A Day in the Life of an Intensivist at Hospital, NHS : a remote and rural hospital.

Mike Duffy

Where I work

Raigmore Hospital, , is the main Hospital for the NHS Highland Health Board area and has 460 in-patient beds. The region covers an area of 15,000 square miles, which represents approximately 41% of the Scottish and 11% of the UK land surface (an area the size of Belgium). The area is highlighted in blue on the map and it also provides certain services to the Western Isles Health Board (Outer Hebrides) – the total population covered being 320,000. The catchment area comprises the largest and most sparsely populated part of the UK with all the attendant issues of a difficult terrain, rugged coastline, populated islands and a limited internal transport and communications infrastructure. The area is recognised for its outstanding natural beauty and access to all sorts of recreational activities such as road and mountain biking, sailing, hiking, climbing, fishing, snow sports and all kinds of water sports. The famous North Coast 500, ''s Route 66' has been named one of the top coastal road trips in the world is a major tourist attraction. The Scottish Highlands are fantastic place to live and bring up a family and provides a great work-life balance.

Map of NHS Highland

INVERNESS

Critical Care Services

The current intensive care unit is equipped to take 7 Level-3 critically ill patients and has around 450 admissions each year. There is a separate 6-bedded surgical HDU and an 8-bedded Medical HDU. All the critical care units have nearly completed a major refurbishment and upgrade and, in May 2018, the ICU and Surgical HDU co-located to a completely new unit that is adjacent to the main theatre complex. This exciting development provides fully updated facilities and equipment. The combined unit has 16 beds – nominally 8 level-3 ICU beds and 8 surgical HDU beds, but works flexibly. The case mix of admissions is very variable – there are frequent polytrauma cases ranging from climbing accidents in the Cairngorms to motorcycle accidents on the rural single track roads. Patients that require cardiac or neurosurgical intervention are transferred to Aberdeen which is about 2.5 hrs away by road ambulance. There are about 12-15 paediatric admissions/ year and the majority of these are retrieved from PICU teams (ScotSTAR), but due to the distance that has to be travelled, and also the challenging weather conditions, this can sometimes take longer than would be the case in other parts of the UK. The elective surgical workload that is on-site covers predominantly vascular, lower and upper general surgery, including liver resections and oesophageal/gastric resections, and major urology. The emergency surgical and medical admissions are varied as well and are probably similar to hospitals of a similar size.

How we work

There are 8 consultants who have daytime sessions on the ICU and the on-call is dedicated to intensive care and shared between us. We are a happy and cohesive team and frequently meet to discuss various issues. We have formal time set aside for consultant, clinical governance and audit, and general MDT/departmental meetings. Key departmental roles have been allocated within the group and we have been encouraged to develop various trust, regional, and national roles. Our working patterns have been specifically designed to give a sustainable and healthy working pattern for members of staff whilst at the same time aiming for the best quality and continuity in patient care. A ‘consultant of the week’ covers the days on the ICU from 0800 -1800 hrs Monday to Friday and is then on-call for 24 hrs on the Saturday. The weekends are ‘split’ – another consultant will cover the Friday night and the 24 hrs on the Sunday. The week following an ICU week is a ‘Zero-hours’ week when we are not expected to be in the hospital at all - this is a great way to catch up with some family time and means that we can actually enjoy the beautiful area that we live in. The remaining 6 weeks of the rota cycle are spent delivering anaesthesia in theatre (but could equally be another speciality), the share of the ICU mid- week night-time on-calls, and other supporting professional activities.

Why might someone work in this environment

A number of the consultants working on the ICU have moved from other regions of the UK, and we are all very happy with the move. There are great colleagues, both medical and in the whole multidisciplinary team, we have an interesting and varied job with great potential for development, and we live in a fantastic part of the UK with outdoor opportunities second to none! Finally, I have written this article as I am a member of the FICMCRW committee – this is made possible as Inverness has excellent transport links – there are daily flights to London, amongst other destinations, and the flights get in early enough to make all the meetings in London. www.highlandcriticalcare.com