My experience of A&E

Manxman_in_exile

This is a vent but I think it more appropriate to post on this board rather than the "Vents" board because of the subject matter. I just need to get this of my chest.


Also I'm a former NHS manager and part of my responsibilities included devising admin processes, procedures, flow charts etc. I also appreciate the difficulties of running an A&E dept.


I've been in poor health for 12 months with some kind of GI complaint. I've had several outpatient investigations. My condition deteriorated over the last few weeks. No appetite, dehydration, widely fluctuating bowel habits, significant weight loss. When I started throwing up whenever I tried to eat or drink anything my wife rang 111(?) and was told "Take him to A&E".


First thing is our hospital doesn't have anything known as "A&E". We eventually decide it must be the "Emergency Department". (Sorry - this may seem petty but I'm very pedantic. Why don't they call it A&E?)


We go through the double doors and on the far side of the waiting room is a desk marked "Reception" with two women sitting behind it. Not unnaturally we go straight there. "Sorry, we can't help you. You have to book in first". "What? This is reception isn't it?" They point to a notice on a flimsy bit of A4 paper by the entrance. In small typeface it says "Do not go to Reception. Wait here to be booked in". There's nobody manning it, there's no desk and no chairs. Eventually the single triage nurse appears, writes some notes on a scrap of paper and tells us to take it reception, and then we are told to wait. (We anticipate a longish wait).


The single triage nurse seems to have three duties: first booking people in, and second carrying out triage assessments. Obviously you can't do both at the same time. At one stage I counted 12 people waiting to be booked in. And most of them had made the same "mistake" we had by going straight to Reception!


The nurses third role appeared to be redirecting people to the oxymoronically named "Minor injuries and urgent treatment unit". Minor injuries and non-urgent treatment or Serious injuries and urgent treatment I could understand, but this?


I eventually get triaged and wait again. It doesn't seem that busy to me in the waiting room but a lot of the people coming in have urgent problems. Parents with toddlers with fevers, toddlers who've swallowed pills and a young woman who had been kicked in the face by her horse - she was covered in blood. I recognise these are all more important than me - fair enough, I understand.


After nearly four hours I'm feeling really unwell. I'm shaking, sweating and really anxious. I've not eaten or drunk anything for a long time. I feel weak and faint.


I ask my wife to try to find out how much longer I'm likely to have to wait. About 30 minutes later we are told there are four people in front of me. I calculate that to be 40 minutes to an hour. I say to my wife I can't stay here any longer. Lets go home. We tell the triage nurse. He strongly advises us to stay and if I leave it's at my risk. I'm happy with that.


Following day my wife gets me a GP appointment for 3:15. We see a trainee GP. She lacks experience but she can see I'm really ill and she says she thinks I should be in hospital. She gets a senior colleague for her opinion And she says "Mr ********, I really think you need to go to hospital". And I think "Oh f**k, they're going to send me back to A&E!". But no! The senior GP says "You need to be admitted to hospital NOW, IMMEDIATELY!" She instructs the trainee to contact admissions at the hospital and arrange it. After a ten minute 'phone call I have a place. Four hours later I'm in a hospital bed under observation.


Now why didn't the triage nurse appreciate this on the day before? I had not significantly deteriorated over 24 hours.


Next day I'm transferred from an admissions ward to a Gastro ward. I'm there for a further 5 nights. The care I received from nurses and HCAs was absolutely outstanding - very caring, kind and gentle. For the first few days I was so weak they would not let me out of bed for fear of falling over. I had to be fed, bathed and toileted - all done with great patience and gentleness.


Why was A&E (sorry - Emergency Dept) so bl00dy useless?


I also suffer from episodes of iritis/uveitis and have attended the Eye Casualty Clinic many times. Again the standard of care there is absolutely superb. Also, all the outpatient investigations I've had in the past six months have been very professional and carried out on time.


Again - why is A&E (sorry - Emergency Dept) so poor in comparison?


Apologies for the length of this post but I feel better for sharing my experience with others. I keep on dwelling on my treatment in the Emergency Dept and fuming and getting really angry!

happyandcontented

Sadly, you are not alone. I listened to a very similar tale of woe from a friend yesterday about her husband who is 59 and has Dementia. Twelve hours in A&E waiting to be triaged with a chest infection. It seems to be the norm.

Manxman_in_exile

happyandcontented wrote: »

Sadly, you are not alone. I listened to a very similar tale of woe from a friend yesterday about her husband who is 59 and has Dementia. Twelve hours in A&E waiting to be triaged with a chest infection. It seems to be the norm.

Disgraceful and unacceptable. I got off lightly by comparison.


Apart from the fact the triage nurse couldn't identify I was a genuine emergency, you couldn't devise a stupider process for "booking" people into A&E (sorry - Emergency Department) if you deliberately set out to do so.

ka7e

In my area, the 111 call would have directed you to call your GP (or out-of-hours GP) for an urgent appointment or telephone consultation. It is the lack of urgent or on-the-spot GP availability that results in feverish children and those suffering minor ailments blocking access to Minor Injury Units and A and E departments. A GP referral gets you triaged more quickly - as you discovered!


Our local MIU is fine at dealing with injuries during the day and it takes some pressure off the A and E dept, which is 9 miles away. But once the GP surgeries have closed, it is a constant stream of concerned parents with unwell children coming in for reassurance and Calpol. It means a 3-4 hour wait if you attend with an injury after 6pm as sick children have priority. There is NO triage at all - unless you collapse or are visibly bleeding profusely.


I must add that dementia sufferers and carers get priority treatment with GPs here too. I've always got an appointment same-day or next day for my husband or myself - a 12 hour wait in A and E would be intolerable.

Manxman_in_exile

ka7e wrote: »

In my area, the 111 call would have directed you to call your GP (or out-of-hours GP) for an urgent appointment or telephone consultation. It is the lack of urgent or on-the-spot GP availability that results in feverish children and those suffering minor ailments blocking access to Minor Injury Units and A and E departments. A GP referral gets you triaged more quickly - as you discovered!


Our local MIU is fine at dealing with injuries during the day and it takes some pressure off the A and E dept, which is 9 miles away. But once the GP surgeries have closed, it is a constant stream of concerned parents with unwell children coming in for reassurance and Calpol. It means a 3-4 hour wait if you attend with an injury after 6pm as sick children have priority. There is NO triage at all - unless you collapse or are visibly bleeding profusely.


I must add that dementia sufferers and carers get priority treatment with GPs here too. I've always got an appointment same-day or next day for my husband or myself - a 12 hour wait in A and E would be intolerable.

That's interesting - thanks. I've been telling people to avoid A&E except as an absolutely last resort. I've told them that, if they can wait, to try to get a GP appointment. Fortunately for me, our surgery is just 2 minutes walk away and they can almost always give you an appointment on the day. They also don't try to get you out as soon as possible. On the day I was admitted my GP consultation took over 45 minutes.

Hermia

ka7e wrote: »

In my area, the 111 call would have directed you to call your GP (or out-of-hours GP) for an urgent appointment or telephone consultation. It is the lack of urgent or on-the-spot GP availability that results in feverish children and those suffering minor ailments blocking access to Minor Injury Units and A and E departments. A GP referral gets you triaged more quickly - as you discovered!

I have rung up 111 a few times and got a referral to the nearest out-of-hours clinic and they have always been excellent. They have also often not had any other patients so it seems that a lot of people don't know about them. It was great for me as the doctor was able to spend ages with me but you wonder how many people he could have treated that were currently sitting in A&E.

The last time I went to A&E (for an asthma attack) I found them excellent. The biggest problem was people shouting abuse at me because I was obviously rushed straight to the front of the queue. One woman was yelling about why I was getting priority when I haven't got any injuries. Sigh...

Manxman_in_exile

Didn't think of out of hours service and our nearest walk in is miles away. But the hospital is very close to us.


Usually, if I can't get a GP appointment I go to our pharmacist just five minutes walk away. He's excellent and has given me really good advice in the past. A few months ago he sorted out an emergency script for my wife when she ran out on a Friday evening after forgetting to request a repeat.


Many years ago one of my responsibilities was managing the pre-reg pharmacist training contract at our local university. Many people don't realise what a useful resource their local phsrmacist is. I thoroughly endorse the current (recent?) TV advertising campaign about getting advice from a pharmacist.

daveyjp

happyandcontented wrote: »

Sadly, you are not alone. I listened to a very similar tale of woe from a friend yesterday about her husband who is 59 and has Dementia. Twelve hours in A&E waiting to be triaged with a chest infection. It seems to be the norm.

And that in a nutshell is why A&E has problems.

People attending with medical issues which should be dealt with by a GP.

Chest infection is neither accident or emergency, so expect a wait.

tacpot12

Manxman_in_exile wrote: »

...
Now why didn't the triage nurse appreciate this on the day before? I had not significantly deteriorated over 24 hours.

The triage nurse did appreciate this the day before and told you wait in A&E. Had you waited you would have seen a Doctor and should have been admitted to Hospital immediately. I'm not a doctor or a nurse, and I don't know about running an A&E department but I expect that the nurse is not allowed to admit you.

You took the risk of leaving A&E when you were clearly very ill. No one else is at fault here - apart from some other NHS manager that doesn't care about signage. I'm glad you feel better now that you have shared your experience with others, but the fault is your own.

happyandcontented

daveyjp wrote: »

And that in a nutshell is why A&E has problems.

People attending with medical issues which should be dealt with by a GP.

Chest infection is neither accident or emergency, so expect a wait.

With someone with Dementia who can't easily articulate their symptoms (out of hours) what would you have done?

It was only diagnosed as a chest infection after the hospital visit, and they kept him in overnight. So, with respect, it was exactly the right course of action.

Hermia

Manxman_in_exile wrote: »

Didn't think of out of hours service and our nearest walk in is miles away. But the hospital is very close to us.


Usually, if I can't get a GP appointment I go to our pharmacist just five minutes walk away. He's excellent and has given me really good advice in the past. A few months ago he sorted out an emergency script for my wife when she ran out on a Friday evening after forgetting to request a repeat.


Many years ago one of my responsibilities was managing the pre-reg pharmacist training contract at our local university. Many people don't realise what a useful resource their local phsrmacist is. I thoroughly endorse the current (recent?) TV advertising campaign about getting advice from a pharmacist.

A lot of the out-of-hours clinics I have been to have been held in the local hospital. The NHS really need to be promoting these better as I am sure it will reduce the number of people going to A&E.

Pharmacists are great and people don't use them enough. The local pharmacist now does the medication review appointments at my GP surgery. I really like this as he seems a bit less out-of-touch than the GP and a lot more approachable.