Aberdeen Royal Infirmary
Hospital A&E Information
There are 7 consultants (5 full time and 2 half time) with 2 more to be appointed in the near future. There is an observation ward where TBI cases are admitted. The majority have a length of stay of less than 24 hours. The unit operates with a planned length of stay of less than 48 hours but occasionally patients remain for up to a week.
The neurosurgical service is very responsive and rapid transfer is possible. Those requiring extended observation are transferred to the neurosurgical ward.
Those discharged from A & E are provided with information leaflets. There is no routine follow up of TBI but a liberal policy for admission operates.
Hospital Post A&E Information
Four neurosurgeons provide post-acute care of TBI case transferred from the A & E observation ward.
The neurosurgical service covers Grampian, Highland and the Northern Isles with occasional cases from the Western Isles (most of which go to Glasgow).
Many patients are in for short periods (e.g. 24 hours) for observation but some wait longer prior to transfer for rehabilitation or if not considered appropriate for rehabilitation, may remain for as long as 3 months often due to difficulties with finding appropriate accommodation or care packages. It can sometimes prove difficult to repatriate patients to other health board areas.
There is a weekly case conference which the consultant in rehabilitation medicine attends and patients requiring rehabilitation (Scenario B) are discussed. In the event of acute behavioural disturbance (scenario C) on the neurosurgical unit, liaison psychiatry provide useful advice on management but patients are very rarely transferred to a psychiatry unit. Very occasionally patients with persisting challenging behaviour (Scenario D) will be transferred to the Scottish Neurobehavioural Rehabilitation Service (SNBRS).
Individuals in a vegetative/minimally conscious state (Scenario E) may be transferred to long term stay beds at Woodend Hospital but otherwise would wait for a nursing home place which could take months. A post-acute rehabilitation unit for people with brain injury is being established at the Tor-na-Dee care centre, the site of a former convalescence hospital.
Hospital Rehabilitation Information
Two of the three consultants in rehabilitation medicine provide rehabilitation for brain injured patients at the Maidencraig Unit, Woodend Hospital. The main source of in-patient TBI referrals is neurosurgery at ARI with occasional referrals from GPs and very occasionally from orthopaedic or general surgeons. A consultant attends the neurosurgical conference each week. Most patients are seen within one week of referral and transfer depends on bed availability but is usually within 1 to 3 weeks of acceptance. The average length of stay is of the order of 2 months.
Maidencraig Unit has 16 rehabilitation beds. In the event of a patient showing acute behavioural disturbances (scenario C) the liaison psychiatrist and/or neuropsychologist would advise. If sectioning proves necessary the patient might be moved to Dunnottor Ward, Royal Cornhill Hospital. There is no real capacity to increase nursing levels to deal with acute behavioural problems. Neuropsychology is regularly involved in assessment of capacity and often involved in discharge planning of more complex patients with behavioural disturbance. Referrals to the SNBRS are infrequent. Similarly, exceptional cases might be referred to the Scottish Brain Injury Rehabilitation Service (SBIRS) at the Astley Ainslie Hospital for a second opinion.
The neuropsychology department sees both in and outpatients, as well as making home visits and visits to community hospitals and to Dr Grays Hospital in Elgin.
Patients are generally followed up at least for one year in the out patient clinic and some are referred to other services such as Horizons and Momentum.
Reviews, Plans and Strateigies
There is a wide range of activity in Grampian related to the development of brain injury services. The report Brain Injury - a call for action 2003 by the Joint Future Brain Injury Group assessed current provision and identified gaps in services.
The Grampian Brain Injury Strategy 2004-2010 was agreed in 2005.
Joint future Brain Injury (phase 1) audit 2006 examined current working practice and explored was of improving services within current resources for Aberdeen City. NHS Grampian has formal planning arrangements for brain injury with Local authorities in Moray and Aberdeen City and arrangements are being discussed with Aberdeenshire. Proposals are also being developed for a Grampian-wide managed Care Network for brain injury.
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