The South West Maternal Medicine Network co-ordinates and standardises care for pregnant women with pre-existing medical conditions or conditions that arise during pregnancy. The overriding aim of the Network is to ensure equitable access, excellent experience and optimal outcomes for women from all communities across the South West.

Governance

The network is overseen by the South West Maternal Medicine Network Steering Group, which consists of both clinical and operational representatives from each trust within the network footprint. The steering group is chaired by the Regional Chief Obstetrician Dr Judith Standing, and reports to its commissioner, NHS England, via the South West Regional Perinatal Quality and Safety Surveillance Group.

Education

For more information about managing acute medical problems in pregnancy, the Royal College of Physicians has a toolkit.

Referrals

There are different referral pathways depending on the condition, as outlined in these documents.

Because you have a medical condition it is likely that you will have specialist team that monitor and manage your health, they may have even been involved in managing your condition in order to help stabilise your health prior to conception.

Some health conditions make pregnancy slightly more complex to manage and in turn pregnancy can make some health conditions more difficult to manage. When this is the case it is usual to have your pregnancy monitored by a consultant who specialises in medical conditions in pregnancy at your local tertiary hospital.

The South West Maternal Medicine Network allows the pool of knowledge about your condition to be larger. We have a team of specialist Doctors and midwives, who, as a group can look at your condition and pregnancy alongside each other and along with you and your family safely plan your pregnancy and birth.

Many conditions will continue to be managed at your local hospital and we can use virtual meetings to review your pregnancy.

Some conditions are more complex and you may need to attend a specialist hospital during your pregnancy and for the birth of your baby. You can see an example of the care plans used in the ‘care plan’ section of this website.

Help us to improve stroke care

Our Trust will soon be taking part in a national survey to find out what patients think about their stroke care.

All NHS stroke patients who received treatment and/or therapy between 16/05/22 and 16/09/22 will receive a copy of the survey. This is part of a national programme to improve stroke patients’ experiences.

The Stroke Patient Reported Experience Measures Survey (PREMS) will be the first of its kind, and will capture positive patient experiences, as well as letting us know where we need to make things better.

PREMS is a partnership project with the Stroke Association and NHS England.

Taking part is voluntary

The survey will be carried out by an independent company, under a signed agreement with NHS England in partnership with the Stroke Association.

Section 251 support has been recommended by the Secretary of State for Health and Social Care following advice from the Confidentiality Advisory Group (CAG), who are an independent advisory group which includes lay representation. This allows Trusts to share your details without your consent.

Regulation 5 of the 2002 Control of Patient Information Regulations provides a lawful basis for confidential patient information to be processed for medical purposes. If you have opted out via the National Data Opt Out, your information will not be disclosed by your Trust.

Why do we want your feedback?

We want to improve people’s experiences of stroke care by giving clear information, showing everyone respect and compassion and keeping patients safe and comfortable.

What happens to the information you give us?

Your NHS Trust will provide your name and address to Quality Health to send you the survey. Your answers will not be linked in any way to your personal contact details. We will keep your information secure and will not publish any information that can identify you.

We will use your answers to tell the people who treat patients what they’re good at and what they can improve.

Taking part

You will be sent a pack in early 2023 which will include:

• The paper copy of the survey
• A link to complete this online if you prefer
• A Freephone number if you need help to complete this or require a translator.
• Further information about the purpose of the survey and data confidentiality.

If you do not wish to take part, or have any questions about the survey, please contact us: alice.brown@nbt.nhs.uk 0117 414 4398.

For more information about the survey and how your information will be used, please visit www.stroke.org.uk/prems2022

Forms

BCARE hosts the Antimicrobial Reference Laboratory which provides a comprehensive antimicrobial assay service for the purposes of therapeutic monitoring and supporting consultative advice on technical aspects and clinical interpretation of antimicrobial assays. The laboratory receives referred samples from all over the UK and Ireland.

Please see the assay booklet below for full details.

Assays of serum drug concentrations are indicated in the following situations:

• Drugs with a known or suspected relationship between concentrations in blood and toxicity
• Drugs with a known or suspected relationship between concentrations in blood and efficacy
• Where there is pharmacokinetic variation such that concentrations in blood cannot be predicted
• To confirm oral absorption
• To test compliance

The Antimicrobial Reference Laboratory routinely provides a wide range of antimicrobial assays. Some of these are routinely performed in large numbers and no advance warning is required if the sample is to arrive during a normal working day; others are performed less frequently and advance warning is essential if a same-day service is required.

In addition advice can be obtained on development of LS/MS assays, problems with immunoassays and patient-related issues.

Minimum inhibitory concentrations (MICs), minimum bactericidal concentrations (MBCs) and serum bactericidal titres (SBTs) can be performed on patients’ isolates and sera.

Analyte Information

Welcome to the Imaging Department

The Imaging department may also be called the X-ray or Radiology department. It is the facility in the hospital where examinations of patients are carried out, using a range of equipment such as a Computerised Tomography (CT) scanner, an ultrasound machine and Magnetic Resonance Imaging (MRI) scanner.

Radiologists are doctors specially trained to interpret the images and carry out more complex examinations. They are supported by radiographers and sonographers who are highly trained to carry out X-rays and other imaging procedures.

What is an ultrasound scan?

An ultrasound scan builds up a picture using sound waves that cannot be heard by the human ear. Ultrasound images complement other forms of scan and are widely used for many different body parts.

Are there any risks?

No, there are no known risks.

Do I need to prepare in advance?

Often it is necessary to prepare for a scan. For example, if your pelvis, kidneys or bladder are to be scanned, you may need to have a full bladder for the examination. For areas such as the liver, you may need to not eat for a number of hours. If so, this will be explained in your appointment letter.

If you feel you may have difficulties with the preparation, please contact our bookings team to discuss. The contact number is on your appointment letter.

Can I bring somebody with me?

Yes, you may bring a friend or relative with you. It may not always be possible for them to accompany you into the scanning room but please do ask and we will try to accommodate your request.

What will happen when I arrive?

Please go to the reception desk. You will be shown where to wait until a member of staff comes to collect you. If you are coming to Southmead Hospital, please follow the check-in process outlined in your appointment letter.

Toilets are clearly signposted within the department. However, please do not use the toilet until after the examination if you have been asked to fill your bladder.

Who will I see?

You will be seen by a radiologist or a sonographer depending on upon the type of investigation you are having.

North Bristol NHS Trust is a teaching hospital; there may be a trainee present for some examinations. They will be introduced at the beginning of the examination. If you would prefer them not to be present, please feel free to say to the radiologist or sonographer.

Will I need to undress?

We will tell you if you need to remove any clothes covering the area being examined before your examination. Private cubicles are available if you need to take off your outer garments or put on a hospital gown.

What happens during the scan?

We will ask you to lie down on a couch, and we will dim the lights so that the images on the screen can be seen more clearly. We will apply a gel to your skin over the area to be scanned.

You may be asked to take deep breaths and to hold your breath for a few moments. For a scan of the bladder, it may occasionally not be full enough for the examination and you may be asked to drink more fluid and wait while the bladder fills up.

The radiologist/sonographer will move the ultrasound probe over your skin while viewing the images on a screen. Selected images will be taken so that they can be viewed later. Upon completion, the gel will be wiped off and you will be free to get dressed.

Will it be uncomfortable?

Ultrasound itself does not produce discomfort and apart from the probe on your skin you should not feel anything.

Occasionally it may be necessary to apply some pressure over an inflamed area to check what is causing the pain; this may cause discomfort temporarily.

If your bladder is uncomfortably full, please tell the radiologist/ sonographer so that this part of the examination can be completed as soon as possible. You can the leave the room to empty your bladder before returning to any further examination.

Intimate examinations

If you are having an intimate examination the radiologist or sonographer will explain the procedure to you and ask for your consent.

Please note we have both male and female staff performing these examinations. If you would prefer a male or female to perform your examination, please contact our bookings team. The number is on your appointment letter, we will be more than happy to accommodate your request.

Types of intimate examinations may include the below.

Female patients - for examinations of the womb or ovaries

A “transvaginal” ultrasound means “through the vagina”.

During the procedure, you’ll be asked to lie on your back with your knees bent.

A small ultrasound probe with a sterile cover, not much wider than a finger, is then gently passed into the vagina and images are transmitted to a monitor.

Internal examinations may cause some discomfort, but don’t usually cause any pain and shouldn’t take very long. You will be asked to empty your bladder before this scan is done.

If you have not been sexually active before, an internal scan will not be performed. Please call the appointment number on your letter to let them know and they will make a note that this component of the scan has been cancelled. It is especially important to make sure your bladder is full for the scan.

Male patients - examinations of the scrotum

In most intimate scans, a chaperone will be present and if there is not, you may request this if you wish. Please let the person doing your scan know.

How long will it take?

The process of carrying out a scan usually takes around 20 minutes. Unless emergency patients delay you, your total time should be less than an hour.

Are there any side effects?

No. You can drive afterwards and return to work as necessary.

Can I eat and drink afterwards?

Provided no other investigations are needed, you can eat and drink normally after your scan.

When will I get the results?

After the scan, we will examine the images further and prepare a report on our findings. This may take some time to reach your referring doctor, but is normally less than 14 days. You could ask the radiologist/sonographer how long it might take to get the results.

References

This leaflet is based on the NHS England website for Ultrasound scans. Ultrasound scan - NHS (www.nhs.uk) (accessed 05.05.2022)

NHS Constitution for England. Information on your rights and responsibilities. The NHS Constitution for England - GOV.UK (www.gov.uk) (accessed 05.05.2022)

If you or the individual you are caring for need support reading this leaflet, please ask a member of staff for advice.

This information aims to answer any questions you may have about the ultrasound clinic you have been referred to by your GP.

Why have I been referred?

You have been referred for an ultrasound to examine a lump in your testicle. Your GP has examined you and feels that an ultrasound would provide extra information to understand the nature of the lump.

What is involved in having an ultrasound?

The sonographer will use a probe and some jelly to image the scrotum and testicles. You will need to remove the lower half of your clothes to allow them to scan your testicles. Sometimes they will scan your kidneys at the same examination.

Who will I see in the clinic?

You will see an experienced sonographer who will be able to report the images they see and give you the results. The written report will also be accessible for your GP approximately one week after the scan so if you have ongoing symptoms or are concerned, they will be able to discuss this with you.

Where do I go for the ultrasound scan?

The clinic is held at Southmead Hospital, Gate 18 in the radiology department.

How long should I expect my appointment to last?

The appointment for the scan usually lasts about 20 minutes.

What happens if there are abnormal findings on the ultrasound scan?

There are different causes of testicular lumps or swelling – cysts, fluid collections, hernias, infections but the important thing to rule out or find and treat is a tumour. Ultrasound scans are very good at identifying if a tumour is present.

If the sonographer is concerned that a tumour may be present, you will be informed at the ultrasound clinic and will arrange for you to be seen by a urologist within the next 48 hours at a dedicated fast track urology clinic. This clinic is held at Gate 36 in Southmead.

At this appointment, the urologist will review the findings on the scan, take a history and examine you. If they are concerned that the lump is a tumour you will be fast-tracked to have treatment for this and will have the opportunity to talk to a nurse specialist.

Useful contacts

Patient Advice and Liaison Service (PALS)

To make comments or raise concerns about the Trust’s services, please contact PALS on 0117 414 4569 or email PALS@nbt.nhs.uk.

NHS 111 Service

Offers health information and advice from specially trained nurses over the phone 24 hours a day.

Telephone number: 111

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

Meet the Vascular Testing Team

We are part of the Bristol, Bath, and Weston Vascular Network, working alongside vascular consultants, interventional radiologists, podiatrists and vascular specialist nurses.

We provide a diagnostic scanning service for all inpatients at Southmead Hospital requiring specialist diagnostic vascular ultrasound as well as an outpatient service to the wider North Bristol Trust and local healthcare community.

As well as the vascular network, we work in collaboration with many departments including:

• Stroke services
• Cardiology
• Renal
• Emergency Department 

Our team comprises of six fully accredited vascular scientists (Society for Vascular Technology), two vascular scientists (National Scientific Training Programme) working towards full accreditation and one trainee vascular scientist on the Scientific Training Programme.

The wider team consists of two renal specialist nurses with a Postgraduate Diploma in Medical Ultrasound, two vascular technicians with an NVQ Level 3 diploma in abdominal aortic aneurysm screening and an administration team.

Patient Initiated Follow-Up at Southmead Hospital

We are now offering some of our patients the opportunity to initiate their own follow-up outpatient appointment.  This means that instead of the hospital automatically arranging a follow-up appointment, you will be able to contact us if you need a follow-up appointment, within an agreed timescale. 

If patient-initiated follow-up is suitable for you, your clinician will discuss what it means and when you should contact us.  If your symptoms return, get worse, or do not improve, during the timeframe agreed with your clinician, you will be able to request a follow-up outpatient appointment.

How to request an appointment

You should contact the Centralised Outpatient Services Patient Contact Centre on 0300 555 0103 or visit www.nbt.nhs.uk/outpatients.

Please let the Call Handler know that you are on a patient-initiated follow-up pathway and would like to instigate a follow-up appointment with your specialty team.

You will either be added to a waiting list and an appointment made for you as soon as possible, or the specialty team will contact you directly to discuss your condition. 

If your symptoms return, get worse or do not improve after the patient-initiated follow-up period has passed, you should contact your GP who may decide to make a new referral to the relevant specialty.

Inherited Metabolic Diseases

Suzanne Ford and Simone Whiteway specialize in managing the diets of people with Inherited Metabolic Diseases (IMDs). These are a group of genetic conditions that vary in severity and rarity, and which for some, diet is the primary and often only treatment.

IMDs can result in a dangerous imbalance of chemicals in the blood, which can lead to disabilities, organ damage or damage to the unborn baby. Some of the conditions we help manage include phenylketonuria (PKU) and other amino acidopathies, fatty acid oxidation defects, glycogen storage disorders, disorders of carbohydrate metabolism, organic acidurias, peroxisomal defects, fish odour syndrome and many others. 

We aim to educate patients and their families, carers and other health professionals on the dietary management, food preparation, specialist prescriptions and complex food choices needed in treating these disorders.

Our service is primarily outpatient based, working as a part of the consultant led clinic, and working closely with all members of the IMD team.

If you feel you would benefit from seeing an IMD dietitian, please ask your Inherited Metabolic Disease team or your Consultant Chemical Pathologist.