Crosshouse Hospital, Kilmarnock
Serves a population of approximately 220,000 - North & East Ayrshire.
Hospital A&E Information
There are 4.5 whole time equivalent (wte) A & E consultants with 24 hours middle grade and junior medical staffing. Head injured patients are admitted to the A & E short stay ward for observation and management. This is usually an overnight period with most younger patients being admitted in the evening or during the night. In the great majority of cases length of stay is 24 hours or less with occasional stays of up to 3 days. Those requiring more than 24 hours are usually transferred to a surgical ward. Elderly patients with head injuries are often admitted during the day and discharged home with rapid response team support.
Discharged patients are provided with information about possible complications as described in SIGN Guideline 46 but not covering cognitive disorder. Some are advised verbally to contact the local Headway group. There is no routine out-patient follow up.
Those identified as having alcohol problems are referred to the Alcohol Liaison Nurse or Psychiatric Liaison Nurse during their stay in the short stay ward.
Neurosurgical liaison is with the Southern General Hospital, Glasgow.
Routine data is collected on head injury admissions.
Hospital Post A&E Information
Those patients not transferring for neurosurgery are admitted under the care of one of 7 general surgeons to the ITU, HDU or surgical wards. Occasionally they may go to medical wards if a surgical bed is unavailable.
The general surgeon on call on the day of admission is given consultant responsibility for the patient whether they are in the ITU, HDU or the wards and when the patients are returned after neurosurgical admission to Glasgow.
If an individual is fit for discharge but has some ongoing cognitive or neurological impairment (Scenario A) they would be referred to the neurologist. Some cases would be referred to Headway.
The acutely behaviourally disturbed patient (Scenario C) is usually managed with existing staff as difficulties can arise in providing additional staffing. Such staff, when available are not Registered Mental Nurses (RMNs). Liaison psychiatry is available but not readily and the informant could not recall any case being transferred to a mental health facility. The same circumstances apply to those with persisting challenging behaviour (Scenario D). One such case was referred to the Scottish Neurobehavioural Rehabilitation Service (SNBRS) in Edinburgh but the family took him home while awaiting a place.
Those patients requiring rehabilitation (Scenario B) are referred to Scottish Brain Injury Rehabilitation Service (SBIRS) or occasionally to the medical wards depending upon the nature of their disability and their age. Patients have access to generic allied health professionals but this resource is limited. A number of disabled patients remain in surgical wards for months, exceptionally as long as two years.
Patients in a vegetative or minimally conscious state (Scenario E) or with severe disability remain in the ward until placed in a nursing home. This is a very limited resource for the continuing care of young people in Ayrshire.
Reviews, Plans and Strateigies
A review of services for people with brain injuries to inform future planning and strategic issues was carried out in 1998. There are no current specific plans for acquired brain injury services.
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