorse all surgical and critical decisions.
  * **ICU and comatose patients** must be formally re-evaluated by neurosurgery daily.
  * The **on-call coordinator or senior consultant** reviews all reports within 48 hours.

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==== ⚙️ 3. Technical and Logistic Readiness ====
  * **Daily verification of essential devices**: valve programmers, external drains, shunts.
  * **Checklist for surgical readiness**: OR availability, drains, emergency CT access.
  * **Formal inter-hospital communication protocols** with nearby centers (e.g. Elche, Orihuela).

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==== 📊 4. Monthly Quality Review ====
  * Monthly audit of on-call reports by the head of department.
  * Identification of recurring issues: vague reports, unclear plans, protocol breaches.
  * Summary report sent to the medical director with key indicators:
    * Number of surgeries
    * Avoidable admissions
    * Incidents or adverse events