Glasgow Royal Infirmary
Hospital A&E Information
Five consultants in Emergency Medicine (4 wte) share the rota. Two consultants do have duties at the Western Infirmary and Stobhill Hospital. The consultants in Emergency Medicine have responsibility for the in-patient care of head injured patients who are usually cared for in 8 beds on an orthopaedic ward close to the Emergency Department. Of those admitted to this ward approximately 80% of head injured patients are discharged within 48 hours and 20% within one week. Occasional cases (1-2 per month) stay in for up to one month. (In times of high incidence there is the capacity to provide short stay observation in an orthopaedic ward). Those requiring to be in hospital for over 4 weeks get transferred to the Physical Disabilities Rehabilitation Unit (PDRU), Southern General Hospital if physical disability is the predominant feature; to the Central Scotland Brain Injury Rehabilitation Centre (CSBIRC) if cognitive or psychosocial problems are most prominent; or to a medical ward within GRI under the care of the receiving physicians from the day of admission. Prior to such transfers there is a case conference to inform the medical team and a Specialist Head Injury Nurse will follow them up whilst in the medical ward. There is also a social worker attached to the head injury team who also follows the patient into the medical ward and post discharge (described as Head Injury Throughcare Project).
With regard to the scenarios, individuals who are able to go home but have some persisting problems (Scenario A) are offered out-patient review in the department. In addition all discharge letters are sent to both the GP and to the CTCBI. Individuals requiring in-patient rehabilitation (scenario B) are referred to PDRU or CSBIRC as described above. There is good support from the liaison psychiatrist for the acutely behaviourally disturbed individual (scenario C) but patients are not transferred to a mental health facility. Additional nursing staff can be used but very rarely RMN staff. Chronic challenging behaviour cases (scenario D) are rare and help is sought from Scottish Neurobehavioural Rehabilitation Service (SNBRS).
Neurosurgical cases go to the Southern General Hospital and some are re-admitted to the head injury beds on the orthopaedic ward if necessary after which they follow the pathway described above.
Reviews, Plans and Strateigies
Joint strategies have been agreed between NHS Greater Glasgow & Clyde and the following local authorities.
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