My experience of A&E

Manxman_in_exile

I still don't know whether to laugh or to cry!


My wife noticed "flashes" in her right eye last night. I know this can be a sign of a detached retina (serious).


Got an opticians appointment this afternoon and he said it could be a detached retina but he could not confirm this (?). The Eye Clinic was closed over the weekend (see below) so he had no option but to send her to A&E with a referral letter. Could not wait until Monday.


I drove her to the Emergency Department thinking "here we go again". Went through the stupid booking in process, but this time she was diverted to the Minor Injuries and Urgent Treatment Unit. (I'm wondering if that is where I should have been sent for urgent treatment?).


We go to MIU and the experience there is the complete opposite of my experience three weeks ago! I had noticed when we booked in at the Emergency Dept that the waiting room was almost empty, but when we got to MIU it was overflowing with people - children, fractures, footballers and rugby players with dislocated fingers and shoulders.


But, in contrast to the Emergency Dept, the MIU is run sensibly and efficiently. Very helpful receptionist. And after we'd seen reception an elderly volunteer approached us with a patient satisfaction survey assuring us that management really were concerned to have feedback about how A&E was working. They needed to know what patients thought of the service to be able to keep on improving it - absolutely right! This categorically did not happen on my visit to Emergency three weeks ago - and I think I know why!


My wife is seen by a triage nurse who says she needs to be referred to Eye Casualty, but that only a doctor can do that. (The nurse is also surprised that the optician could not give a more definitive diagnosis). Not long after she's seen by a doctor who thinks there probably is no problem but he refers her to Eye Casualty and gives her an appointment for the following day (Sunday).


And that's it - in and out of MIU in less than two hours.


How can two different units in the same department be so far apart?


(Also in MIU, doctors and nurses were all over the place).

Manxman_in_exile

Frogletina wrote: »

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So, maybe she shouldn't have taken him - but 6-10 hours wait for a 5 year old? And if the triage nurse wasn't able to assess that he didn't need to be there, how was my daughter able to assess that herself?

frogletina

A very good point!

Loanranger

I experienced flashing lights and black floaters, like long spider legs. Emergency appt at Eye Casualty on a Sunday. They diagnosed a tear in the retina. They lasered there and then. It did not hurt at all. They use anaesthetising eye drops. Your wife will not be allowed to drive home after any eye drops.
I had to have the procedure repeated a week or so later and then again treated with cryotherapy. None of this was painful in any way.

GlasweJen

Frogletina wrote: »

My grandson who is 5, and autistic, fell on his hand, hurting his finger, first at school, and then at home. He wouldn't let my daughter look closely at his hand and was screaming in pain, unable to explain how bad it was due to his autism.

My daughter was worried that he had damaged it and took him, and his 3 year old brother, to A&E where he was triaged, and she was still there 6 hours later by which time it was midnight and by then he was crying because he was so tired and wanted to go home.

My daughter with 2 very tired children asked how much longer she would have to wait and was told it could be another 4 hours. So she gave up and went home.

Fortunately, my grandson was fine in the morning, and on examining the finger my daughter was no longer worried about it.

So, maybe she shouldn't have taken him - but 6-10 hours wait for a 5 year old? And if the triage nurse wasn't able to assess that he didn't need to be there, how was my daughter able to assess that herself?

frogletina

Triage nurses aren't allowed to discharge people or turn them away, they just work out what order people have to be seen in and escalate to a doctor if the person is a high triage category.

There's usually 4 triage categories: cat 1 is immediately life threatening: heart attack, stroke, RTA, cat 2 is in urgent need of a medic, just a step below cat 1. Cat 3 is needs a doctor but won't die waiting, 4 is turned up and could have probably seen a GP/practice nurse.

Triage can note special needs like that the person is a child or has dementia but if they're a 4 they go to the front of the other 4s, they won't put a 4 in front of a 2 because the 4 happens to be a child.

Where I worked before (Glasgow) they had a child's A&E, it often had a huge wait, under 2s could be prioritised but everyone else was strictly to triage category.

Frogletina

GlasweJen wrote: »

Triage nurses aren't allowed to discharge people or turn them away, they just work out what order people have to be seen in and escalate to a doctor if the person is a high triage category.

There's usually 4 triage categories: cat 1 is immediately life threatening: heart attack, stroke, RTA, cat 2 is in urgent need of a medic, just a step below cat 1. Cat 3 is needs a doctor but won't die waiting, 4 is turned up and could have probably seen a GP/practice nurse.

Triage can note special needs like that the person is a child or has dementia but if they're a 4 they go to the front of the other 4s, they won't put a 4 in front of a 2 because the 4 happens to be a child.

Where I worked before (Glasgow) they had a child's A&E, it often had a huge wait, under 2s could be prioritised but everyone else was strictly to triage category.

Maybe replace the triage nurses with doctors' receptionists!

Only joking, they are good at my GP surgery...but years ago I often had a battle to prove I needed an urgent appointment.

frogletina

Manxman_in_exile

Glaswejen - I suspect I was wrongly put in category 3 rather than category 2.


Certainly my GP the next day was in no doubt that I needed to be admitted to hospital immediately.

Manxman_in_exile

Loanranger wrote: »

I experienced flashing lights and black floaters, like long spider legs. Emergency appt at Eye Casualty on a Sunday. They diagnosed a tear in the retina. They lasered there and then. It did not hurt at all. They use anaesthetising eye drops. Your wife will not be allowed to drive home after any eye drops.
I had to have the procedure repeated a week or so later and then again treated with cryotherapy. None of this was painful in any way.

Yeah - our Eye Casualty is excellent - I've had to visit it frequently to have bouts of iritis treated. The last time, apart from having to put steroid eye drops in every 30 minutes for three weeks, I also had to have four steroid injections into the inside of my lower eyelid. The anaesthetic eye drops they use are great and I never felt a thing.


I'm confident my wife will be in good hands at Eye Casualty

GlasweJen

Manxman_in_exile wrote: »

Glaswejen - I suspect I was wrongly put in category 3 rather than category 2.


Certainly my GP the next day was in no doubt that I needed to be admitted to hospital immediately.

I was correctly triaged as a 3 for appendicitis, I only became a 2 when I stopped screaming and they realised it had ruptured. When I went to a 2 I was seen within half an hour and was en route to theatre at 1130pm.

2 is deathly ill but not actually going to die imminently so the fact you survived the night means you were probably a 3 and it was the correct category.

System

I think you're quote harsh tbh. I work in a&e and there's a lot going on behind the scenes so as somebody in the waiting room it may appear that people aren't being seen promptly but that's because there are already 10-20 patients behind the next door that are seriously ill waiting for beds to enable you to then have your turn to be seen.

I have to explain this daily to patients and relatives when they're frustrated but the hospital is like a conveyor belt. If we have 50 patients in that need to be admitted then we need 50 beds empty in the hospital it just doesn't happen consistently therefore there is a bottleneck in a&e.

We have see and treat rooms which is supposed to be like a walk in so u see the patient give them their diagnosis and treatment and then send them home.... however if there's 5 rooms you can quickly get 4 really poorly patients come in to see and treat and you simply can't send them out into the waiting room because they need obs and iv treatment etc... now we're down to 1 room for the whole of the waiting room... Fingers crossed another poorly doesn't come in.

In my experience I honestly don't think it's down to staffing levels. It is down to supply and demand. The demand on a&e is just TOO high to be met by the physical capacity of the hospitals.

Unless they build more rooms and beds and wards. Or patients agree to top and tail (joking lol) then there's not much more the triage nurse can do.

morgandlin

A lot of it is down to bed vacancies.

Until they can find a patient that needs to be admitted a bed, then they clog up A&E.

It recently took 4 hours to get my Dad even transferred from Ambulance care to A&E care, simply because of lack of space.

There were beds in corridors, two patients per cubicle and reclining chairs bought down, and still the ambulance crews were lined up in the car park.

My husband was shortly afterwards taken by ambulance to another hospital. He was taken to Resus straight away and brilliantly looked after, but then it took 15 hours to find him a bed to be admitted.

Apparently, they were having trouble getting some older people a care package to enable them to be discharged and free up some beds.

Meanwhile, A&E visitors were queing out of the door - with a lot of druggies, alcoholics, and mental health patients all yelling.

Until there is a proper triage system, that can send tinewasters back to their GP, the chaos will go on.

We also need to sort out adequate social care to stop the bedblocking.

I don’t blame the doctors and nurses, it’s down to lsvk of enough hospitals, lack of beds, lack of a sensible A&E system, and lack of decent social care..