neurological rehabilitation - Outreach, outpatient and day patient

These patients may be in other hospitals, in nursing homes or residential placements, or living in their own home. Services are offered on an outreach, outpatient or day patient basis.

These services work in close conjunction with other services including:

• a number of community neurology advanced nurse practitioners
• the physiotherapists working in the Physical Disability Services in the community
• other community-based therapists, especially speech and language therapists
• social services and their occupational therapists and care managers
• continuing healthcare and their care managers and of course
• primary care service including District Nurses

Outreach

The Centre offers a medical outreach service (where patients are seen at locations other than OCE).  This service may be suitable in two particular circumstances:

• where the primary question relates to admission for inpatient rehabilitation
• where the primary need is for advice on longer term prognosis and management

There is also some limited outreach by other professions, often for patients who are already attending as daypatients. This may be appropriate when there is a particular need to see a patient in their own home environment. On rare occasions patients will be assessed and treated in their home, but this is not commonly possible given the time and resource implications.

Outpatients

Our outpatient service is suitable for people with a variety of different needs, including those with:

• a recent onset new disability who no longer need to be inpatients
• a recent marked change in the context of more slowly progressive disability, where there is a prospect of returning them to some higher level of independence
• a fluctuating and/or progressive disability where there is a need for more regular review particularly in relation to
• changing needs for care,
• changing needs in relation to equipment
• concerns about safety and vulnerability

Patients who are being seen in relation to an acute change may receive input between one and three times a week for a period of weeks or months. Patients who are being seen in relation to longer term problems where major improvement is not expected will usually be seen for episodes of day hospital care, an episode being between four and six weeks. The frequency of episodes is determined by the needs of the patient.

At the end of the course of treatment, the person is usually discharged back to the care of their general practitioner and other community based services if needed.

There is one specialist outpatient clinic - the spasticity clinic - which focuses largely on botulinum toxin injections.

Daypatients

People who have longer standing disabling conditions, particularly if they fluctuate or if the condition is progressing, will usually be seen on a daypatient basis. This means attending for the day and often seeing several members of our team (physiotherapy or occupational therapy, clinical psychology, a speech and language therapist, a nurse and sometimes a doctor). When not being seen by a therapist, patients will usually take part in activities in the day hospital day room.

We usually arrange for daypatients to attend for a series of appointments (often between four and six) where they attend once a week on the same day of each week. This is referred to as "a block of day hospital attendance".

At the end of any particular block, the team will discuss the situation and consider if a further block is needed. If no further blocks are to be arranged, we will give clear information on how to re-establish contact with the service should it be necessary. Sometimes an Advanced Nurse Practitioner will follow up by telephone or a home visit; sometimes follow-up by a community specialist will be arranged.

Location

Day hospital rehabilitation occurs in the OCE (Rivermead) building, particularly involving the day hospital day room.

Referrals

How to make a referral