Spinal injuries is a specialist area and expert advice regarding
patients' care and ongoing management is limited outside of
specialist units. This problem is recognized by the Spinal Injuries
Association (SIA) whose response is set out in A Cliarterfor Support
(SIA, 1997).The Charter recommends that spinal injuries centres
provide a system of open access and ongoing support so that the welfare of individuals with SCI is maintained, and prevention,
and/or detection of problems, is addressed at an earlier stage in
order to reduce the chances of hospital admission (SIA, 1997).
Patient review is aimed at assessing the patient holistically.
This can include addressing a number of specific issues relating
to neurological dysfunction, such as bowel, bladder and sexual
dysfunction, as well as social and psychological issues. The
review is usually undertaken by a member ofthe medical team
(senior house officer (SHO) to consultant) although the
consultant's knowledge and experience within this field is
more extensive than the more junior medical staff. This fact
had become apparent to the nurses working on the spinal unit,
who often reported that patients visited the ward following their check-up to seek help and advice relating to specific care
issues from the more experienced nursing staff. When
challenged as to why they had not discussed this with the
doctor in clinic most reported that the junior doctor lacked
practical advice, or simply did not ask.
An inhouse audit carried out by the ward manager to
identify a profile of admissions and referrals revealed an
increasing number of patients lA'ere being referred for
admission to review or resolve specific issues associated with
skin, bladder and bowel problems. Unfortunately, a lack of
available beds on the unit often resulted in patients i^'aiting a
number of months before being admitted, which again resulted
in the development of more complications that sometimes
resulted in longer periods in hospital. This not only had
financial implications, but also often restricted the availability
of admission beds for newly-injured patients.
Spinal injuries is a specialist area and expert advice regardingpatients' care and ongoing management is limited outside ofspecialist units. This problem is recognized by the Spinal InjuriesAssociation (SIA) whose response is set out in A Cliarterfor Support(SIA, 1997).The Charter recommends that spinal injuries centresprovide a system of open access and ongoing support so that the welfare of individuals with SCI is maintained, and prevention,and/or detection of problems, is addressed at an earlier stage inorder to reduce the chances of hospital admission (SIA, 1997).Patient review is aimed at assessing the patient holistically.This can include addressing a number of specific issues relatingto neurological dysfunction, such as bowel, bladder and sexualdysfunction, as well as social and psychological issues. Thereview is usually undertaken by a member ofthe medical team(senior house officer (SHO) to consultant) although theconsultant's knowledge and experience within this field ismore extensive than the more junior medical staff. This facthad become apparent to the nurses working on the spinal unit,who often reported that patients visited the ward following their check-up to seek help and advice relating to specific careissues from the more experienced nursing staff. Whenchallenged as to why they had not discussed this with thedoctor in clinic most reported that the junior doctor lackedpractical advice, or simply did not ask.An inhouse audit carried out by the ward manager toidentify a profile of admissions and referrals revealed anincreasing number of patients lA'ere being referred foradmission to review or resolve specific issues associated withskin, bladder and bowel problems. Unfortunately, a lack ofavailable beds on the unit often resulted in patients i^'aiting anumber of months before being admitted, which again resultedin the development of more complications that sometimesresulted in longer periods in hospital. This not only hadfinancial implications, but also often restricted the availabilityof admission beds for newly-injured patients.
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