Falkirk & District Royal Infirmary and Stirling Royal Infirmary

Hospital A&E Information

Stirling Royal Infirmary (SRI) and Falkirk District Hospital (FDRI) have A & E departments. All cases of traumatic brain injury requiring imaging are sent to SRI. There are 5 (4.9 wte) consultants in A&E. Patients requiring observations are admitted to the orthopaedics wards (usually ward 28) or occasionally elsewhere. They are under the consultant charge of the general surgeon on call, not the consultant orthopaedic surgeon (7 surgeons and 1 rehabilitation medicine consultant comprise the rota). The middle grade orthopaedic medical staff and orthopaedic nurses are involved in the patient's care.

Those individuals requiring neurosurgical care are referred to Edinburgh (unless a Glasgow resident). Those discharged directly from A&E are provided with written information.

Hospital Post A&E Information

People admitted to ward 28 (or other surgical wards) for observation are reviewed the following day and may remain for a few days or transfer to rehabilitation at Ward 14, FDRI or to a general surgical ward.

Similarly those returning from neurosurgery at the WGH are transferred to ward 14 FDRI or a surgical ward. A small percentage of such patients are admitted to SBIRS for rehabilitation.

Hospital Rehabilitation Information

In-patient rehabilitation

Since November 2006 there have been 8 beds designated for neurological rehabilitation in a 28 bed ward (ward 14) at FDRI. These 8 beds are available for ABI cases but are not protected/ring fenced for the purpose [indeed at the time of our visit, July 2007, the ward was being closed for three months for fiscal reasons]. Patients may be referred from a number of services: orthopaedic, general surgery, neurosurgery, and SBIRS.

There is a consultant in rehabilitation medicine and part-time/sessional commitments from AHPs (occupational therapists, physiotherapists, and speech & language therapists) but no neuropsychology input and AHP staff work on a rotational basis.

Patients are admitted within days to weeks of injury and average length of stay is of the order of 2 months (it is not possible to provide a true average length of stay as the unit has only been active for 8 months).

The unit is designed principally to address the needs of individuals with a mixture of cognitive and physical problems after TBI (scenario B). If a patient is acutely behaviourally disturbed in the rehabilitation or surgical ward the duty psychiatrist might be called but it would be unlikely that the patient be transferred to a mental health facility. Extra nursing would be used and could be a registered mental health trained nurse (RMN). The surgeon would be unlikely to section the patient while this is done in the rehabilitation unit if required.

Most persisting challenging behaviour would be referred to SNBRS. Vegetative or minimally conscious state patients are uncommon and the informant had little experience of such cases. They would be referred to Marchglen care home or a nursing home.

Out-patient rehabilitation

There is a well established Area Rehabilitation Team directed at those aged 16 to 65 years with neurological problems including ABI. Team comprises consultant, associate medical specialist, 5 occupational therapists, 4 physiotherapists, 2 part-time speech & language therapists, 2 nurses, 0.5 psychologists, 5 rehabilitation assistants. It provides an area wide service and estimate 5% of cases are TBI or approximately 15 cases per year. Contact with patient is not for a fixed period and probably averages about 1 year.

Reviews, Plans and Strateigies

There are no specific plans for services for people with ABI however; there are action points in joint community care plans which relate to ABI and there is ABI joint agency planning group.

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