How does this work ? (A&E question)

Actually in some hospitals where there is an interface between the 111 IT system and the ED system, a pre arrival for the patient does appear automatically on the ED system, with a document attached which contains details of what 111 recorded on their system (I work in NHS IT and have tested this functionality).

This is the core point. In your case you thought you were very ill and you were right but many people who think they are very ill are wrong. A feeling of impending doom is also a cardinal symptom of a panic attack. Vomiting and looking ill and sweaty could easily be alcohol withdrawal. Some people sitting quietly are in fact very ill. Until triage no one really knows.

The key is that the triage really needs to happen within those first 15 mins or the risk remains unaddressed. It was the overwhelmed triage queue that was the problem not the order of being seen. The only way that I know of to jump the queue is if the ambulance crew call ahead for a patient to go straight to majors.

Ah I see. In that case yes maybe there was a bit of a miscommunication between reception and triage nurse. Anything heart related they really should take seriously/quickly! Yes thank goodness you are here to tell the tale!

how could the staff have been brilliant if you had to wait so long ? i’m so sorry this happened to you and i’m sure someone could have been kinder to you. o don’t believe all nurses and doctors are ‘angels’ and when necessary we need to call this out.

Were you not triaged? I’ve been in A&E twice in the last two years or so - both after loss of consciousness episodes - first one my DH took me in - I was hooked up to an ecg within 5 minutes of arrival but then the wait was interminable (I was having focal seizures - all lead to an epilepsy diagnosis). I would’ve thought if you were vomiting and in severe distress they’d see you quickly but maybe that’s just in Casualty.
Second time I was brought in by ambulance because I was injured, so it was different, but 100% you get seen quicker even though the crew denied this! I was on a bed in the assessment area within 15 mins or so of arrival then I went to majors.

I once had an elderly patient who came in following a fall. His main concern was a foot injury, transpired he later admitted to having hip pain. Turns out he had a fractured neck of femur and had been walking round for two weeks post fall. You never can tell. We now have a nurse at the entrance to ask key probing questions and will do a set of obs if clinically needed right there and then. If found to be sick or look particularly sick they will ask triage to make a priority however this only works if the majority coming through are well enough to wait their turn. I have had shifts where it’s been endless queues of sick people who all need prioritising and escalating but then the problem is that not everyone can be triaged or seen straight away. Someone has to wait. No ED nurse wants to risk patients collapsing or dying in the waiting room, we are constrained by the system and resources provided.

I used to work in A&E, and this is how it worked.

Unless someone arrived via a crash call (usually something very serious like a major car accident or cardiac arrest) everyone checked in at reception. When I worked there, it was a receptionist rather than a nurse. Patients where then triaged quickly by a nurse. Triage usually included things like observations, history taking, bloods/heart ECG if necessary. They were then streamed into three categories:

1. “Exam” / Minor injuries - things like sports injuries, suspected fractures, minor wounds, etc. these people were the ‘least sick’ in the department.
2. Intermediate care - issues such as abdominal pain, vomiting, dizziness, and similar concerns go there.
3. ‘Majors’ was for the most serious problems like chest pain, seizures, allergic reactions, or breathing difficulties.

What people in the waiting room often don’t realise is that after triage, patients are placed into one of these three streams. They are then seen based on both clinical priority and how busy that specific area is. If at triage, someone’s observations show they are safe to wait, they will be sent back out to the waiting room, this is usually because there’s no space in that area. If someone’s observations are not safe, they should be taken into the department regardless of space - often on a trolley in a corridor with monitoring. The sections function separately, so you might see someone go through to minor injuries while others are still waiting, that doesn’t mean they’ve ‘skipped the queue’ it’s just that they’re in a different stream (there are different staff members in these areas so they don’t ’share staff’ so to speak) You also may not realise that someone who looks like they’ve just walked in the door may have been triaged 3 hours before and were just getting called back in to be treated.

So yes, patients are absolutely seen and prioritised based on clinical need, but waiting times also depend on how many patients are being treated in that particular section. Someone above made a really good point, if clinical judgement wasn’t made and staff just listened to how sick people claimed to be it would be absolute chaos. I’m sorry you had to go through that! If you had presented only with nausea and vomiting they likely would have initially triaged you to intermediate care and sadly found your heart issue later… these things unfortunately happen. So many conditions present awkwardly, for example some of the patients with the worst headaches I’ve ever seen… have simply had migraines. Some of the sickest patients I’ve seen have walked through the door quite the thing…with a heart rate of 200!! It’s very hard to initially tell with presenting symptoms sometimes.

Hope that clears things up!

@socksandshoosI get what point you are making but even with this complaint how do you propose this could be changed? Triage is the point where the team find out more about why you are in ED, receptionists are not qualified to decide how gets triaged first. For instance, an abdo pain can actually be a heart attack and someone with dizziness can be having a stroke. The headache can be a brain bleed and a low blood pressure can be a dissecting aorta which requires immediate lifesaving surgery (within minutes). The elderly who tend to sit quietly and not make a fuss can be seriously unwell. Experience states younger people shout the loudest for the smallest of things. People do not always present as text book cases. Staff are doing their best in a completely broken NHS although soon it’ll be private!

In my experience it often speeds things up if you can tell them specifics. I have a family member with chronic issues which put them at higher risk of sepsis and when we need A&E I do basic obs and lead with those. E.g. to reception "he has a 40.1 degree temperature, his heart rate is 162bpm at rest and his oxygen saturation is 86%, we are worried this is sepsis". We keep blood pressure monitor, thermoter and pulse oximeter handy for this purpose.

And move on….

Yes, it was nice of her to clarify what was already obvious for you.

@gototogothis is not true. 111 do not alert ED to your pending arrival nor do they send over notes. They pretty much tell everyone to attend ED within the hour. I can vouch for this as both experienced ED nurse and as a patient/relative. you do not jump any queue because you called 111 first. Same as if you arrive by ambulance, you are still seen in order of priority by how sick you are. If you arrive by ambulance but can sit in the waiting room then you will go through the triage process via the waiting room.

When I took my daughter a while ago, there were signs up advising people that patients were seen in order of urgency, not order of arrival and not to go to the desk to complain/query if you see this happen. Maybe different hospitals function differently, but I would have thought that this would have been the norm?

Incidentally we sat there that day and waited, and waited, and waited.....we saw people come and go. Then someone came across and asked if we'd been to xray yet. No, we hadn't. Oops, they said. We thought you had! We'd been forgotten 🙄

And you move on and read as well, op has kindly clarified 🙄

Glad you are sorted now but when people book into A&E they can literally list any reason so that finger injury may well have booked in as chest pain or something unrelated. Equally you may have been listed as presenting with vomiting. I will also say that just because people look ok that actually they may not be. 90% of people attending will state they feel like they are dying, at work I hear it on a constant loop, everybody wants triaging first and want to be seen by a dr straight away. I’m an experienced ED nurse and as much as we try to stick to the 15min target for triage it rarely happens now as the arrivals come through thick and fast and book in a lot quicker than the triage process takes hence the bottleneck. Triage is the process of sorting and prioritising so it would make sense no one can prioritise accurately until the triage is complete.

Triage is seen in order but when I was an A&E receptionist we would alert the triage nurse to anyone with chest pains as soon as we'd booked them in. Ditto anyone else we were worried about. The nurse would see them next.

No, read it again.

I had a health scare recently and was given a tip by my gp, assuming out of hours (in hours ring gp) to call 111 because if they triage you are needing hospital care triage are expecting you and it’s quicker, she also said 111 can advise which a&e to use, we have 3 equidistant time wise

My next door neighbour has heart failure, she was sent in by her GP with a heart beat of 160 per min. She sat in A&E for 11 hours before being admitted on a bed and given medication to try get her heart to slow down.

She was told next time go by ambulance, no messing around because going through the normal A&E route with heart failure is risky.

Glad doing better OP, hope getting all the help you need. x

Agree with this, it highly depends. We live 10 mins walk from A&E and once they have suggested we go under our own steam (I thought I'd dislocated my knee so DH drove me!) and obviously I could wait in the waiting room, and an ambulance would not be tied up for hours but was miles away. Same thing happened when DS had a fit as a baby - we walked him down in his buggy because he was too rigid to get in the car seat
But when he had a lengthy fit more recently and when he was knocked over by a car they took him in an ambulance, the ambulance could come quickly both times thankfully. The car accident was about as minor as you can get and he could have walked but they didn't want us to wait.

When I went to A&E with a known insect venom bite allergy I was triaged very quickly, sent into a bay for immediate life saving treatment and then waited for a couple of hours for further treatment. In another A&E when I had life threatening asthma I had to wait to be triaged. Different hospital, different systems. I know where I would go in future.

OP you should have been prioritised! I would be putting in a complaint. You rights feared you were going to die- and you could have!

I was recently taken by ambulance to A&E for serious agonising stomach ache after calling 111. They told me to sit in a chair where I had to wait for an hour to be triaged and they checked my heart and then left me alone for 10 hours. The issue was completely unconnected to my heart and by the time I ended up in resus with sepsis. It was a complete nightmare as I was given the wrong drugs (despite me telling everyone what I was allergic to) and had a reaction so needed even more attention. It was chaos and I now dread ever needed to go there again. The A&E waiting room in our hospital doesn't even have sufficient chairs for the patients waiting to be seen (and the plastic chairs they do have are really uncomfortable).