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Outpatient Services at the Duke of Cornwall Spinal Treatment Centre
Mission Statement
The Spinal Centre specialises in the total management of patients paralysed following spinal cord injury or non-progressive spinal cord disease. This will include ongoing advice and follow up to meet the changing needs of the patient.
We have a multidisciplinary approach to enable the individual to optimise their physical and psychological ability to achieve independence appropriate to their level of disability, taking into account values, choice and the social situation of the individual, their families and carers.
Outpatient Staff
A multidisciplinary team who are experts in the long term care of people with a spinal cord lesion.
3 Consultants
1 Associate Specialist
1 Urologist
3 Medical Secretaries
1 Nurse Specialist – Outpatient Services
1 Community Liaison Sister
1 Community Liaison Charge Nurse
1 Outpatient Sister
1 Technician
1 Senior Health Care Support Worker
1 Senior Physiotherapist
1 Senior Occupational Therapist
Spinal Radiographers
Links to other specialist areas within the Trust
| Plastic Surgery | Gynaecology |
| Burns Unit | Medical Physics |
| Fertility Services | Medical Engineering |
| Gastroenterology | Speech and Language Therapy |
Catchment Area
The area that the Outpatient Services provide a service to is the south and south west of England, as far as Cornwall, east to Kent, the whole of the south coast, as far north as Gloucester, and including the Channel Islands and the Isle of Wight.
Caseload
Following discharge from hospital the patient is followed-up by the Spinal Centre Outpatient Team for life. Consequently the caseload increases each year. The current number of outpatients is in excess of 2500.
Referrals to the Outpatient Team
Referrals will only be accepted if the person with the spinal cord lesion is under the care of one of the Spinal Consultants. If this is not the case the person’s General Practitioner is able to refer them to one of the Spinal Consultants. Once the person is part of the Centre’s caseload they have access to the majority of the Outpatient Services provided by the Outpatient Team.
Referrals to each service will then be accepted from patients, relatives, carers, General Practitioners, Community Nurses, Community Occupational Therapists, Community Physiotherapists, Continence Specialists, other Trust staff, District General Hospitals, and Nursing Homes.
Outpatient Services
- Routine Outpatient Clinics
- The Pressure Clinic service
- The Community Liaison service
- Occupational Therapy service
- Physiotherapy service
- Urology Outpatient Clinics
- Sexual Function Clinics
- Video-urodynamic Clinics
- Telephone advisory service
- Assessment and management of chronic bowel problems
- Tissue Viability service
- Posture Assessment service
- Pre-admission clinics (for major surgery)
- Spinal X-ray service
- Day Assessment Service
- Information services: leaflets, fact sheets, guidelines for outpatients, their relatives/carers, and external agencies
- Outpatient Contacts register
- Liaising with District Nurses, Care agencies, Wheelchair Services, Community Occupational Therapists, Community Physiotherapists, Continence Nurses, Tissue Viability Nurses, Stoma Nurses, Staff within the Trust and at other Trusts, General Practitioners
Telephone Advisory Service
This service is offered to outpatients, their relatives, carers, Community Nurses, General Practitioners, Wheelchair Services, Continence Nurses, staff within District 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 to colleagues as necessary. People telephoning for advice can also be put in contact with external agencies such as The Spinal Injuries Association (S.I.A.). The outpatient staff have many years of spinal cord injury knowledge and several have specialist areas of knowledge. (To ensure the correct staff member is contacted refer to Appendix 1).
Information Services
The Pressure Clinic holds a number of patient information leaflets, in particular about bladder and bowel management, urological operations, video-urodynamics, cushions, mobilising times, travel advice etc. In addition copies of protocols and guidelines are kept ready to send out on request.
Routine Outpatient Clinics
Each Consultant holds one routine outpatient clinic per week, assisted by outpatient nurses. Patients are seen at 10/12 weeks after their initial discharge from the Spinal Centre. They are then seen 6 monthly, progressing to yearly, every 18 months or every 2 years for life. Each clinic has an ‘emergency appointment’ available for outpatients who are unable, due to medical reasons, to wait until their routine appointment date.
The routine clinic appointment is of a holistic nature and the following are reviewed/carried out:
- Bladder/kidney function
- Bowel
- Skin
- Pain
- Spasm
- Sexual function/fertility
- Psycho-social
- Neurological status
- Assessment/treatment of contractures
- Autonomic dysreflexia
- Renal ultrasound
- Abdominal x-ray
- Functional abilities/changes
- Onward referral e.g. to Plastics, Gastroenterology
The Consultant writes to the patient’s General Practitioner following the review. The Consultant may also refer to other outpatient services within the Centre, e.g. to Community Liaison for a follow-up visit to the patient’s home, to the Pressure Clinic staff, Posture Clinic, Video-urodynamics, or the Therapy Team.
Spinal X-ray Department
This is staffed by Radiographers who also provide radiography services to the Spinal Centre’s inpatient caseload. The department is fully wheelchair accessible and the staff are expert in the manual handling of spinal patients onto the x-ray table using various types of equipment. At a patient’s routine outpatient appointment they attend Spinal x-ray for a renal ultrasound and abdominal x-ray. The results of these are immediately available for the Consultant to review and compare with previous scans and x-rays when he sees the patient later that day. In addition any presenting problems can be addressed when the Consultant sees the patient in clinic e.g. a suspected fractured limb can be x-rayed on the same day.
The Pressure Clinic
This is staffed by a Technician, a Senior HCSW, Outpatient Sister or the Nurse Specialist (Outpatient Clinic Nurses). Patients are seen whilst they are staying in the Spinal Centre, when they are outpatients at each routine clinic appointment, and during other times of the year on request.
Staff assess the patient’s seating needs in relation to pressure ulcer prevention at each appointment. Patients are accurately weighed using industrial wheelchair accessible weighing scales. Interface seating pressures are recorded enabling cushion, seating and posture to be reviewed. This ensures that seating continues to be assessed and evaluated throughout the patient’s life. Contact is maintained with the patient’s Wheelchair Service by letter or telephone. If problems are identified, further seating assessments can be arranged for patients to attend the Pressure Clinic, or a Posture Assessment can be arranged with the Therapy Team where appropriate.
In addition staff educate patients, relatives/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. The staff also offer telephone advice, see ‘Telephone Advisory service’.
Community Liaison
There are 2 senior registered nurses experienced in the field of spinal cord injury based at the Spinal Centre. They provide good links for community staff to the Spinal Centre’s staff and resources.
Service Offered
- They can visit outpatients in their own homes, at work, in a local hospital or a nursing home
- They are able to give advice, information and support to outpatients, their relatives, carers and also to community health care professionals involved with the individual
- Telephone advice: see ‘Telephone Advisory Service’
Visits
- Visits are made to any outpatient, on referral, and who is under the care of a Spinal Consultant, depending on the distance from the Spinal Centre
- All patients receive an initial visit at approximately 6-8 weeks following discharge, unless they live over 100 miles from the Centre. In this case the patient will be visited when a Community Liaison nurse is next in that area. Specific dates are identified at the beginning of each year.
- They can also meet up with community health care professionals involved in the outpatient’s long-term care either at the patient’s home or at the Health Centre
- Subsequent visits are made from referrals
- Referrals can be made by the outpatients, their relatives/carers, community staff, General Practitioners, other members of the Spinal Centre Outpatient Team
- Visits address specific aspects of spinal injury care such as tissue viability issues, bladder and bowel management
Outpatient Occupational Therapy Service
There are two part time Occupational Therapists that make up a whole time equivalent. A referral can be made to this service provided the spinal cord injured patient is under the care of one of the Spinal Consultants. An individual can self refer as well as Community Occupational Therapists (or other community based staff), and other members of the Out patient Team.
Services offered:
- Wheelchairs and seating: address difficulties or queries about wheelchair and seating equipment including manual or powered products. The staff are able to work with the patient and a wheelchair representative to take a specification for a new wheelchair (in liaison with the patient’s local Wheelchair Service)
- Equipment: assist with identifying new or replacement specialist equipment such as manual handling and showering products, helping, where appropriate, to identify possible sources of funding
- Hand management and splinting: advice about exercises and/or equipment, with the provision (where necessary) of straps or splints
- Surgical procedures: advice and help with ongoing short term equipment loan and care requirements for patients that are to have surgery which will affect their ability to be independent for a few weeks post surgery. Liaising with the patient’s local community staff
- Driving/transport: advice and information about returning to driving or finding a suitable vehicle
- Work/training/leisure: advice and information about returning to work, considering employment, training or a new leisure pursuit. See Employment and Training Clinic
- Change in function: assessment of problems associated with a change in function due to ageing e.g. difficulty with transfers, or deterioration in mobility
- Home visits: visits to the patient’s home with another outpatient colleague (as appropriate)
- Upper limb surgery: advice and information for patients with tetraplegia about upper limb surgery, and referral onward to the ‘tendon transfer’ team. See Tendon Transfer Service.
- Telephone advice: see ‘Telephone Advisory Service’
Outpatient Physiotherapy Service
There are two part-time Physiotherapists running this service. Any patient under the care of one of the Spinal Centre Consultants can be referred to the Outpatient Physiotherapy team. Referrals are accepted from Spinal Centre and community staff, as well as staff from other hospitals. Patients can also self-refer.
Areas addressed by this service:
- Seating and posture: this is an assessment service. Please see ‘Posture Clinic’.
- Spasm management: assessment and advice regarding spasm control.
- Standing: advice and information regarding standing equipment and regimes.
- Exercise programmes: assessment and advice regarding suitable home exercises.
- Change in function: for example, difficulty with transfers, wheelchair propulsion, or walking.
- Gait assessment: advice regarding exercises and/or equipment to improve gait.
- Orthotic service: review of orthotic requirements, for example, provision/replacement of foot-drop splints and braces.
- Home visits: visits can be made to a patients’ home where this is deemed appropriate. The visit may be made jointly with other spinal centre or community staff.
- Physiotherapy needs: once identified, these are referred on to the patients’ local service where possible. Spinal Centre physiotherapists liaise with local physiotherapists regarding the requirements of individual patients and provide guidance and follow-up assessment where required.
- Outpatient physiotherapy treatment: patients may be offered a limited period of inpatient or outpatient physiotherapy at the Spinal Centre by the Outpatient Physiotherapists should local services not be available.
- Botulinum toxin: should the physiotherapist feel botox might be indicated, they will liaise with the Spinal Consultant.
Posture Assessment Clinic
Held by the Outpatient Therapists with input from the Outpatient Technician and Medical Engineering as appropriate. An appointment at this clinic involves an in-depth assessment of the patient’s posture and current seating equipment. The Therapist liaises with the patient’s local Wheelchair Service to discuss provision of alternative equipment.
Employment and Training Clinic
An Employment and Training Clinic runs once every 6 weeks. This service is available to inpatients and outpatients. The clinic is designed to be a forum for information and advice regarding all aspects of employment and training. A Senior Occupational Therapist (who co-ordinates the service) and a Disability Employment Advisor see each patient attending the clinic. The patient may also be seen by an Employment Advisor from The Spinal Injuries Association.
Tendon Transfer Service
The Spinal Centre offers assessments to patients with tetraplegia who may benefit from upper limb reconstructive surgery to improve arm and hand function. There is a separate multidisciplinary team involved with this service. Referral to this service is made by the patient’s Spinal Consultant.
Sexual Function Clinics
Each Consultant holds one clinic per month. Referrals to these clinics should be made via the Consultants’ secretaries, and can be made by any of the Consultants’ colleagues within the multidisciplinary team, by patients, or by General Practitioners.
Issues addressed at these clinics are:
- Assessment of erection
- Treatment of erectile dysfunction (intracavernosal injection, oral medication such as Viagra, vacuum pumps)
- Fertility
- Means of collecting sperm specimens
Urology Clinics
These are held by a Consultant urologist on a weekly basis. Referrals are made by the Spinal Consultants and other members of the multidisciplinary team. Patients are discussed at a weekly meeting between the Spinal Consultants and the Urologist. Routine and specialist urological procedures, such as Mitrofanoff, Clam Cystoplasty, insertion of suprapubic catheter, are available to patients within the Centre and to Outpatients, following consultation with the Urologist. Patients requiring major urological procedures may need to be readmitted to the Spinal Centre. The first change of a suprapubic catheter is carried out at the Centre by the Clinical Nurse Specialist.
Video-urodynamic Clinics
There are 2 clinics per week, staffed by a Spinal Consultant or Associate Specialist, a Radiographer, and an Outpatient Clinic nurse. Referrals are made by the Spinal Consultants, Associate Specialist, the Consultant Urologist, and from other members of the Outpatient Team. Following the procedure the Spinal Consultant writes to the patient’s General Practitioner. Patients’ urodynamic results are discussed with the Consultant Urologist, as necessary and patients are referred to him for follow-up if appropriate.
Assessment and management of chronic bowel problems
Patients who are experiencing chronic bowel problems are referred to the Nurse Specialist or to the Outpatint Sister. Referrals are made by the patient’s Spinal Consultant, the Community Liaison nurses, Outpatient Clinic nurses, Outpatient Therapists, patients, relatives, carers, Community Nurses, and General Practitioners.
A holistic assessment of the problem is carried out with the patient, identifying care needs, agreeing possible interventions and implementing an action plan to address the problems. The patient completes bowel diaries for up to 2 weeks at a time. These are then posted to the Nurse Specialist or Outpatient Sister, who maintains telephone contact with the patient, altering the bowel regime as necessary. Follow-up continues until the problem is resolved, or referred onwards, e.g. back to the Spinal Consultant for referral to a Gastroenterologist. Some patients may need to be readmitted to the Spinal Centre for surgical procedures such as a colostomy.
Intrathecal Top - up Clinics
These clinics are held by the Associate Specialist who sees patients who have an implanted intrathecal pump to deliver medication for spasm and/or pain control. Clinic appointments enable ongoing assessment and follow-up as to the efficacy of the medication and the dose. The pump is refilled by the associate specialist, altering the dosage accordingly. He is assisted by an outpatient nurse.
Pre-admission Clinic
All patients who are considering an operation that will result in a stoma are seen at the ‘Pre-admission Clinic. They are seen by the Nurse Specialist and the Stoma Care Sister, the Occupational Therapist (if appropriate), and the Clinical Psychologist.
Tissue Viability Service
The Community Liaison service offers a holistic assessment of the patient’s needs, and can advise about treatment options, including wound management, seating and mattress advice. The Community Liaison nurses link up with the local District Nurses and Tissue Viability Nurses, offering advice and support as appropriate. If the patient requires surgical treatment of their pressure ulcer, the Liaison nurse refers the patient back to their Spinal Consultant, who will then refer the patient to the Salisbury Plastic Surgery Department. Some patients may be readmitted to the Spinal Centre for conservative or surgical treatment
Outpatient Contacts Register
A database of spinal outpatient’s who have undergone various surgical procedures is updated regularly to enable other outpatient considering surgery to contact them.
Day Assessment Appointments
New outpatients who have not been through rehabilitation at the Spinal Centre are offered a Day Assessment appointment on referral. This consists of the patient having a joint appointment with a Spinal Consultant and an Outpatient Clinic Nurse, a Pressure Clinic appointment to assess their seating, a joint appointment with an Outpatient Physiotherapist and an Outpatient Occupational Therapist, and an appointment at the Spinal X-ray department for a renal ultrasound and an abdominal x-ray. Plans for further intervention are agreed with the patient during this appointment.
Community Study Days
These study days are held several times a year and are available for community nurses, therapists, continence nurses, private carers, and agency staff to attend. The study days are held at Salisbury District Hospital and address all aspects about caring for a person living in the community with a spinal cord injury. It is possible to hold this study day away from Salisbury, for those areas over 100 miles away. For details contact the Outpatient Secretary (Appendix 1).
Bowel Care for Patients with a Spinal Cord Injury
3-4 study days are held each year. The purpose of the study day is to provide knowledge and skills to healthcare professionals to enable them to appropriately and safely provide bowel care to spinal cord injured people.
APPENDIX 1
OUTPATIENT CONTACTS
The outpatient service consists of senior experienced staff. Each member of staff has different areas of expertise and can offer advice and support.
In the first instance please consult your District Nurse / GP.
If you need specific advice please consult the contact names and numbers below. This will enable you to utilise the most appropriate services offered by the outpatient team.
| INDEX | NAME | TELEPHONE NUMBER |
|---|---|---|
| BLADDER | ||
| Catheter Issues | Wendy Slater or Pressure Clinic | 01722 429291 |
| Condom Issues | Wendy Slater or Pressure Clinic | 01722 429291 |
| Infections | Wendy Slater or Pressure Clinic | 01722 429291 |
| Operations | Wendy Slater | 01722 429291 |
| SPC changes (1st plus problems) | Wendy Slater | 01722 429291 |
| VUD bookings | Pressure Clinic | 01722 429291 |
| BOWELS | ||
| Altered Bowel Function (problems) | Wendy Slater | 01722 429291 |
| Individual District Nurse issues | Community Liaison | 01722 429130 |
| Operations | Wendy Slater | 01722 429291 |
| Training issues (District Nurse / Carers) | Wendy Slater | 01722 429291 |
| EQUIPMENT | ||
| Beds | Community Liaison | 01722 429130 |
| Cushions | Pressure Clinic | 01722 429291 |
| Hoists / transfer aids | Occupational Therapy | 01722 425083 |
| Mattresses | Community Liaison | 01722 429130 |
| Wheelchairs | Occupational Therapy | 01722 425083 |
| SEXUAL FUNCTION | ||
| Sexual function advice | Pressure Clinic | 01722 429291 |
| Sexual function-aids and equipment | Pressure Clinic | 01722 429291 |
| SKIN | ||
| Autonomic Dysreflexia (ongoing problems) | Pressure Clinic or Community Liaison | 01722 429291/429130 |
| Broken skin / pressure ulcers | Community Liaison | 01722 429130 |
| Burns, scalds | Community Liaison | 01722 429130 |
| General skin marking | Pressure Clinic | 01722 429291 |
| Marking from cushion | Pressure Clinic | 01722 429291 |
| Marking from mattress | Community Liaison | 01722 429130 |
| Operations | Community Liaison | 01722 429130 |
| THERAPY ISSUES | ||
| Access to property / facilities within property | Occupational Therapy | 01722 425083 |
| Chest Infections | Physiotherapy | 01722 429339 |
| Driving | Occupational Therapy | 01722 425083 |
| Employment / Leisure | Occupational Therapy | 01722 425083 |
| Fractures | Pressure Clinic | 01722 425083 |
| Home exercises | Physiotherapy | 01722 429339 |
| Posture | Physiotherapy or Nichola Harris | 01722 429339/425083 |
| Spasms and spasticity | Physiotherapy | 01722 429339 |
| Splinting | Occupational Therapy | 01722 425083 |
| Standing | Physiotherapy | 01722 429339 |
| MISCELLANEOUS | NAME | TELEPHONE NUMBER |
|---|---|---|
| Change of address / details | Consultant's Secretary | See below |
| District Nurse / carer issues | Community Liaison | 01722 429130 |
| Outpatient appointments | Consultant's Secretary | See below |
| Transport for outpatient appointments | Consultant's Secretary | See below |
| Travel / holidays | Community Liaison or Occupational Therapy | 01722 429130/425083 |
| Waiting list for operations | Glenda Stainer | 01722 429111 |
| Mr Troman’s Secretary | Chris Beaver | 01722 429084 |
| Dr Soopramanien’s Secretary | Sue Poutney | 01722 429007 |
| Mr El-Shafei’s Secretary | Julie Broadbent | 01722 429095 |
| Waiting List queries | Glenda Stainer | 01722 429111 |
If you need this information in another language or medium (audio, large print, etc) please contact the Patient
Advice and Liaison
Service (PALS) on 0800 374 208 email: [email protected]
