Borders General Hospital, Melrose

Hospital A&E Information

A & E services are provided by 4 orthopaedic surgeons. From November 2008, A & E services will be led by one Consultant in Emergency Medicine. There is no observation ward. Patients requiring admission are admitted under the care of general surgeons principally to surgical wards 7 & 8. CT scanning is available and liaison is with neurosurgery at the Western General Hospital, Edinburgh.

Patients are provided with information leaflets based on SIGN 46 format. There is no specific reference to longer term complications and no routine follow up.

Routine data is collected and in the year 2007 there were 866 attendances recorded.

Hospital Post A&E Information

Five general surgeons have the rota for in-patient care of TBI cases, most of whom are admitted to ward 7. Most patients are in for less than 24 hours. Small numbers of younger patients are admitted for a few days or weeks. Longer stays tend to occur in older patients. Quite often elderly patients (e.g. those on clopidogrel) are not accepted for neurosurgery and are managed conservatively in the surgical ward. Patients with mixed cognitive and physical problems (scenario B) may be admitted to the stroke unit (Ward12) under the care of a physician and rehabilitation team. This usually relates to older patients. Occasional patients are referred to the Scottish Brain Injury Rehabilitation Service (SBIRS).

Acute behavioural problems (scenario C) in Ward 7, especially in elderly patients, is a relatively common occurrence and difficulties occur in getting extra nursing -Registered Mental Nurses (RMN's) or otherwise. The same circumstances apply to those in Ward 12. Liaison psychiatry is available to give advice but often after a delay. Patients are not transferred to a mental health facility.

Ward 12 has referred one case fitting scenario D to the Scottish Neurobehavioural Rehabilitation Service (SNBRS).

Patients with severe disability including those in a vegetative/minimally conscious state (scenario E) would be transferred from ITU to Ward 12.

Reviews, Plans and Strateigies

There are no specific plans for acquired brain injury services.

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