Monklands Hospital, Airdrie
Hospital A&E Information
There are 4 A & E consultants (until very recently 3) who take responsibility for TBI patients. They have an observation ward, the Emergency Recovery Unit ( ERU) of 30 beds of which about 6 are used for TBI (although not ring fenced for the purpose).
Those patients not requiring neurosurgery or ITU admission remain in the ERU. Average stay is 2-3 days but may be as long as 2-3 weeks. Occasionally 'overflow' TBI cases will be transferred to an orthopaedic ward but remain the responsibility of the A & E consultants.
Neurosurgery is provided by the Southern General Hospital, Glasgow.
Patients returning after neurosurgery are admitted to the orthopaedic wards, principally one ward (ward 10) of three possible under the care of the orthopaedic surgeon.
In the event of a patient being discharged from A & E with any persisting cognitive or other impairment (scenario A) they are given an appointment for the Head Injury Clinic which is held fortnightly. They are given appointments within 4 weeks depending on need. Head injury warning forms are regularly given and Headway leaflets are available.
Patients requiring in-patient rehabilitation (scenario B) are referred to the Central Scotland Brain Injury Rehabilitation Centre (CSBIRC) and are generally seen and accepted quickly.
Acutely behaviourally disturbed patients (scenario C) are not usually seen by the liaison psychiatrist but by a psychiatry liaison nurse. It is possible to get increased nurse staffing (including Registered Mental Nurse trained staff although this is uncommon). Psychology input is very limited with long waiting lists.
Longer term challenging behaviour cases (scenario D) are usually discharged home with a care package. Our informant was unaware of the Scottish Neurobehavioural Rehabilitation Service (SNBRS).
Vegetative & minimally conscious state patients (scenario E) are rarely encountered and do not prove a problem.
An additional resource is a family and carer support worker who sees all families to provide advice and direct families to organisations such as Citizen s Advice Bureau, Headway and the Princes Royal Trust.
Hospital Post A&E InformationAs indicated above the A & E consultants provide this in the ERU. The exceptions are those returning from neurosurgery who are under the care of orthopaedic surgeons.
Reviews, Plans and StrateigiesThere are no specific plans for services for people with ABI. However, both local authorities have carried scoping work on ABI. North Lanarkshire council commissioned a review of brain injury services. South Lanarkshire Council undertook a Traumatic Brain Injury Service Development Project which review current services and identified gaps.
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