Outpatient review is a valuable component in maintaining a healthy life and avoiding complications following spinal cord injury.
The long-term clinical management needs over a person’s life after spinal cord injury is far greater than the initial acute care and rehabilitation costs.
Significant health benefits can be realised when long-term management occurs in a proactive and preventative way, versus responding to medical emergencies or problems after they occur.
Changes in the neurological function of patients with spinal cord injury (e.g. bladder and bowel function, syrinx and cyst formation) can be identified in a skilled re-evaluation and any intervention necessary implemented.
Although SCI re-evaluations can take place elsewhere, if the clinicians and evaluation team are not experienced in evaluating potential complications and integrating the results into recommendations, problems can be missed, and the risk to the patient can be significant.
The Spinal Injuries Association, the national patients’ organisation, encourages all their members to demand re-referral back to their treating centre whenever possible.
We support this stance and wherever possible will accommodate the wishes of those registered with us throughout their lives.
- What is the purpose of outpatient review?
Reviews are overseen by a consultant in spinal cord injuries and, depending upon each patient’s needs, the clinical manager of each department (e.g. nursing, case management, physiotherapy, clinical psychology and occupational therapy).
Patients are invited to attend the outpatient department and where necessary ambulance transport will be arranged.
However, we actively encourage people to use their own transport as this allows the centre to review more patients at each clinic.
All our services are provided within the centre, and only in rare cases would referral on to another hospital be necessary. Depending upon the individual person’s needs the evaluation can include some or all of the following:
- Review of records and history-taking as necessary
- SCI physical examination by a medical or specialist nurse
- Clinical evaluation of bowel, bladder, medications, and skin condition
- Urological studies
- Respiratory review
- Blood tests and analysis
- Physical and occupational therapy evaluations for motor/sensory changes, posture, transfers, activities of daily living and functional tests, equipment evaluation and minor repairs or adjustments
- Psychosocial evaluation and counselling
- Case management evaluation of care, financial or environmental issues
- Consultations with other medical specialists as necessary (neurology, skin, respiratory consultants, etc)
- Radiological investigations CT, MRI, etc as necessary
A comprehensive, written review will be forwarded to your GP after the visit, and a copy forwarded to the patient when requested.
- Frequency of review
Following initial inpatient rehabilitation, we typically recommend that patients meet their treating consultant team between four and eight weeks after discharge to monitor progress and identify any immediate concerns return to life in the community presents.
We would normally then arrange a review as an outpatient after 12 months, and then annual review at 12-month periods for the first three to five years after initial rehabilitation, or until such time as patients have established a consistent record of healthy routines and re-integration into the community and family life.
In some circumstances ongoing support and intervention after the outpatient review may be undertaken directly by our staff in the patient’s place of residence. The treating consultant will discuss these issues directly with the patient prior to implementation.
Once the re-evaluations indicate that the patient has consistently demonstrated their ability to manage their complex and chronic conditions, we may recommend a reduction in frequency to every other year, or sometimes longer, depending on the patient and the expertise of their local providers.
Some patients elect to get their re-evaluations locally but come back to us once every three to five years as a precaution to ensure conditions or complications may not have been missed locally.
Local providers of care not experienced in spinal cord injury often appreciate knowing that we are still involved.
As patients age with spinal cord injury, especially into their second and third decade of injury, their medical and functional conditions can change significantly, and may require a resumption of annual evaluations.
Many of the complications associated with the ageing process are preventable, if identified early.
Patients, GPs and other care providers interested in accessing the review programme for a patient registered with us should call 01704 704333.