Perth Royal Infirmary
Hospital A&E Information
Six consultants share responsibility for A & E departments in Ninewells Hospital, Dundee and Perth Royal Infirmary (PRI).
Hospital Post A&E Information
A specialist registrar or consultant provides input to the A & E unit at PRI on a 9-5 basis on weekdays. A bypass protocol operates so that patients requiring intubation/ventilation or neurosurgery are transferred directly to Ninewells. Others requiring observation are admitted under the care of the general surgeons to the acute receiving unit (Ward 4). The average length of stay is less than 24 hours with maximum stay of about 4 to 5 days. Those requiring longer stay would be transferred to general surgery (Ward 1) and are often referred to the neurorehabilitation service.
Patients discharged with some on-going problems are referred to the GP with the advice to arrange follow-up with the neurorehabilitation service. Acute behavioural problems can usually be managed by existing staff and there is a liaison psychiatry service available but rarely used.
Hospital Rehabilitation Information
A single handed consultant is responsible for the 16 bed neurorehabilitation unit (Royal Victoria Hospital) for patients aged 16-65 (with some flexibility at the older age). TBI accounts for almost 30% of admissions the great majority of whom come from the neurosurgical unit. A small number of patients are from north Fife or lower Grampian.
Referrals are seen within a week and usually admitted within a week of acceptance. Average length of stay is 4-5 months with occasional cases being in for around a month or over a year.
The rehabilitation team includes 3 physiotherapists, 2.7 occupational therapists, 2 speech & language therapists, 1 neuropsychologist, 1 clinical artist, 3 technical instructors. 0.5 dieticians, an junior doctor and nursing staff. After a period of rehabilitation some patients are discharged to Seven Arches Nursing Home (part of south Grange nursing home) where ongoing physiotherapy and a form of slow stream rehabilitation is available. Others are discharged home, often with planned support packages.
Acutely behaviourally disturbed patients (scenario C) would not be admitted. If a new pattern of this nature arises liaison psychiatry support is available and transfer to a psychiatric unit is possible. Persisting challenging behaviour (scenario D) is rare but referral to the Scottish Neurobehavioural Rehabilitation Service (SNBRS) would be made.
People in a vegetative or minimally conscious state (scenario E) are not taken into the unit but the consultant will advise in the neurosurgical unit.
The service also provides medical, neuropsychology and social work follow up clinics for those discharged from the unit and new referrals from primary care.
Reviews, Plans and StrateigiesWork on the redesign of the brain injury rehabilitation service is underway in Tayside.
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