Dumfries & Galloway Royal Infirmary
Hospital A&E Information
Two A & E consultants are based at the hospital and provide acute assessment. Patients are observed for up to 4 hours and if requiring longer are transferred to a general surgical ward unless needing neurosurgical transfer or admission to ITU.
Those discharged from A & E are provided with an advice card regarding acute complications. Headway leaflets are available in the department but are not routinely given. However, not infrequently patients are seen in A & E 2-3 weeks after discharge, either by self-referral or via the GP if problems persist. They may have a repeat CT scan or be referred to the rehabilitation service. Patients are given the consultant's secretary's phone number so that they can arrange to be reviewed.
Neurosurgical services are provided in Edinburgh.
Hospital Post A&E Information
There are 6 general surgeons who admit head injured patients to one of two surgical wards. Some patients with concurrent orthopaedic problems might be admitted under orthopaedic surgeons or those with maxillofacial injuries to the maxillofacial ward where there is a single-handed consultant.
The majority of head injured patients are in for 1-3 days, occasionally as long as two weeks. Those requiring rehabilitation will be transferred to the rehabilitation ward (Ward 14) sometimes after a delay because of bed availability.
Patients with challenging behaviour (scenario C) are difficult to deal with and there is no specific contingency or liaison psychiatry support.
Hospital Rehabilitation Information
There is a general rehabilitation ward (Ward 14) with 23 beds. There are no "ring-fenced" neurological rehabilitation beds the ward taking elderly hip fractures and other diagnostic groups and sometimes accepting "boarders" from other departments. TBI patients are admitted from surgery at Dumfries & Galloway Royal Infirmary but also from neurosurgical units in Edinburgh, Glasgow and Newcastle if they are Dumfries and Galloway residents. A small number of Ayrshire patients are accommodated due to the lack of in-patient services in Ayrshire.
Multi-disciplinary rehabilitation is provided including neuropsychology. Medical follow up is provided to those discharged from Ward 14 and all TBI patients are referred to Headway.
The typical length of stay is 1-2 months. In a few cases there has been a prolonged stay of more than one year.
There is no provision for extra nursing to deal with behaviourally disturbed patients (scenario C). Occasional patients are transferred to psychiatric care and advice and occasional transfer is arranged with the Scottish Neurobehavioural Rehabilitation Service (SNBRS). The number in both these cases is very small.
Those in a vegetative or minimally conscious state (scenario E) would be referred to and transferred to Allanbank, a private provider of continuing NHS care.
There is a community ABI meeting held monthly to discuss and arrange services to discharged patients.
Reviews, Plans and Strateigies
There are no specific plans for services for people with ABI, however services to people with a disability, including those with ABI, are referred to in the joint community care plan for 2008-9. These are aimed at achieving more integrated and sustainable services.
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