Dietitians at North Bristol NHS Trust (NBT) provide both an inpatient and outpatient service.

Inpatient services

Our inpatient team is made up of dietitians who work within North Bristol NHS Trust providing a dietetic service to all wards.

The service is available between 8:30am - 4:30pm Monday to Friday.

• If you are an inpatient and your care team thinks you would benefit from seeing a dietitian, they will refer you directly.
• If you are an NBT health care professional and want to refer an inpatient to the nutrition and dietetic service, please do so via ICE.

Malnutrition is common in hospital patients and it’s important that it’s identified and treated early to reduce recovery time and complications. Each patient should be screened for malnutrition risk on admission to hospital and weekly throughout their stay. At NBT, we use the BAPEN Malnutrition Universal Screening Tool (MUST).

We use a range of assessment techniques to devise and review nutritional plans for patients. The aims of treatment are to improve nutritional status or symptoms to aid recovery.

Outpatient Services

Outpatient clinics are run at Southmead Hospital Bristol and Cossham Hospital where adult patients can be treated for conditions under a range of different specialties including:

• Gastroenterology
• Neurology
• Diabetes
• Bristol Bariatric Service
• Inherited Metabolic Conditions
• Renal
• Diet and Cancer

For more information click on the relevant specialty above to find out more.

If you are a clinician and want to refer a patient to a specialist outpatient clinic please view Nutrition & Dietetics – For Clinicians.

Community Services

• Patients who continue to need support to increase nutritional intake following discharge from hospital will be referred to the Community Nutrition and Dietetic team if appropriate. Read more information about their services.
• Patients who are being fed through a feeding tube (enteral feeding) will be referred to the Home Management Service (HMS). HMS will make arrangements to deliver feed products at home and to monitor progress. This service covers all of Bristol, South Gloucestershire and North Somerset.
• If a patient requires specialist dietetic input, the ward dietitian will arrange follow up through the GP or book directly into clinic.
• If you have never seen a dietitian and think that you need to, you can ask your GP, practice nurse or hospital consultant to refer you depending on the nature of your condition.
• If you have seen a dietitian at North Bristol Trust in the past, you can telephone the dietetics department directly and ask if you would need a referral.

Patient Handover for Clinicians

Inpatient handovers

If you are a dietitian and your patient has been transferred to NBT, please ring the department on 0117 4145428 to hand over.

Please note that University Hospitals Bristol also provide inpatient care to patients in the Bristol area.

Community handovers

If a patient has been discharged to the Bristol community, please contact the community team to handover.

If the patient has been discharged to the Bristol community and is receiving enteral nutrition, please contact the Home Management Service to handover.

The North Bristol NHS Trust Adult Neurosurgery Department, Brunel building, Southmead Hospital (previously located at Frenchay Hospital) is a tertiary referral centre providing Adult Neurosurgical care for Gloucestershire, Somerset and Wiltshire and the city of Bristol.

The Neurosurgical team includes 13 consultants, who are world-leading experts in their specialities, carrying out more than 3,500 individual procedures each year, of which 50% are operations for emergency admissions.

The service at Southmead Hospital is supported by three state-of-the-art Neurosurgical theatres including one theatre dedicated to emergency procedures.

The Neurosurgery wards, Gate 7, Level 3, Brunel building, Southmead Hospital provides patients with a high level of nursing care in a modern and spacious environment. 

The service provides all aspects of Neurosurgical practice, including:

• Cranial & Spinal Trauma
• Neuro-Oncology
• Complex Skull Base Surgery
• Complex Cerebro-Vascular Surgery
• Epilepsy Surgery
• Pituitary Surgery
• Spinal Surgery Including Spinal Tumors
• Neuro-modulation For Pain
• Neuro-modulation For Movement Disorders Including Parkinson’s Disease
• Surgery For Trigeminal Neuralgia
• Paediatric Neurosurgery
• Surgery For Hydrocephalus
• Neuro-Endoscopy

You may be asked to attend a little earlier for tests or investigations e.g. x-rays, before seeing the doctor.

When you arrive

As soon as you arrive please check in at the self-check in kiosk (Brunel only) or at the reception desk. If you need any help ask a member of staff.

Your visit

You may see a doctor or other healthcare professional depending on which service you have been referred to. There will be a nurse who will be able to deal with any queries you may have. To make best use of your time with the doctor think of any brief questions you may have before coming to clinic. Keep a note of these to ask during your visit.

You may be offered minor treatment during your consultation, which you have the right to decline if you wish. You can arrange another appointment for the treatment to be carried out.

Some examinations or treatment may mean you will be in hospital for 2-3 hours or longer. Please make arrangements for travel, childcare and time off work on this basis.

After seeing the doctor

If you need a further appointment you will be given a form to take back to the receptionist before you leave.

If you are going home by ambulance or hospital car, please tell the Receptionist you are ready to leave and be prepared to wait 2-3 hours or longer in exceptional circumstances. This is regrettably due to the pressures on the transport system and is beyond our control. Every effort will be made to ensure a swift return journey. If you can organise a lift to and from the hospital yourself this would be appreciated.

If you are listed for Surgery under a General Anaesthetic you will need to be assessed by a Pre-Operative Assessment Nurse. You will be given further information regarding this.

Please return any equipment on loan to you e.g. crutches, walking sticks, etc. to the department that gave them to you. A lot of public money is lost when valuable equipment is not returned.

Neuro-Rehabilitation Consultant
Dr Angus Graham
Telephone: 0117 9562697
Fax: 0117 9569941
Email:angus.graham@nbt.nhs.uk

Outpatient services

Outpatient services for Neuro-Rehabilitation include clinics in:

• General neurological rehabilitation
• Spasticity
• Head injury
• Intra-thecal Baclofen

Clinics will be delivered at Neurosciences Outpatients, Level 1, Brunel building, Southmead Hospital, as well as satellite clinics at:

• BraMS Unit
• West of England MS Therapy Centre, Bradley Stoke
• Portishead Marina Health Centre
• Knowle Clinic, Broadfield Road, Knowle

Inpatient Management

Frenchay Brain Injury Rehabilitation Centre is a regional/supra-regional unit for the management of patients with neuro-physical and/or neuro-behavioural consequences following acquired brain injury who need intensive in-patient neurological rehabilitation. Frenchay Brain Injury Rehabilitation Centre remains at the Frenchay Hospital Site.

If you wish to cancel or reschedule your outpatient appointment please contact the Outpatients Appointments Department. To speed our response please have the following details available:

• Name
• Date of birth
• Appointment date
• Clinic
• Hospital or NHS number

If you need to change the date or time of your appointment, please call with as much notice as possible. If you wish to change the appointment a second time, we will not be able to offer you another date except in exceptional circumstances.

If you are unable to attend and have not informed the Outpatient Department, we will not offer you another appointment. We will write to you and your GP to tell you this. If you do still require an appointment, please contact your GP.

If you have booked hospital transport and cancel or rescedule your appointment, please cancel your hospital transport.

www.brainandspine.org.uk The Brain & Spine Foundation website contains information resources for people with neurological conditions.

www.bps.org.uk Free leaflets aimed at the general public. More topics will appear over the next few months, so please revisit the site.

www.encephalitis.info The Encephalitis Society website provides evidence based information on all aspects of the condition in printed, electronic, video and audio formats .

www.epilepsy.org.uk Epilepsy Action was set up in 1950, and since then the Association has changed dramatically, but their aim is still the same - to raise awareness of epilepsy.

www.headway.org.uk Headway, the charity that works to improve life after brain injury.

www.neurosymptoms.org NeuroSymptoms is a website about symptoms that are neurological (such as weakness, numbness or blackouts), real (and not imagined), but not due to neurological disease. The website is written by a neurologist with a special interest in these problems and aims to give you a better understanding of these symptoms. It has no advertising and does not make any money for the author.

Attention and Concentration: this refers to an individual's ability to focus, sustain and switch their attentional resources appropriately.

Verbal Intelligence: this refers to an individual's level of acquired intelligence. This acquired knowledge is typically developed through schooling and other forms of education. It is often considered a marker for an individual's 'premorbid' level of functioning as it represents, on average, what someone was able to accumulate when they were able to apply their cognitive resources prior to any brain damage.

Visuospatial/Non-verbal reasoning and problem solving: this refers to the more visual and fluid aspects of intellectual ability. Performance here is far less dependent upon an individuals formal level of education or knowledge of the English language. Performance on these tests represents what is often considered to be a 'culture-fair' indicator of intellectual ability. Typically , as these tests attempt to avoid reliance on English language abilities, they are presented within a visual and spatial format.

Working Memory and mental flexibility: this refers to those abilities that relate to the temporary storage, organisation and utilisation of information in one's mind. This information is used to guide and evaluate ongoing behaviour and decision making.

Anterograde Memory: this refers to those abilities that are necessary for the acquisition, storage and retrieval of newly learned information. This ability can be divided in terms of the nature of the to-be-remembered material, i.e. material presented within the auditory versus visual modality.

Language function: this refers, in the neuropsychological setting, mainly to verbal fluency, both phonemic and semantic and visual confrontation naming. In addition to these formal measures of language functioning qualitative assessment of language function is also undertaken. A complete and detailed assessment of language abilities is usually undertaken by a Speech and Language Therapist.

Processing Speed: this refers to the speed with which cognitive abilities can be utilised in relation to specific task demands.

Executive function: this is a broad concept that incorporates many facets. Some of these can be tapped, to some extent, through formal cognitive assessment, but many aspects of this domain are only really apparent through the skilful evaluation of an individual using multiple sources of evidence. This domain refers to the highest level of cognitive function and is typically thought to be important in such things as planning, organisation, time management, adaptability to changing task demands, social appropriateness of behaviour, etc. In essence executive function refers to the ability of an individual to appropriately make use of their abilities in applying themselves to achieve a goal in a culturally appropriate way.

Should I bring my glasses or hearing aid to the appointment?

Is there anything else I should bring?

I’m worried about my memory, should I be worried?

Will a neuropsychological assessment hurt, involve injections or other procedures?

How long will it take?

What happens after I have completed the assessment?

What happens if my assessment suggests that there is something seriously wrong?

Will my interactions with neuropsychology be confidential?

Neuropsychological Assessment

A neuropsychological assessment provides an objective way of characterising cognitive, emotional and behavioural symptoms. This process typically involves completing a number of different cognitive tasks and questionnaires. The process is not painful but it may take a number of hours.

A neuropsychological assessment might involve assessment of:

• Attention and concentration
• Verbal intellectual skills
• Visuospatial/Non-verbal reasoning and problem solving
• Working memory and mental flexibility
• Auditory memory
• Visual memory
• Language
• Processing speed
• Executive function
• Mood and anxiety/stress
• Test score validity

Results of the  assessment are typically presented in report format and may also be discussed directly with the patient.

The significance of the findings of the assessment in relation to the referral question, along with a short summary, are briefly summarised at the end of the report.

Neuropsychological Treatment

Where appropriate, treatment is offered to help improve or mitigate the impact of presented cognitive, emotional and behavioural difficulties. Within the Clinical Neuropsychology service this is provided within the framework of a brief goal-focused intervention model. This work involves aspects of cognitive rehabilitation, the implementation of strategies to compensate for cognitive problems and, where appropriate, brief psychological therapy interventions for associated psychological difficulties, typically within a cognitive-behavioural therapy framework.

Comprehensive post-acute multi-disciplinary neuro-rehabilitation, including neuropsychological input and behavioural management approaches, is offered by the Frenchay Brain Injury Rehabilitation Unit and the Head Injury Therapy Unit at Frenchay .