When you are discharged from hospital after being critically ill, there will be a period of physical, mental and emotional recovery that will likely take some time. We feel it is important to ensure you are not alone during this. 

Our follow up clinic aims to provide somewhere for you and your family to be supported through this journey after hospital. All patients admitted to NBT ICU are entitled to attend our follow up clinic, however, as one of the largest ICUs in the country we treat on average 250 patients a month.  As you can appreciate this creates a huge volume of potential visitors to our follow up clinic.  For us to manage these numbers there are certain patient groups we will actively contact, based on their length of stay and condition. That doesn’t mean we don’t welcome everyone else, but instead, ask that you contact us via our email address if you feel the need to discuss your time with us in ICU, we’d love to hear from you. 

For those who we actively contact, we aim to get in touch approximately 8 weeks after being discharged from hospital. We ask you to complete a health questionnaire allowing us to gain more information about how you are getting on post discharge. Once completed and returned to the Follow up Clinic, a member of the team will contact you to discuss the questionnaire in more detail and establish whether you would benefit from more input. In this instance, you will be invited back to the hospital for a face-to-face or virtual meeting with the team, where we will aim to establish any current issues and attempt to assist you in dealing with these or signpost you to support available.    

In addition to hearing how your recovery is going, we are also really keen to gather feedback from relatives and patients about their stay, and what we can do to improve future patients experiences.

Useful links

Home - ICUsteps: There are fact sheets about what to expect after an ICU admission, and patient stories. 

Intensive care: Patients' experiences - Overview (healthtalk.org): Real life patients talking about their experiences in ICU.

South West Placenta Accreta Spectrum (PAS) Network – For Clinicians

In order to refer patients to the South West Placenta Accreta Spectrum (PAS) Network visit the referapatient website at www.referapatient.org/patient/genericreferraltypeform.

This service is only for patients that meet network criteria as stated on the Placenta Accreta Spectrum pathway. Please read the pathway guidance below: 

- Booked pregnancy within the South West of England

- Have had uterine surgery/procedure in the past

- Have been reviewed by a local fetal medicine doctor who has concerns that there may be features of FIGO 2 or 3 PASD (placenta increta or percreta)

Please include as much relevant clinical information as possible including recent imaging and reports. 

This is NOT an emergency referral system. If your referral is an emergency, then please request to speak to our on-call Obstetric Consultant via Switchboard on 0117 950 5050. Once you have spoken to the on-call Obstetric Consultant, then please submit your referral via the referapatient system to ensure follow up and relevant multi-disciplinary planning. 

Regardless of the level of urgency, if you feel that you need to discuss the referral in detail via a telephone conversation, then please feel free to do this on the above number. 

The network team will receive and aim to action your referral within 5 working days.  

Information for patients and carers

Introduction

Being involved in a traumatic event is something that we do not expect to happen.

You may experience a range of unfamiliar emotional and physical reactions associated with the suddenness of the event.

You may have a lot of questions about these reactions.

This information tries to answer some of the most common questions with some information and guidance.

There are no right or wrong ways to react, and different people experiencing the same trauma may respond in quite
different ways. Encouragingly, for most people the distress caused by traumatic injury starts to settle during the first few weeks as a person’s physical recovery progresses. For some people however, the emotional impact can become a concern.

How can I help myself overcome difficult emotional reactions?

• Reminding yourself that having a range of emotions is very natural. It can be very up and down in the first few days or weeks following the event.
• Try to settle back into your usual routine as much as you are physically able to. This will help you feel safer more quickly.
• Get plenty of sleep, rest and relax, eat regularly and healthily.
• Try to manage responsibilities and demands one at a time.
• Reminding yourself that the traumatic event is over and that you are now safe.
• When your feelings have settled and you feel safe, calmly go over what happened.
• Try to express yourself freely rather than bottling up your feelings.
• Talk to people you trust. You don’t have to tell everyone everything, but sharing your feelings with someone can often help you feel better.
• Don’t feel embarrassed or ashamed of your feelings and thoughts. Something very unexpected and sudden has happened to you and it is likely that you will have some reactions to the event.

Supporting someone else who has experienced trauma

• Reminding them that they are safe now, and that they have survived the traumatic event.
• Try not to press them into talking about it. Acknowledging that sometimes the person may not want to talk about their experience yet is completely ok.
• Be available to talk when the person is ready.
• Give the person time to talk and express their feelings, at their own pace, and allowing them to talk as much or as little as they feel able to.
• Try not to offer solutions or advice unless asked for this. Just being a listening ear can be a great source of support.
• Allow the person to be upset or angry about what has happened. These are the most common reactions, but not the only way a person might react.
• Reminding the person that they are not to blame, and that this was an unexpected situation that nobody would have anticipated.

Things that can impact your recovery

If it has been several weeks or more and your emotions have not settled and there is no sign of this getting better, it may be helpful to think about what is getting in the way of recovery.

You might need help if you have been experiencing any of the following reactions persistently:

• You want to talk about what happened and feel you don’t have anyone to share your feelings with.
• You find that you are easily startled and agitated.
• You keep experiencing the traumatic event over and again in your mind and have intense emotional reactions to it.
• You have disturbed sleep, unsettling thoughts preventing you from sleeping, or vivid dreams and nightmares are affecting you.
• You are experiencing overwhelming emotions that you feel unable to cope with or experience steep changes in mood that are out of character.
• You feel physically uneasy when you remember or think about the traumatic event.
• You feel emotionally numb or distant from people around you.
• Your relationships seem to be suffering.
• Your performance at work has suffered.
• Someone who you are close to tells you they are concerned about you.

If so, at this point you may be helpful to speak to a professional.

Where to go if you believe you need help

There are some very effective treatments for people experiencing the effects of trauma, such as Cognitive Behavioural Therapy (known as CBT) or Eye Movement Desensitisation and Reprocessing therapy (known as EMDR).

Most areas have a NHS psychological wellbeing service to which you can self-refer. You might start by contacting your GP.

Some of the services that they might use are listed below.

VitaMinds Service, Bristol, North Somerset & South Gloucestershire

www.vitahealthgroup.co.uk/nhs-services/nhsmental-health/bristol-north-somerset-and-south-gloucestershire-mental-health-services/

Let’s Talk Service, Gloucestershire

www.ghc.nhs.uk/our-teams-and-services/letstalk/

BaNES IAPT, Bath & North East Somerset

www.iapt.awp.nhs.uk/talking-therapies-banes

Talking Therapies, Somerset

www.somersetft.nhs.uk/somerset-talking-therapies/

Swindon LIFT Psychology, Swindon

www.iapt.awp.nhs.uk/lift-psychology-swindon

Wiltshire IAPT, Wiltshire

www.iapt.awp.nhs.uk/wiltshire-iapt

NHS 111

Alternatively, contact NHS111 if you are concerned about low mood, anxiety or posttraumatic stress, or visit NHS Choices at www.NHS.uk

Further support

Please note that we are not responsible for the content or views posted on any of the below sites.

ASSIST Trauma Care

Experienced therapists trained to work with Post Traumatic Stress Disorder (PTSD) and the aftereffects of trauma in line with current evidence based practices.

http://assisttraumacare.org.uk/

After Trauma

A national forum aiming to provide a community for patients and families to rebuild lives and support each other after experiencing a traumatic injury.

www.aftertrauma.org/

Brake

A charity for road safety which provides information and resources for victims of road traffic collisions.

https://www.brake.org.uk/

Headway

Supports people and families after a brain injury.

https://www.headway.org.uk/

ICU Steps

A patient support charity set up by experts by experience, for patients who have been admitted to an Intensive Care Unit.

https://icusteps.org/

Mind

The national association for mental health. A resource for people providing information and signposting, helplines, online forums and low cost counselling.

https://www.mind.org.uk/

The Spinal Injuries Association

Provides support and information to patients and families affected by a spinal cord injury.

https://www.spinal.co.uk/

Winston’s Wish

Supports children and families who are bereaved by the loss of a family member.

https://www.winstonswish.org/

Victim Support

Provides emotional and practical support for people affected by crime and traumatic events.

https://www.victimsupport.org.uk/

The Limbless Association

A patient support charity supporting amputees and people who have experience limb loss.

www.limbless-association.org/

What does the Psychology service offer?

Suffering multiple injuries requiring intensive treatment and rehabilitation is inevitably distressing. The way this unfolds varies a lot between different people and their different circumstances.

Encouragingly, the distress caused by a traumatic injury usually starts to settle as a person’s physical recovery progresses.

For some, however, the emotional impact can become a concern and in those circumstances we have the expertise within our team to help.

Our clinical psychologist is a specialist in this area of work and it is their role to offer effective support in a timely way.

This service has a number of roles, including:

• Offering emotional support, including psychological assessment and interventions, for patients throughout their time in Southmead Hospital and after discharge.
• Supporting patients with the experience of being in hospital.
• Helping patients adjust to living with traumatic injuries, managing the demands of the injury and the demands of rehabilitation more generally.
• Helping patients through the experience of medical interventions. This can include:
  • Supporting and preparing patients if they are anxious about procedures such as blood tests and surgery.
  • Helping patients to talk to their family members about surgery.
  • Supporting patients after surgery.

Frequently asked questions

“I’ve been referred to a psychologist. What can I expect when I meet with the psychologist?”

After asking for your consent to discuss your worries, they will ask about how you are managing with your injuries and your treatment.

They will ask about the things that are most important to you looking ahead in your plan of care with the Major Trauma team.

They can provide information and advice about what others have found helpful and work out what further support you may need.

“What happens to the information I share with the clinical psychologist?”

Information will always be kept private and confidential, unless there is reason to think there is a risk of harm to you or others. The psychologist will talk to you about this first whenever possible.

The psychologist works as a member of your multidisciplinary healthcare team and will communicate with your healthcare team (for example your GP or consultant) about the work they have done with you.

“How long can I see the psychologist for?”

Sessions usually last up to an hour. Sometimes, it may be enough to meet with the psychologist once or twice for you to feel you can take things forward with the support you already have in place, but others need more sessions.

“I can see this could be helpful for me. How do I arrange to see a psychologist?”

If you feel you need this service then it is possible to move this forwards yourself. Either ask someone from your hospital care team or contact the Psychology base. The details are on the back of this leaflet.

Our specialist clinical psychologists are Dr Mattia Monastra, and Dr Joanna Latham who lead the Major Trauma Psychology Service.

Patient feedback

“Thank you for being so easy to talk to. These psychology sessions have been the best thing for me since the accident.” - Mrs H, road traffic collision.

“These appointments were so integral to my healing and my wellbeing. They honestly were really important to me, really helping. The weekly appointments were my safe space. After each session it sets me up for the day with calmness.” - Mr M, work-related crush injury

“This is the first time I’ve really felt heard. Thank you for listening to me.” - Mr P, fall from height

“I’ve never spoken to anyone about my feelings before... I’ve always been a man’s man. After my first session talking with the psychologist, I’ve been speaking to everyone. They were really surprised about how I’ve opened up. I’m having really deep conversations with my friends and family which has helped. I feel like a different person!” - Mr A, injury through assault

“The psychologist had helped me throughout the whole recovery, as an inpatient and outpatient. They helped me think about my needs and helped me realise what I can do and the strength that I have, even though I didn’t know I had it.

The recovery has not been easy in any shape or form but it has been so helpful to be able to speak to the psychologist, learn why and how I think about situations, and to take the difficult step in driving again. There are not enough words for me to express my gratitude for what the psychologist has helped me through.” - Mrs C, road traffic collision.

How to contact us

Major Trauma Office

Gate 19, Level 2, Brunel building

Southmead Hospital

Westbury-on-Trym

Bristol

BS10 5NB

Email: MT&PlasticsPsychologyTeam@nbt.nhs.uk

Phone: 0117 414 1543 (Opening times: Monday - Friday, 8.30am - 4.30pm)

The range of specialised Histology reporting we offer includes:

• Breast pathology
• Endocrine pathology
• Genitourinary pathology
• Gynaecological pathology
• Head and neck pathology
• Lymphoreticular disease (part of the Specialist Integrated Haematological Malignancy Diagnostic Service (SIHMDS))
• Oral pathology
• Paediatric and perinatal pathology
• Renal pathology
• Thoracic pathology
• Dermatopathology
• Upper and lower gastrointestinal pathology, including liver and pancreatic pathology

We also provide a referral service in many of these specialisms for other NHS trusts and Pathology providers.

The laboratory offers the following specialist services:

• Rapid Intra-operative Diagnosis (frozen sections)
• Support for Moh’s micrographic surgery
• Immunocytochemisty including Her-2, ALK D5F3, PDL1 testingImmunofluorescence

Welcome

North Bristol NHS Trust acknowledge that older people are an important and growing population in our community. We celebrate the fact that our population is living longer and commit to providing care and support for patients, carers, and their families. Our aspiration is to provide the best possible care and support for people living with Dementia and those who care for them in a holistic way.

Intro from Chief Nursing Officer

At North Bristol NHS Trust, we are committed to our focus of providing a high quality care for people living with dementia. We will deliver this through our dedicated workforce and amazing volunteers, developing their skills and knowledge through innovation and research.

A key aspiration of Challenge on Dementia 2020 (DoH 2015) is to create dementia friendly hospitals.

The National Dementia Action Alliance and Dementia Friendly Hospital Charter (NDAA 2019) contribute to improving the experience and outcomes for people with dementia in hospital care.

Within this strategy, there is recognition of the importance of taking a holistic person-centred approach when we deliver care. We recognise the need to support and engage with our patients who have dementia, their carers and family.

- Professor Steve Hams, Chief Nursing Officer

Our vision

Our vision is to put individuals at the centre of their own health and care. People will be inspired and supported to care for themselves more and to take an active role in how we provide care and treatment at NBT. Our services will become more joined up, informed by public decision making and where possible closer to or at home. Access to our leading-edge hospital and specialist services will be simplified and capable of best caring for the population we serve.

Our aspiration is to provide the best possible care and support for people living with dementia and those who care for them.

“Dementia is a long-term condition affecting memory, cognition, health and behaviour experienced by the person and their family/carers that can benefit from proactive planning, timely treatment, support and compassionate care”. Department of Health, Making a Difference in Dementia: Nursing Vision and Strategy (refreshed September 2016).

Our commitment

To empower people to have a more active role in their own care.

To ensure that people who use services and the professionals who provide care work together as partners.
 

Empowering people in their own care involves three core steps.

1. Listening to our people about what matters to them
2. Including patient voices in addressing areas of concern and give patients/carers an active role to participate in improving services.
3. Working together to enable people to understand their health, condition, and treatment, enabling shared decision making.

We recognise there is more we can do to make this happen and need to start by sharing the journey of improvement that we have been on and giving patients and the public full confidence in the services that we provide.

We aspire to move towards understanding and involving the public more in decision making, using consistent and agreed co-design methodologies.

Our goals

• Our goal is to create a dementia friendly hospital in line with the ambitions of the Challenge on Dementia 2020 (DoH,2015). The National Dementia Action Alliance and Dementia Friendly Hospital Charter (NDAA 2019) supports improving the experience and outcomes for people with dementia in hospital care.
• In providing a dementia friendly hospital, we aim to work with the NICE guidance to support initiatives that will enhance this. (NICE, 2019).
• We will implement the principles related to reasonable adjustments to deliver the best quality experience of hospital care for people with dementia and their carers.
• North Bristol Trust fully supports and is committed to achieving this through exceptional healthcare personally delivered.

Introduction

Purpose of the Strategy

The launch of Challenge on Dementia 2020 (DoH 2015) is to create dementia friendly hospitals, and since the National Dementia Strategy in 2009 much has been achieved nationally and locally.  However, dementia care continues to provide challenges to maintaining our achievements, toward implementing our objectives and planning for the future.

The aim of the strategy is to provide a clear overview and understanding of how staff and volunteers at NBT can support people with dementia when they are in our care.

This support could be as an inpatient, attending outpatients or day services or as family members or visitors to our hospital.

The Dementia Strategy sets out the objectives for exceptional healthcare personally delivered for people living with dementia recognising the vital role that family and carers provide.

Fundamental to NBT providing support is the relationship with the person living with dementia, the patient, the family/relative/carer and the healthcare professional.

The Carers Trust (2015) described this as the carer’s ‘Triangle of Care’. 

This promotes safe care and support through communication.

 

National and Local Picture

Process of Delivery

Ensuring our strategy is delivered

Engagement

Our objectives

This is what NBT aims to provide for people living with dementia.

1. Assessment
2. Person-centred care
3. Structured quality governance framework to provide safe exceptional care
4. Skilled workforce
5. Dementia friendly hospital/environments
6. Care/family involvement in personalised care
7. End of life care
8. Research and innovation

Objective 1 - Assessment

Objective 2 - Person-centred care

Objective 3 - Structured quality governance framework to provide safe exceptional care

Objective 4 - Workforce: We will have an informed, confident and competent workforce

Objective 5 - Dementia Friendly Hospital/Environments

Objective 6 - Carer/family involvement in personalised care

Objective 7 - End of life care

Objective 8 - Research and innovation

How we will measure and improve our dementia care

This strategy will require us to continue to build on the achievements and the commitment and energy of staff, volunteers, partner organisations and patient and carer representatives to ensure delivery.

Acknowledgements 

• John's Campaign
• Alzheimer's Society
• Carers Support Centre, Bristol & South Gloucestershire
• Young Dementia Network, hosted by Dementia UK
• Dementia Action Alliance (DAA)

We run regular Adult Immunology/Immunodeficiency (and Allergy) clinics on Tuesday mornings, Thursday afternoons, and all-day Friday reviewing patients referred (see Patient Referral Pathways) to our service with suspected or confirmed immune deficiency. Criteria and advice for whom to refer can be found on the Remedy website.

Our service provides replacement antibody therapy (immunoglobulin) to patients with confirmed antibody deficiency. This can be given in the hospital (as a day case) or at home.

For patients with recurrent infections please try to confirm the nature of the infection before referral. For example, by sending relevant microbiological cultures, viral swab tests, taking the patient’s temperature, inflammatory markers, radiology etc.

Last updated: 25/11/2022

We run regular Adult Allergy (and Immunology/Immunodeficiency) clinics on Tuesday mornings, Thursday afternoons, and all day Friday seeing patients referred (see Patient Referral Pathways) to our service with suspected or confirmed allergic disease. Criteria and advice for whom to refer can be found on the Remedy website.

Patient referrals are accepted via the NHS e-Referral Service (e-RS) and an Advice and Guidance service also operates via the same channel. Please ensure Adult Allergy is selected for both of these services (not Immunology).

We see patients in our Adult Allergy service with the following conditions:

• Anaphylaxis
• Allergic rhinoconjunctivitis
• Bee or wasp venom allergy
• Drug and anaesthetic allergy. Referral for anaesthetic allergy investigation will only be accepted from the relevant anaesthetic department – see below
• Food allergy
• Urticaria and/or angioedema
• C1 esterase inhibitor deficiency (Hereditary Angioedema)

Please include as much detail about the clinical reaction/issue, relevant hospital discharge summaries, past medical history, past treatments (if relevant) and current medications. Referrals will not be accepted with inadequate information. For suspected General Anaesthetic Allergy Referrals please email allergy@nbt.nhs.uk  and a referral pro-forma will be supplied to you. 

We also offer a dedicated ‘Adult Allergy COVID-19 Vaccine Advice and Guidance’ service that can be accessed via eRS by General Practitioners. Patients who have had a suspected allergic reaction following their COVID-19 vaccination can be referred by their GP for advice. Please see Remedy for more information and please check the most up to date information about COVID19 vaccine reactions in the Green Book (chapter 14a) as well as the BSACI FAQ sheet before proceeding. For up to date information on COVID-19 vaccine allergy you can also visit the Anaphylaxis UK website. For suspected non-allergic reactions to this vaccine other specialties or the Southwest Immunization Regional Clinical Advice and Response Service may be better suited to offer advice.

Please note we do not see patients for:

1. Patch testing (e.g. for eczema, contact hypersensitivity) – please refer to Dermatology instead.
2. Lactose or food “intolerance” as we do not have expertise in these conditions.
3. Myalgic encephalomyelitis (ME), chronic fatigue, or fibromyalgia as we do not have expertise in these conditions.
4. Mast cell activation disorders as we do not have expertise in the management of these conditions.

Our service also performs:

• Sublingual and subcutaneous desensitisation (COVID19 permitting)
• Omalizumab injections for chronic spontaneous urticaria
• Drug and food allergy challenges
• Drug desensitisation

Last updated: 25/11/2022