Outpatient Services is staffed by a Multidisciplinary Team who have expertise in the long term care of spinal cord injured patients. The Spinal Centre Outpatients Department offers outpatient clinics for the follow up of people who have sustained a spinal cord injury. Discharged patients are given their first appointment within 10 – 12 weeks from the date of their discharge. Following this review Outpatients are seen in review clinics 6 monthly, progressing to yearly, every 18 months or every 2 years, depending on their individual needs. Spinal centre outpatients are followed up for life. Some outpatients may opt not to be followed up by the Spinal Centre, in which case they are discharged from the Spinal Centre outpatient caseload and their GP is informed.
There are a range of specialist led general clinics as well as more specific focus clinics as follows:
Routine Review Clinics
At routine review clinics the following are assessed and reviewed: bladder, kidney function, bowel, skin, pain, spasm, sexual function/fertility, psycho- social, neurological status, contractures, autonomic dysreflexia, renal ultrasound, abdominal X-ray and functional abilities/changes.
The Pressure Clinic Service
At each attendance at review clinics, outpatients are offered an appointment in the Pressure Clinics. This ensures that seating continues to be assessed. If problems occur, further assessments can be arranged for the patient to attend the Pressure Clinics together with an outpatient physiotherapist/occupational therapist. The Pressure Clinic staff liaise with patients’ local ‘Wheelchair Service’ about seating assessments and cushion recommendations. Pressure mapping is carried out, when appropriate, to record interface seating pressures which enables cushion, seating and posture to be reviewed. In addition staff educate patients, relatives and carers about the development of pressure ulcers and how to prevent them. This is discussed in relation to seating, bladder and bowel management and activities of daily living. A telephone advice service is also available.
The Community Liaison Service
Patients are initially visited at their discharge address, home, nursing home or local hospital, usually 6 – 8 weeks following their discharge from the Spinal Centre. They may then be offered a second visit 6 months after the first, dependent on individual needs. The Community Liaison Nurses will cover all aspects of care related to the patients spinal cord injury i.e. bladder, bowels and skin care. They will refer the patient to other disciplines as necessary, either at the Spinal Centre or to other agencies. As part of the Community Liaison Service the Nurses run a Tissue Viability Service. This offers a holistic assessment of the patients’ needs and the team can advise about treatment options, including wound management, seating and mattress advice. The team link with the Local District Nurse, Tissue Viability Nurse and other healthcare professionals offering advice and support as appropriate. If the patient requires surgical intervention the team refer the patient to their Spinal Consultant who may suggest referring them to the Plastic Surgery Department via the patients GP. Community Liaison staff also address the cause(s) of the pressure ulcer and how the development of future ulcers can be prevented. Wherever possible the patient is followed up by the same nurse to ensure continuity of care.
Occupational Therapy Service
Services offered include wheelchairs and seating including manual or powered products, equipment to assist with everyday life, hand management and splinting, help and advice with ongoing equipment loan, driving/transport advice, work/training/leisure advice, change in function assessment, home visits and advice in regards to upper limb surgery.
Services offered include seating and posture, spasm management, standing advice and equipment, exercise programmes, change in function, gait assessment and review of orthotic requirements if provision or replacement is needed.
Respiratory Specialists provide telephone support to ventilated patients and their care teams or community staff about equipment, training and care, and other clinical issues. They are available for specialist spinal advice regarding respiratory problems following discharge from the Spinal Centre.
Posture Assessment Service
The Posture Assessment Service is held by Outpatient Physiotherapists and Occupational Therapists with input from the Rehabilitation Engineer and Medical Engineering as appropriate. Providing an in depth assessment of posture and seating equipment. The therapists liaise with Wheelchair Services to discuss provision of alternative equipment.
Sexual Function Clinics
Each Consultant offers sexual function appointments in their clinics. The appointments address assessment and management of erectile dysfunction and fertility, including retrieval of sperm.
Respiratory Outpatient Service
This service is staffed by the Respiratory Lead Consultant and the Respiratory Specialist Physiotherapist. Patients seen are those who have a tracheostomy, who are ventilated, or have other respiratory issues.
There are 2 clinics per week staffed by a Spinal Consultant, a Radiographer and an outpatient Nurse. Results of the test are discussed in the multidisciplinary urology meeting for further management plans.
Assessment and Management of Chronic Bowel Problems
Patients are referred to the Nurse Practitioner/Outpatient Staff Nurse. A holistic assessment is carried out identifying care needs, agreeing interventions and implementing an action plan to address the problems. Bowel diaries are kept for 2 weeks by the patient; these are sent to the Registered Nurse who can alter the bowel regime as necessary. Follow up continues until the problem is resolved.
Spinal X-ray Service
This is staffed by Radiographers who also provide radiography services to the Spinal Centres inpatients. The department is fully wheelchair accessible and staff are experts in the manual handling of patients. At a routine appointment the patients attend Spinal X-ray for a renal ultrasound and abdominal X-ray. The results are immediately available for the Consultant to review and compare with previous results.
Day Assessment Service
New outpatients who have not been through rehabilitation at the Spinal Centre are offered a Day Assessment appointment on referral. This consists of a joint appointment with a Spinal Consultant and an Outpatient Nurse, a Pressure Clinic appointment to assess their seating, a joint appointment with an Outpatient Physiotherapist and an Outpatient Occupational Therapist and an appointment for an ultrasound of the urinary tract and abdominal x-ray. Plans for further management are agreed with the patient at this appointment.
Telephone Advisory Service
This service is offered to outpatients, their relatives, carers, Community Nurses, General Practitioners, Wheelchair Services, Continence Nurses, staff in General Hospitals and Nursing Homes. Advice is given about all aspects relating to living with a spinal cord injury in the community and referrals are made as necessary. People can also be put in touch with external agencies such as the Spinal Injuries Association, Back Up etc.
Musculoskeletal Pain and Spasticity Service
Patients with musculoskeletal problems, pain and/or spasticity are reviewed by a Consultant and a Therapist (when appropriate). Problems are identified and managed appropriately to prevent complications.
Intrathecal Drug Delivery System (IDDS) Service
Patients who require intrathecal drug therapy are identified by carrying out a trial and by multidisciplinary assessment. Implantation of an IDDS, post-operative management and follow-up appointments for refills are a part of this service