Raigmore Hospital, Inverness

Hospital A&E Information

There are 3 A & E consultants. There is no observation ward and occasionally TBI cases lead to a breach of the 4 hour limit. CT scans are transmitted to the neurosurgeons in Aberdeen for advice and the majority of cases requiring neurosurgery go to Aberdeen. Some are transferred to Glasgow and it is now possible to transmit CT scans to Glasgow.

Those patients not requiring neurosurgery are transferred to a surgical ward under the care of general surgeons.

People discharged from A & E are provided with a head injury advice sheet and a letter is sent to GP within 24 hours. The informant was unaware of any support for head injury patients and routine follow up is not provided.

Hospital Post A&E Information

TBI cases are admitted to ITU or one of 3 surgical wards under the care of one of 8 general surgeons. The surgical wards have a HDU. This includes occasional patients transferred from Caithness General Hospital, Wick or Belford Hospital, Fort William or referred by GP because of problems post injury (e.g. vomiting). They also receive patients from throughout the Highland area (excluding Argyll and Bute) after neurosurgical admission.

Length of stay is usually of the order of one or two days for most admissions but varies.

Those able to be discharged but with persisting impairment (Scenario A) would be referred to the rehabilitation medicine consultant. Alcohol advice is offered to appropriate cases.

Those requiring rehabilitation (Scenario B) are referred to the rehabilitation service within the hospital.

Acute behaviourally disturbed patients (Scenario C) are referred to liaison psychiatry and occasionally transferred to their care. It is possible to get increased nursing staff, including RMN, on occasion. Persisting challenging behaviour (Scenario D) is uncommon and the informant recalls only one case being referred to the Scottish Neurobehavioural Rehabilitation Service (SNBRS) in the last six years.

Similarly vegetative/minimally conscious state cases (Scenario E) are uncommon but might remain in surgical care for prolonged periods prior to nursing home placement.

Hospital Rehabilitation Information

There is a single handed rehabilitation medicine consultant with an 8 bedded unit within the hospital. Advice is provided for TBI patients in surgical wards prior to discharge and many are offered outpatient review appointments. Referrals are accepted and patients admitted from surgical wards at Raigmore; from other acute hospitals (e.g. Belford Hospital, Fort William and Caithness General Hospital, Wick); from neurosurgical units; after periods at Scottish Brain Injury Rehabilitation Service (SBIRS) and from general practice. All patients resident in the Highland area discharged from the rehabilitation unit are offered outpatient review at their nearest location which may be at a peripheral hospital.

Time from referral to admission varies between 3-4 weeks when a bed is not available. In the latter cases allied health professionals will provide input in the referring ward.

Length of stay in rehabilitation varies between 2 weeks and 18 months.

Acutely behaviourally disturbed patients (scenario C) are seen by the liaison psychiatrist but they are no longer accepted to their in-patient facility. Sometimes extra nurses including RMN trained will be provided to assist. Approximately one patient per year will be referred to the Scottish Neurobehavioural Rehabilitation Service (SNBRS). These individuals are difficult to discharge to nursing homes etc. Vegetative and minimally conscious state patients (Scenario E) are rare but would be transferred to a cottage hospital, nursing home or cared for at home with support.

Acutely behaviourally disturbed patients (scenario C) are seen by the liaison psychiatrist but they are no longer accepted to their in-patient facility. Sometimes extra nurses including RMN trained will be provided to assist. Approximately one patient per year will be referred to the Scottish Neurobehavioural Rehabilitation Service (SNBRS). These individuals are difficult to discharge to nursing homes etc. Vegetative and minimally conscious state patients (Scenario E) are rare but would be transferred to a cottage hospital, nursing home or cared for at home with support.

Reviews, Plans and Strateigies

Report of the working group on Services for people with brain injury 2002 is a review of services following the SNAP report and was compiled by a group chaired by Dr Cameron Stark. It estimates the number of people with a brain injury in Highland, their needs, what services are available and what changes they would recommend. However, there are currently no specific plans for services for people with ABI.

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