At the Spinal Cord Injury Unit, we seek to treat people with spinal cord injuries in order to alleviate the related disability and, therefore, improve the quality of life, health and social participation of patients. Here, patients receive comprehensive care for all the deficiencies and disabilities that can be caused by a spinal cord injury.

Every year, the Spinal Cord Injury Unit receives more than 80 patients with acute spinal cord injuries. We also admit about 60 patients with chronic spinal cord injuries to treat complications. Outpatient clinics cover around 1,400 patients, with 200 initial visits yearly, 1,200 subsequent visits and 200 visits from other hospitals.

We have a team of specialised multidisciplinary professionals: rehabilitation doctors who are experts in spinal cord injuries, nurses, clinical assistants, physiotherapists, occupational therapists, phoniatricians, speech therapists and social workers, along with other professionals from other hospital departments, such as the ICU, Spinal Surgery and Neurosurgery. Our mission is to make a referral to the hospital in the best conditions, with early diagnosis and personalised rehabilitation treatments.

A&E and EMS now follow a system of protocols, both for adult and paediatric patients, and care for spinal cord injury has been standardised, taking into account all the professionals who will be handling the disability.

We also take into account the neurological level and seriousness of the injury in order to reduce the hospital stay and achieve the best possible functionality, always including patients and their families.

This collaboration between the professionals involved takes place at clinical sessions twice a week and at the sessions with the rachis surgery team once a week, where the case of the acute patient is commented on and decisions are made about the most appropriate surgical treatments for each vertebral fracture.

The Spinal Cord Injury Unit is a reference centre in Catalonia, Andorra and the Balearic Islands in the care of patients with acute spinal cord injuries. We offer treatment and teach medical residents studying Rehabilitation and Physical Medicine in Catalonia, and we are also very active in research.

Research

Clinical follow-up of people with acute spinal cord injury accounts for 40% of research carried out by the Department, which is reflected in the growing number of articles published and their impact over recent years.

The Spinal Cord Injury Unit participates in international clinical trials related to acute spinal cord injuries. We are currently conducting the first international trial with mesenchymal cells in acute injuries, in coordination with surgery of the spinal column and neurosurgery, which is funded by a joint venture between a pharmaceutical company and a biotechnology laboratory.

Teaching

The teaching activity of the Spinal Cord Injury Unit covers undergraduate, postgraduate and continuing education of professionals in the field of spinal cord injuries. Another highlight is our organisation and management of an online training programme through the 4Doctors web platform.

We also have a preferential agreement with the Step By Step foundation, which organises an International Spinal Cord Repair Meeting (ISCORE) every two years, where the latest advances in basic and applied research are presented.

We give nutritional and diet support to hospitalised patients across all clinical departments at the Hospital, and carry out follow-up monitoring at outpatient care for those patients who need it. We also provide outpatient care for patients referred from other healthcare areas of the Hospital and primary care centres that require specialist nutritional and dietary support. Patients requiring nutritional support are treated at the Horta Primary Care Centre. We actively collaborate in educational programmes to detect nutritional problems and for home monitoring of enteral nutrition, that is, feeding via a tube.

As a transversal unit, we support the General, Maternity and Children’s and Traumatology, Rehabilitation and Burns Hospitals, as well as the Primary Care Office in Sant Andreu; we also collaborate with a range of different medical and surgical specialties. We also participate in and direct a number of joint protocols with various other areas of the Hospital, and we maintain a very close working relationship with the Pharmacy Department, both in developing artificial nutrition and in selecting nutritional products. We act together with the Biochemistry Department in monitoring the nutrition of patients and in pursuing lines of research. We also provide support for the Pere Virgili Health Park.

We work to educate patients and family members, as well as providing courses for our staff through our continuing education programme, and we collaborate on continuing education in primary care. We organise training courses for primary care nursing staff, nursing staff from the Hospital and our orderly staff. We also educate patients and relatives about managing enteral nutrition, parenteral nutrition, as well as nutrition in cases of nephrology and inflammatory bowel disease.

Portfolio of services 

During a hospital stay, the nutrition support we provide might cover:

• Diet: adapted and/or personalised diet. In some cases where a conventional diet is not able to meet the needs of patients, nutritional supplements are prescribed.
• Artificial nutrition (enteral or parenteral) according to protocol. Prescription, preparation and monitoring of efficacy and safety of the treatment.

Once a patient has been discharged, we continue to monitor nutritional treatment through:

• Home nutrition programmes (enteral and parenteral)
• Nutritional evaluation and support through consultations
• Daily consultations with a nutritionist
• Preparation of diets after discharge for different diseases

In short, we prepare diets for hospital patients, always taking into account menu alternatives, menus for treatment and diet changes depending on patient cycles. We work together with the Catering Unit to organise and prepare the hospital’s catering operation.

Finally, we also take care of preparing and distributing baby bottles, baby food and special liquid meals for healthcare units, as well as collecting and cleaning utensils.

Teaching

Our teaching work includes:

• Training undergraduate doctors and specialists in endocrinology and nutrition in accordance with the medical residency programme
• Undergraduate training in diet and human nutrition (University of Vic, University of Navarre, University of Barcelona, Blanquerna University, Polytechnic University of Valencia, University of Zaragoza)
• Degree in Dietetics and Human Nutrition (University of Barcelona, Blanquerna University)
• ERASMUS exchange programme for dietitians (Portugal, Mexico, Italy)
• Extended visits for dietitians from abroad (Argentina, Mexico)
• Postgraduate training: Master's degree in nutrition from the Autonomous University of Barcelona (Autonomous University of Barcelona, University of the Balearic Islands, University of Granada)
• Periodic clinical sessions: reviews and clinical cases

Vall d'Hebron handles the most priority 0 and 1 Code Polytrauma cases (the most serious cases) in Catalonia, and we are the only Centre for Specialised Trauma Care, with the highest possible category for patient care with polytrauma.

As a level three hospital, we offer all the departments and units necessary for 24-hour emergency and specialist care of patients with emergency trauma. This is known as Traumatology Intensive Care, which includes: conventional and interventional radiology and CAT (scans); care for acute bone marrow trauma; neurosurgery and thoracic, vascular, cardiac and maxillofacial surgery. General, orthopaedic and traumatology surgery, as well as surgery of the rachis (spine) and other highly specialised services.

The Hospital has a special department for exploration of patients in such cases, with the possibility of x-rays and an adjoining operating theatre. The centre also treats paediatric patients using the same systems, but at the Maternity and Children’s Hospital. We also have a top level care ward, with several separate bays, a polytrauma care ward, an observation ward, two operating theatres, as well as support from the Intensive Care Unit (ICU) and the Resuscitation Ward.

Our Unit is responsible for an intensive training programme in advanced trauma care for the professionals involved. All of our staff know how to proceed at all times, and have highly defined tasks to guarantee our ultimate goal: ensuring the survival of patients with polytrauma and their recovery.

Our Department is home to a large number of practitioners involved in admitting patients with both simple and complex traumatisms and poly-traumatisms in the Accident and Emergency Department, as well as throughout the duration of the treatment.

As it is located within Vall d'Hebron University Hospital, we are able to take a multidisciplinary approach to the treatment of patients with musculoskeletal pathologies, in close collaboration with the Radiology, Neurophysiology, Anaesthesia, Intensive Care, Rehabilitation, Neurosurgery and Plastic Surgery Departments.

Our objectives are excellence in care, research and teaching. Our Department has a significant number of resident doctors, and hosts regular visitors from other centres from Spain and abroad.

Portfolio of services

We are specialised in paediatrics, shoulder surgery, microsurgery and neuroorthopaedics, wrist and hand, hip, ankle and foot, knee, osteoarticular reconstruction, septic and tumoural pathology. We also specialise in patients with traumatism and surgery of the spine.

The Department is organised into functional units and subunits, each of which deals with a particular area of the pathology. This means professionals can train in a wide-reaching specialty with a multitude of surgical techniques that are constantly evolving.

Many of our units are considered reference centres by the Spanish Ministry of Health, such as the Septic Pathology Unit, the Pelvic Osteotomy Unit and the Children's Orthopaedic Unit. Finally, the Department is also present in other areas, such as the Outpatient Surgery Unit at the Pere Virgili Health Park.

Our Department offers a consolidated portfolio of services, and we have a pharmaceutical team that monitors all registered prescriptions and pharmaceutical treatments.

We are responsible for distributing, dispensing and preparing medications with automatised systems and robotics, with one of the most significant technological systems in Europe. We use a system of drug-use indicators based on case histories to assess use of medication. This helps us detect opportunities for improvement, both in terms of security and reducing variability in clinical practice, meaning avoiding differences in the way our staff prescribe treatments.

The Department enjoys ISO 9001-2008 certification, which specifically covers prevention of medication errors. We have established a quality policy aimed at satisfying the needs and expectations of patients, and providing the services that contribute to improving quality of care through personalised attention for effective, efficient and safe drug treatment, while improving our systems.

Our main objective is to ensure our Department continues to contribute value to patients, bearing in mind the conditions at any given time in the Hospital, the Catalan Health Institute and the Catalan Health System in general. For this reason, between 2009 and 2015 we followed a strategic plan that uses the Balanced Scorecard methodology. This strategic plan takes into account new scenarios, social changes and emerging trends, which all necessitated a thorough review of our methodology, in a spirit of critical creativity and continuous improvement.

Rapid evolution in concepts and technology has resulted in the Pharmacy Department receiving several awards and honourable mentions for our clinical innovation and excellence.

Portfolio of services 

Guidance in drug use and management

• Promotion and participation in the selection of medication to be used by the Hospital and primary care. For this reason we contributed to the development and help update the "Pharmacotherapeutic Guide", based on criteria of efficacy, quality, need and cost.
• Preparation of clinical guides and treatment protocols agreed with the rest of the Hospital’s clinical departments.
• Assessment of medication use using a system of drug-use indicators. This helps us detect opportunities for improvement, both in terms of security and reducing variability in clinical practice.
• Organisation and participation in continuous training to increase quality in drug treatment decision making: seminars, clinical sessions and courses accredited by the Catalan Council on Continuing Education.
• We also respond to medication inquiries we receive from the Drug Information Centre of the Vall d'Hebron University Hospital Pharmacy Department (CIMSFHUVH). We collaborate with the Catalan Drug Information Centre (CEDIMCAT).
• We produce newsletters.
• We participate in committees where pharmacists’ knowledge can be useful.
• We carry out studies of medication use.
• We draw up technical reports to assess medications, using a proof-based methodology.

Dispensing of medications

• We offer a service for the Dispensing of Medication in Units that is deployed at all beds at Vall d'Hebron University Hospital, and where this is not available, we use automated medication dispensing systems.
• We provide all necessary information on the administration of medications with an electronic nursing file.
• Special dispensing methods for medications in clinical trials, cytostatics, narcotics and compassionate-use drugs.
• Automated distribution systems.
• Alternative distribution/dispensing systems:
• Dispensing with subsequent intervention by pharmacist: replacement by patient
• Dispensing of medications using a protocol by patient (CMA)

Preparation of medications 

• Preparation of both magistral and standardised formulas.
• Preparation of special dosing regimes.
• Intravenous therapy unit, with the preparation of: parenteral nutrition and intravenous mixtures
• Re-packaging of oral dosage into unit doses.

Financial management 

• Management of purchases: in the framework of the Law on Public Administration Contracts.
• Management of stock: existence of a single, fully automated, general store (KardexCarroussel (R)), which restocks sub-dispensers located in different buildings, also automated (Kardex (R) vertical), all integrated into the IT system.
• Preparation and monitoring of budgets.
• Clinical management of consumption.

Participation in deciding the treatment plan for patients

• Participation in the multidisciplinary team to help decide medication for treatment, with the safe and efficient use of medicines as the main objective.
• Monitoring of treatment and pharmaceutical intervention (prescription management) and analysis of its impact.
• Conciliation of the medication of patients admitted, adapting home medication to Hospital’s Pharmacotherapeutic Guide after evaluation of the treatment.
• Information and advice on the treatment of discharged patients, with the use of software to create personalised medication planning.
• Clinical pharmacokinetics. Design of individualised posology.
• Lines of pharmacological and clinical specialisation, such as: individualised parenteral nutrition, oncohaematology, antimicrobial therapy, antiretroviral therapy, critical patients, biotechnology, paediatrics, neonatology, and geriatrics.

Structurally, we distinguish between two levels of treatment complexity at the Traumatology Intensive Care Department: one intensive, or high complexity, and another semi-intensive, or medium complexity. The Neurotraumatology Intensive Care Medicine Department has an Intensive Care Unit (ICU) and a Semi-Intensive Care Unit.

The Neurotraumatology Intensive Care Unit presents the following characteristics:

• Specialised staff with extensive experience.
• A good location, as it is on the 1st floor, near the A&E Department and the scanner, and allows for easy evacuation of patients in case of emergency.
• The Intermediate Care Unit helps provide progressive care for certain ICU patients, as well as helping treat patients who, though not suitable for intensive care, might not be able to be admitted to a hospitalisation ward.
• Neurotraumatology Clinical Research Unit.
• Reference unit in Catalonia for acute spinal lesions.
• Reference unit for Catalonia in the treatment of patients diagnosed with malignant infarction of the middle cerebral artery.
• The Unit enjoys an extremely high level of credibility and prestige, making it the first option for medical residents from all over Spain and other specialists to update their knowledge in our areas of reference.  

Research 

Most of the research and clinical trials carried out at the Neurotraumatology Intensive Care Unit are carried out through the Neurotraumatology and Neurosurgery Research Unit (UNINN), set up in 1992.

The UNINN is composed of a multidisciplinary team (neurosurgeons, intensivists, anaesthetists, neuroradiologists, rehabilitators and neuropsychologists), and support staff contracted by the Unit. It has carried out several subsidised research projects, doctoral theses and multicentre, international clinical trials, which are carried out largely at the Traumatology Intensive Care Medicine Unit.

The Neurotraumatology and Neurosurgery Research Unit has two co-directors, namely Dr J. Sahuquillo and Dr M. A. Poca, from the Neurosurgery Department, and Dr A. Garnacho, from the Neurotraumatology Intensive Care Unit.

At the Plastic Surgery and Burns Department, we handle congenital or acquired diseases that affect soft tissue and bone, traumatisms and large burns, as well as specialising in face, limbs, grafts, treatment of tumours and significant deformities and regeneration of tissues and reparative microsurgery, and more.

We treat diseases that require the use of plastics and tissues in the form of flaps and biomaterials. For these treatments, we often use advanced wound healing, microsurgery and endoscopy techniques. We treat the whole body, but focus on the face, the skull and the neck, as well as the torso, in particular the mammary glands, and the extremities, especially the hands and the legs.

Our main objective is reparatory surgery. We specialise not only in techniques for transplants of the face and extremities, but also in biomaterials and tissue regenerators, adult stem cells and reparative microsurgery.

With over 50 years of history, Plastic Surgery and Burns Department is a leading centre in severe burns and a Spanish Reference Centre (CSUR) for complex reconstruction of the auricle, microtia, face and hand treatment and stem cells and major catastrophes. Tragedies such as the Hipercor terrorist attack and the fire at the Els Alfacs campsite are examples of this.

Plastic surgery is highly focused on hospital services and is a multidisciplinary specialty, characterised by constant innovation, the relationship with other specialties and the constant search for excellence. We were pioneers internationally in total facial transplants and in treatment with stem cells for burn scars.

Our Department is home to many functional units, and we participate in various multidisciplinary teams from other specialties; the Burns Unit, the Microtia and Facial Malformation Unit, the Breast Pathology Unit and the Face and Extremities Transplant Unit are all worthy of mention.

At the Anaesthesia Department, our mission is to offer comprehensive perioperative care, from the moment the patient arrives at the clinic or hospital, during the operation and beyond.

We have a staff of professionals specialised in all areas, essential for the large number of transplants of all kinds that are performed at our Hospital. We should also mention our nursing team specialising in anaesthesia, who begin their career at our Department.

The Department is divided into four main geographical and care areas:

• Traumatology, Rehabilitation and Treatment of Pain Hospital
• General Hospital
• Maternity and Children's Hospital
• Pere Virgili Hospital with distance pre-anaesthesia consultation (major outpatient surgery)

The Department encompasses several key working areas:  

• Research
• Training
• Simulation
• Teaching

Outpatient preoperative consultations work with primary care in processes such as obstetrics and endoscopy labs. Preparatory and postoperative care are of vital importance in establishing a good flow of patients, especially in areas such as resuscitation.  

Patients attended to by the Pain Unit have often been treated previously. This is due to the nature of their problem and the difficulty in solving the symptoms they suffer. This is why we have established fast-stream resolution and care schemes using a mobile application. Patients can inform us from their home of the degree of pain, thus improving their quality of life.