My experience of A&E

humptydumptybits

Manxman_in_exile wrote: »

Understood - and this is part of the problem with A&E. Complete uncertainty as to when you will be seen by a doctor as more and more people come in - some more urgent/higher priority than you. Although I note an earlier poster suggested that there is no triage in some A&Es.


Your seven hour wait makes me look like a whinging wimp!

Bloody useless NHS, why aren't they using crystal balls? I mean if they started the day knowing that there is going to be a pile up on the ring road, little Johnny is going to decide to take mum's anti depressants and Jenny is going to be thoughtless enough to break her leg in the gymnastics club they could tell you exactly how long you would have to wait.



By the way as you had been ill for several days did you think to ring them the day before to warn them that you would be coming in rather than getting an appointment to see your GP? I'm sure that sort of planning ahead would help everyone.

humptydumptybits

Just wanted to add that when I had to go to A& E a few months ago I found them absolutely brilliant. My GP did a telephone triage and told me to go to hospital, checking I had someone to drive me there, andI was triaged, had a ECG and was admitted within an hour.



Similarly a couple of years ago I took son to see out of hours GP and was told to get him straight to A&E where a team would be waiting for us. Oh yes I thought likely story, but sure enough when I gave his name a nurse magically appeared rushed us through to a cubicle where a doctor was getting ready to set up IV antibiotics and lance the quinsy that was by now obstructing his breathing.


Unless it is a sudden emergency/accident then I recommend going through GP, as I found you don't even have to see the GP as my telephone triage worked perfectly.

Manxman_in_exile

My wife had her appointment at Eye Casualty this morning.


The Specialist Practitioner nurse who tested her sight and dilated her pupils was also surprised that the optician who had seen her the day before apparently did not have access to a split lamp and couldn't examine her eye properly. (All the times I've had my eyes tested the optician has always used a split lamp, but maybe that's because I'm a known iritis/uveitis sufferer).


Twenty minutes later the doctor called her in. After ten minutes she returned and told me the doctor had given the OK and there was nothing to worry about unless it got worse.


He also said the optician was completely wrong to refer her to A&E, and that he should have referred her direct to Eye Casualty, as, not surprisingly, they were open at weekends! The optician never rang them to find out if they were open. So that's another two hours wasted in Minor Injuries and Urgent Treatment. This was not A&E's fault, but I'm not sure why they referred her to MIU rather than Eye Casualty?


Anyway, we were in and out of Eye Casualty in 65 minutes.


I'm more than a little bewildered as to why my wife received a first class, efficient and relatively speedy service in both Minor Injuries and Urgent Treatment, and Eye Casualty, when there was nothing wrong with her (we hope!), whereas I was seriously ill and received what I can only describe as steerage class service in the Emergency Department.


I assume the purpose of MIU is to alleviate some of the pressure on the Emergency Department. Now if they use a similar triage classification as Glaswejen has described, then I think the only people who should be in Emergency are those falling into categories 1 and 2. I think category 3 should be in MIU (and I'm wondering if that's where I should have been sent for Urgent treatment). I'm also wondering whether people in category 4 ought to be sent home and told to see their GP/Practice Nurse/Pharmacist. So long as people who shouldn't be in A&E are accepted, there are always going to be logjams in A&E. (I know, I know - it's not as straightforward as that).

Manxman_in_exile

tessiesmummy wrote: »

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.

.

I fully understand that, but the following day the hospital agreed to admit me to an inpatient bed immediately after a ten minute 'phone call from my GP. I don't actually know how seriously ill I was, but I assume that for this to happen it must have been recognised by my GP and hospital admissions to be sufficiently serious to admit me there and then.


Please understand, I'm not suggesting that there is some simple solution to the problems facing A&E (indeed, there may be no solution at all). It's just that I was very disappointed with my first hand experience of A&E. And I was even more disappointed when I accompanied my wife to MIU and Eye Casualty, and compared her experience to mine three weeks earlier.

elsien

80 year old parent collapsed while out and about and was ambulanced to A&E.
On arrival she was told that as it was 7pm on a Tuesday, it shouldn't be a long wait. At 1am she's still in the corridor along with many other patients, waiting for a cubicle and an ECG. She was feeling ok by then so didn't mind because she could see how busy they were and when she did get seen, the staff were very good.
We were just very relieved it was a supposedly quiet night. Lord knows how long she'd have been there on a Friday or Saturday night.

The whole system seems to be grinding to a halt and I do think more education should be part of it. I had a work colleague who despite first aid training had an instant reaction of A&E for pretty much everything including cut fingers. At work I could tell him not to be so silly and to get the plasters out but him and his kids did seem to have their own seats in A&E.

Nicki

Manxman_in_exile wrote: »

I fully understand that, but the following day the hospital agreed to admit me to an inpatient bed immediately after a ten minute 'phone call from my GP. I don't actually know how seriously ill I was, but I assume that for this to happen it must have been recognised by my GP and hospital admissions to be sufficiently serious to admit me there and then.


Please understand, I'm not suggesting that there is some simple solution to the problems facing A&E (indeed, there may be no solution at all). It's just that I was very disappointed with my first hand experience of A&E. And I was even more disappointed when I accompanied my wife to MIU and Eye Casualty, and compared her experience to mine three weeks earlier.

And if you were triaged as Class 3, as Glawejen has explained, and furthermore were advised not to leave, this is all consistent. Classes 1 and 2 both covered those who had imminently life threatening conditions. Your condition didn’t worsen appreciably after leaving the hospital and spending a night at home with no access to medical treatment or supervision. You did need medical treatment (ie you were Class 3) but you were stable and it wasn’t critical that you be seen in the few hours that you waited in A&E as has been demonstrated by the fact you were able to wait until you saw your GP the following day.

It’s not implausible that all capacity was being occupied by Class 1 and 2 patients in the time in which you were waiting - not least because patients in those categories often need emergency treatment which takes a considerable time to administer to put them in a stable position.

Manxman_in_exile

humptydumptybits wrote: »

Bloody useless NHS, why aren't they using crystal balls? I mean if they started the day knowing that there is going to be a pile up on the ring road, little Johnny is going to decide to take mum's anti depressants and Jenny is going to be thoughtless enough to break her leg in the gymnastics club they could tell you exactly how long you would have to wait.



By the way as you had been ill for several days did you think to ring them the day before to warn them that you would be coming in rather than getting an appointment to see your GP? I'm sure that sort of planning ahead would help everyone.

Sorry - I'm a very literal person so can't tell if you are being serious or facetious :T.


Perhaps I haven't been as clear about the substance of my "complaint" as I could have been - if so I apologise.


My moan is not about the unpredictability of demand on A&E services and neither is it just about the amount of time spent (wasted?) in the Emergency part of A&E. My moan is that the single triage nurse on duty in Emergency did not recognise how ill I was. I think this is borne out by the fact that the following day two GPs (one a trainee GP who thought I needed to be in hospital but had the common sense to get a second opinion) agreed that I was so ill that I needed immediate admission to hospital. And despite the fact that several other posters have said that there aren't enough empty inpatient beds available, the hospital admissions unit got me a bed immediately after a ten minute 'phone call from my (trainee) GP. Maybe I was exceptionally unlucky on that particular day in Emergency, but I can't help but think there was something wholly wrong about my experience.

Manxman_in_exile

elsien wrote: »

We were just very relieved it was a supposedly quiet night. Lord knows how long she'd have been there on a Friday or Saturday night.

The whole system seems to be grinding to a halt and I do think more education should be part of it. I had a work colleague who despite first aid training had an instant reaction of A&E for pretty much everything including cut fingers. At work I could tell him not to be so silly and to get the plasters out but him and his kids did seem to have their own seats in A&E.

That is definitely part of the problem.


My wife was seen in Minor Injuries and Urgent Treatment early Saturday evening and the place was heaving! But this did not prevent them from seeing her efficiently and relatively quickly.

Manxman_in_exile

Nicki wrote: »

And if you were triaged as Class 3, as Glawejen has explained, and furthermore were advised not to leave, this is all consistent. Classes 1 and 2 both covered those who had imminently life threatening conditions. Your condition didn’t worsen appreciably after leaving the hospital and spending a night at home with no access to medical treatment or supervision. You did need medical treatment (ie you were Class 3) but you were stable and it wasn’t critical that you be seen in the few hours that you waited in A&E as has been demonstrated by the fact you were able to wait until you saw your GP the following day.

It’s not implausible that all capacity was being occupied by Class 1 and 2 patients in the time in which you were waiting - not least because patients in those categories often need emergency treatment which takes a considerable time to administer to put them in a stable position.

I see what you are getting at, but does this mean that in effect I jumped the A&E queue by going to my GP? Was I admitted to a bed when there was somebody more deserving of admission waiting in Emergency?


As somebody who worked as an NHS manager for 25 years (Accountant, Training Contracts Manager and Workforce Planning & Information Manager) This "system" just doesn't feel right.

knightstyle

It isn't just A&E that does not work. My DD rang 111 when I was very ill, there is no out of hours doctor here in North Lincolnshire, and was told a doctor would ring back in an hour 1 hour 20 mins later she rang again to be told the same. I was deteriorating fast so she called 999, no ambulances available in our area and 4 to 6 hours for a paramedic!
So she and my DW took me to A&E, absolute chaos, there is no triage, everyone is too busy 2and a half hours later I was unconscious/delirious so my daughter wheeled me into A&E ward and demanded some attention. The nurse who then treated me said if we had waited any longed it could have been fatal!