Neurosciences Emergency Admissions and Bed Management
Neurosciences
The Atkinson Morley Neuroscience Centre provides tertiary neuroscience care to a regional population of 3.5 million in
South West London, Surrey and Sussex and some district neurology and neurosurgery services to the local
population.
The Neurology service includes a Regional Head Injury Service and Hyper Acute Stroke Unit providing specialist
stroke services to the population of South West London.
There are approximately 7000 admissions to Neurosurgery and Neurology annually with Neurosurgery carrying out
between and 2400 – 2500 operations of which 60% are emergencies.
Neurosurgery also runs one of the busiest neuro-oncology services in the country and manages approximately 1300
patients a year with brain and other central nervous system tumours. These patients form a large part of our elective
admissions.
Stroke at St Georges is one of the leading stroke services in the UK. There is a twenty bedded HASU to provide
service to patients from South West London, and also a sixteen bedded Stroke Unit providing services for local
patients. This service has approximately 2000 admissions per year.
St George’s also acts as a regional and national referral for specialised stroke cases. We have a well developed
carotid intervention service offering endarterectomy and stenting in collaboration with the regional vascular surgery
unit also housed at St George’s and receive referrals from throughout the district for this.
Neurosciences bed configuration;
Ward
Location
Kent
Number of beds
Third Floor
8 Head Injury
William Drummond
Third Floor
22 Neurology (incl 4 dedictate Video
Telemetry beds with IT/camera wiring)
20 Hyper Acute Stroke Unit
Brodie Neurosurgery
Second Floor
14 Neurosurgery (Female)
Brodie Stroke
Second Floor
16 Stroke Unit
McKissock
Second Floor
24 Neurosurgery (Male)
The bed configurations are based on Service Specifications set by commissioners and the demands experienced by
each service. The Neurosciences staff will flex the non-stroke beds after discussion with the clinicians and a review of
the tertiary emergency and elective demands.
The following emergency conditions have to be admitted to St George’s as a tertiary Neurosciences centre;
Neurosurgery/TBI;
Cranial extradural haematoma regardless of whether a craniotomy is required
Cranial acute subdural haematoma requiring craniotomy
Clinically suspected blocked VP shunt
Acute hydrocephalus with clinical neurological deterioration of GCS (eg Subarachnoid haemorrhage, colloid
cyst, tumours) or with radiological evidence of likely imminent deterioration or coning
Acute deterioration in GCS of chronic, or acute onset chronic subdural haematoma, intracerebral haematoma
or where there is radiological evidence of likely/ imminent coning
Clinically suspected cerebral abscess with consistent contrasted CT or MRI imaging
Cerebral tumour with mass effect and acutely deteriorating GCS despite 16 mg iv dexamethasone
Painful 3rd nerve palsy with proven posterior communicating /superior cerebellar artery aneurysm on CT /MRI
Stroke patients being considered for craniectomy.
Acutely deteriorating cord compression from trauma, tumour, infection, haemorrhage, acute disc herniation.
Not from central cord syndrome or degenerative changes alone. Patient must have been on strict bed rest and
in the case of tumour, acute disc or haemorrhage, also on dexamethasone 16 mg IV loss
Proven central lumbar disc herniation with established perineal sensory + incontinence / urinary retention
Acute traumatic brain injury on CT brain scans
All of these patients can be managed and placed as directed by the Neurosurgical SpR and consultant on call
and do not normally require site management intervention unless they are admitted via St George’s A&E
This will only happen if Neurosurgery have no beds to admit directly to.
Stroke; these must be brought into A&E and placed via the Neurology/Stroke SpR on call
All ?Stroke patients who are ambulanced into A&E (from home/community or another Hospital)
All patient found to have a medical condition should be referred back to their local DGH and either transported
back or placed under the team that would normally care for a patient with that condition
The Neurosciences bed manager will ensure elective admissions are reviewed daily and prioritised along with the
emergencies awaiting transport to a neurosciences bed.
The Neuroscience Management team, in liaison with the DDNG for Neuro/Surgery/Theatres will make a decision on
the opening and staffing of the Neuro Day Unit (NDU) – this will also take into consideration the patients due to come
into the NDU at 7.30am.
Key criteria for placing patient in the NDU;
 All patients must be of the same sex and fulfil the criteria below:
 The patient should be mobile and require minimal nursing assistance
 The patient should be able to be fully dressed in the day time
 The patient is a neurosciences patient
 The patient is pre – operative and is due to have surgery the following day
 The patient is due to be discharged the next day from a neurosurgical or neurology ward
Stroke patients should not be accommodated within the escalation area.
The Neurosciences bed manager will ensure that there are;
1-2 HASU beds empty at 7.30pm, failing that they will identify 2 patients who can be moved to alternative beds
to provide acute stroke beds
1-2 Neurosurgical beds empty at 7.30pm, failing which they will identify 2 patients who can be moved to
alternative beds
This will be based on the proviso that there are no patients in a neurosciences bed that does not have both a neuro
condition and is not under neuro consultant (ie outliers) and following discussion with the Neurosciences on call SpR’s
Any further placement of patients should be discussed with the Neurology/Stroke (bleep 7277) and Neurosurgery
(bleep 7242) SpR on call who will be able to advise on the tertiary nature of their demand.
If the rare event that the clinical priority cannot be agreed by the two Neurosciences SpR’s the two
consultants on call will need to be contacted.