To say stop moaning about A&E

@heroinechic our minor injuries can’t X-ray as I’ve said, so any and all suspected breaks has to be seen in A&E. I agree it should be able to be seen in minor injuries if it’s a walking wounded suspected wrist fracture or something (as opposed to half a femur sticking out of a leg which is definitely fully an emergency), but reality is it can’t. I think minor injuries here is like going to the school nurse for a cold compress.

When I read “real emergency” I think of heart attack, stroke, serious allergic reaction, appendicitis etc. A broken bone or dislocation can be seen in minor injuries…

How are you defining what a “real emergency” is? Are you basing this on your own judgment of how people look or do you actually know what’s wrong with everyone in the department? A lot of very unwell/injured people don’t necessarily exhibit obvious signs. You don’t have to have lost consciousness or be bleeding out to warrant A&E.

When I’ve been in A+E as a cancer patient on chemotherapy with neutropenic sepsis - which is life threatening - I’ve spent hours with no treatment listening to patients with pancreatitis who have said they have a single small sherry at Christmas and eventually, after about 8 hours, admitted they were drinking a litre of rum per day, so it’s a lottery.

Good for you.

Here we have 12 hour waiting times sometimes- we live in a tourist area so as well as dealing with everyone who lives in the area, it's packed with holidaymakers too and can't cope with the numbers.

Glad it was a positive experience for you.

So sorry.

You're one of those people who thinks that because of the experience you had, every other experience must be the same.
You can't possibly apply critical thinking to the matter to understand that some people genuinely do have awful experiences. And those awful experiences are for a variety of reasons including the NHS is on its knees or working in the NHS doesn't make somebody a good person. Some of them are arseholes, just like in every other walk of life.

So maybe just try and understand that not everybody has the experience you did, and their opinion on the NHS is just as valid as yours.

That is absolutely bleak. I'm so sorry she experienced that.

I'm so sorry to hear that

I’m delighted that you had such a great experience.
My elderly mother had a very apparent, massive stroke and was taken in by ambulance. She was left, distressed and naked from the waist down, on a trolley in a corridor for almost 5 hours. A&E staff had been informed that she’d most likely been laying on her cold kitchen floor for 20 hours after collapsing while making her dinner, and had been asked to consider that her agitation may be partly due to dehydration…yet she received no fluids and no medications for 5 hours. I reported several times that she was so distressed that she was throwing the blanket off repeatedly, and was showing her private parts to every man and his dog - but they did literally nothing.
So, to repeat - I’m super happy that your relatively fit and healthy young son received great treatment, but my gravely ill elderly mother was treated like shit, and I’d suggest you start to realise that you were in the very fortunate minority. I don’t mind waiting, and I would never complain about it. But the service is so overwhelmed that in places they’re losing control entirely.

Obviously depends on the hospital and how busy A and E is, but I’d say my two visits in the last month have been very different to yours OP.
I attended in severe pain from a gallbladder attack. I have had attacks before but nothing like this. Triage were terrible, I was rocking backwards and forwards on the floor on all fours and offered paracetamol. I was left like this for 6 hours. I was sent away and told it was a stomach ulcer. 3 weeks later, with pain after eating or drinking, even water, I attended again as my eyes were going yellow and my urine was brown. I was in agony, and well aware this suggested I had a blockage in a bile duct.
Again I was left for 7 hours and my husband had to chase pain relief. This time, 3 hours later I was given OTC strength cocodamol (did nothing).
I’d have No problem with sitting and waiting - if they’d given me effective pain relief rather than leaving me in agony for hours.
A gentleman was in clear distress howling in the corner in pain for a similar length of time.
This time, I was admitted and stayed in hospital for 11 days whilst they gave antibiotics for a very infected gallbladder and removed a stone blocking my common bile duct.
I am terrified of needing to attend A and E again, a real possibility as I will not have my gallbladder removed for another few months. I would add though, once I was seen by the doctors, the second time at least, my care was brilliant. But at triage there seems to be a real inability to accept that unless your obs are a concern, you could possibly need medical attention sooner than 6 or 7 hours. I would also add there is clear compassion fatigue from many of the staff.
Just to add I’ve worked in hospital and had to see patients in A and E in my speciality - and I know they’re run ragged. But the care I’ve received this last month at A and E was abhorrent.

I agree that far too many people go to A&E that would be better off using an alternative service but when GP appointments are impossible to get and people are being incorrectly directed to A&E it's hardly surprising.

I was taken to A&E in an ambulance last October after collapsing in my GPs office with pneumonia (I'm usually an extremely fit and healthy 30 something who runs half marathons and triathlons for fun). I was out on oxygen and despite being taken in by ambulance I was still expected to wait over 10hours and was left to soil myself as I couldn't take myself to the bathroom and no one would help me despite me asking several times. That is unacceptable treatment and no one would deny I needed to be there. When I was eventually seen I was admitted for 4 nights for IV antibiotics so was clearly extremely ill.

I agree. In the waiting room they were coming to do my obs every 30 minutes - they did not do that for any other patient, so clearly I was sicker than everyone else there that day. It didn't mean I waited less time. There was another patient who ended up on the same ward as me who waited a similar amount of time. I've unfortunately been through A&E a lot over the last couple of years, always referred by my GP or 111, and always at least a week stay, so definitely needed to be there, and time and time again the complex patients wait longer. There are targets for A&E to treat, admit, or discharge within 4 hours which means that they see as many patients as they can within 4 hours of arrival. That means straightforward injuries and minor illnesses are seen quickly, whereas those of us who need a bed (of which there are none) wait even longer. I also think being younger, early 20s, means you wait even longer for beds as you are deemed 'fit to sit' in a way that elderly people aren't. I've sat in a chair for 3 days before, 4 drips running at once, blood transfusions, 24 hour heart monitoring... where noone else in the room was even on medication. Just there for straightforward injuries.

I'm still unwell and dreading needing to go back through A&E again. The hospital are amazing once you get to a ward, but getting there when so unwell is an awful experience. Lack of staff and beds mean that long waits are a reality for lots of people who need emergency treatment.

There are other places. There are loads of assessment places, medical, surgical, early pregnancy, cancer, speciality, frail and elderly, same day emergency treatment, loads. The vast majority (in my hospital) once a decision to admit is made, go to these units before going to a specialised ward, the exceptions being cardiology, neuro, stroke, and nofs (hips fractures) tend to go direct to those wards, but the overwhelming majority to to an assessment unit first, designed to bridge the gaps. But these are full also, because wards are full, because they cant discharge patients, because cottage hospitals, nurse led units, and rehab wards, have all but closed down. The issue is A&E gets fuller, forced to use corridors, forces patients to wait hours upon hours to be seen whether outside on an ambulance meaning that team cant get out to others in need, or in a waiting room on uncomfortable chairs feeling like they are forgotte about. Wards and assessment units arent forced to find the space.

We also have an onsite GP, open 8am-10pm, where we can refer elegible patients, overnight we can send people home for a referral the next day to them, or to the same day treatment unit and surgical assessment units. Sometimes, if they return at 8am, this is infact the faster option than waiting to be seen by ED dr's - but that is seen as fobbing patients off in some cases.

But these inbetween departments do exist, and have for a long time. What needs to happen is cottage hospitals be phased back in to manage the care of elderly patients, not well enough to return home unsupported, and waiting for packages of care, or need longer physio input, or adaptions made to homes. The hold up in A&E is because cubicles are used to house patients needing bedspaces on wards, but ward beds are being used to house patients who could be cared for in cottage hospitals. Some patients are in because they failled the physio stair assessment, they could fail it 5 days in a row, theres no alternative but to keep the on the ward anymore. This directly impacts A&E. Which affects ambulances. Its all connected. The impact from the difficulty to see a GP is much lesser than the impact of "bed blocking" from elderly patients as theres no longer other care options for them.

Fortunately for your son he got seen and dealt with quickly and efficiently. For many, many people they are left for hours, often in vulnerable and extremely poorly circumstances with inadequate care, attention or even basic dignity. Maybe instead of preaching here about how we should all be grateful, think about how bad other people have it compared to your son's one off experience. Very small minded approach to life you have.

The whole A and E department needs a complete over haul.

No beds for patients who need them suggests there needs to be another department that bridges A and E and the rest of the hospital.

Something needs to be done as employees and patients of A and E are equally hopeless about the situation.

I mean what is actually happening with the Gp's ? are they being phased out because no one I know can get near them, I suppose once they have gone and their pensions sorted they still won't plough the cash back into the A and E departments.

DH waited 12 hours in severe abdominal pain. It wasn't the staff's fault, they were snowed under. It's not always possible to be treated in 3 hours, even if it was an emergency.

Having spent many months visiting someone in hospital over many different periods, I've actually noticed the quiet in the main hospital, fewer people arround, visitors, patients, quiet corridors with nurses doctors, porters just moving to and from departments, it seems quieter than previous years.

Turn the corner and go to A and E and it's like a war zone, it seems like the only part of the hospital with noise and busyness.
I would hate to work in that department, front line facing every trauma imaginable, the drunks, the drug addicts, the minor patients who have been signposted there because there is no way of seeing a GP.

The lack of accesibility with Gp's it seems to all have been dumped on the A and E departments.

Frontline, first port of call, A and E staff should be paid more, from the receptionists, the nurses, health assistants and doctors, they need more staff and an incentive to work there. Most people will not be admitted to the main hospital but there needs to be more staff to ease the situation and better pay.

A and E deserve danger money.

I know!! If they'd actually given me any pain relief I would've thought I was hallucinating!

I then saw a doctor who told me my toe needed relocating but she was a vegetarian and too squeamish to do it.

I'm sorry WHAT

@TheCurious0range

Complaining to pals does get back to us, in that we have "huddles" where senior staff are brought in to discuss what went wrong, why, and how we could attempt to stop that in the future. That discussion is then opened to all staff for suggestions for improvement. However if the complaint comes down to waiting times, there isnt a solution that can be found by staff in the department. We recently "won" funding to have additional staff on shift, we were able to argue and prove that staffing levels were causing direct harm to patients using pals complaints to assist us, and helped us go from 1 nurse to 6 patients in majors to 1 nurse to 5 patients, it was only 1 additional nurse on shift, but everything counts right? We also have system such as named professionals, so at the start of our shift we have to write on boards our names so families and patients know who is responsible for their care. That again came in through pals. If it is a bigger complaint, internal invesitgations and action plans are completed, thankfully i have only been involved in one and the responsibility wasnt on ED staffing, but it was awful, traumatic for everyone involved, and still on going.

So in a nutshell, pals are flagged to us, we do what we can to answer them and make changes, but all to often our hands are tied and theres nothing we can do to improve outcomes as cant change how many beds there are, and how long people are waiting.

The quick handling of simple stuff is very important here.

DH went into A&E with a suspected eye injury after a smack in the face last year and was in, xrayed and out in an hour and a half with a small fracture to his cheekbone.

He has a history of heart lining infections (pericarditis) and we've had huge variation in experiences of that being handled both badly and brilliantly.

One where the receptionist was hitting the panic button as we booked in and he was straight into the unit, bloods, ultrasound and seen by a cardiac specialist and diagnosed and provided with medication in an hour and out the door.

Another where they nodded, told him to take a seat and I had to chase them every hour for the next five hours pointing out we don't know if he's having a heart attack (symptoms are the same) before someone bothered to see him then another 8hrs for the blood results. We were there for 13hrs that day with no ultrasound, no specialist and no meds.

Meanwhile my young neighbour who has had a kidney transplant was sent to the same A&E with sepsis last month and sat for five days in a chair in A&E awaiting a bed before spending a week in HDU.

Does complaining (like PALS for example) help at all in the grand scheme of things? Can it actually bring change?

There seem to be two school of thoughts on MN, never complain or moan or bring anything up and complain as it’s the only thing that will help.

Hats off to you though, I couldn’t do what you do in a million years , even in great conditions, nevermind being understaffed, overworked, overwhelmed and frustrated at the state of it all.

You were lucky. My mil languished in an and e on a trolley in a corridor for 48 hours after being blue lighted. She died before they got her to a ward for antibiotics. It was no better than third world.