Ambulances at a&e - what can be done?

[thebourne]

This morning my DHs grandma had a fall, she's 91, and has most likely broke her leg and/or hip. She was on the floor for 3 hours waiting for an ambulance as we couldn't get her up.

The ambulance took her to a&e this morning at 11. And they've only now, at 5pm, finally gone inside so the ambulance could leave.

That's their whole shift, on one job.

It's a crisis. I hate thinking of how many people were in need of an ambulance while my grandma's team sat outside an a&e department for 6 hours.

What can be done? Is there a solution?

I feel like shouting about this issue because it's so shocking to me but want to know if there's anything I can actually do in a useful way.

Exactly the same thing happened with my 92 year old mother, several times. I agree it's shocking but I don't know what the answer is. I hope someone can suggest a solution.

The solution is to sort out community care so that patients who are medically fit for discharge, but need help and support in the community, can go home. That will free up beds on the wards for A&E patients to be transferred into, that frees up space for the ambulance patients to get into A&E, then that frees up the ambulances.

Absolutely this.
you sort out the care, it frees up space and has that positive knock on.

you need money, lots of it.

Re-opening the cottage hospitals as the stepping stone between hospital and home/care home would also help

Too right. Or it’s about to get very Jonathan Swift up in here quite quickly, except eating OAPs instead of babies.

Get the bed blockers out but they can’t as there’s no community care

That’s terrible. I have to say I had a great experience being blue-lighted in December. Straight in to A&E - the paramedics did their handover and took about 15 mins for me to get on a bed in the assessment bay. Busy London hospital.
I do agree that ‘bed blocking’ is an issue, I’ve seen it w elderly relatives; care packages need to be put in place.

There's no community care , so the whole system.snarls up and people suffer

Care needs to be brought back under heathcare. Local Authorities don't have sufficient funding for all the care they are required to provide. The system is disconnected and broken.

Yes, this.

Costly but bring care back into LA ownership- including care homes - cut out the profits and free up beds for those who need it.

Also agree with cottage hospitals

my daughter’s friend is a paramedic - she spent 9 hours of a 12 hour shift outside a hospital - came back on shift to sit in the same ambulance with the same patient!

That's awful. I'm so sorry for her. I hope she's going to get fixed and better soon.

I guess I was lucky in that when I broke my hip; even though I had to wait 7.5 hours for an ambulance they did seem to treat me pretty quickly. I went straight in and was on a trolley in corridor then triage room. Then they had to wait for the second theatre to open as it was Sunday so I got my surgery at 8am the next day.

I don't understand how it can be so bad in some areas and acceptable in others. There seems a vast difference in hospital experience depending on where you go.

Wishing her a smooth recovery x

It needs to stop wasting an enormous amount of what it got before it gets any more
ask anyone who works for them inefficiency and waste is breath taking they’ll scrimp over 5p and throw £20 away
Last week there was a thread about dominoes other 1/2 and child had literally just eaten out of date food not ill or anything everyone was saying go to a+e
Another one where daughter had been injured and checked at a+e discharged but later got call and said there was a fracture and she’d been referred to fracture clinic and will get an appointment she rung to chase they had details and would get an appointment when there was one ( the reason they didn’t get her back to a+e would of been because it didn’t need urgent treatment) and everyone was saying go to a +e When it was sorted it was one of those that didn’t need anything doing that’s why she’d been left to wait

and we wonder why a+e rammed

@rwalker A&E is rammed because we have an older and sicker population not because children are blocking beds due to eating out of date food.

There's a lot of academic research on it. ED clinicians are screaming (often literally, when they are not crying) about it. There is very strong evidence that it causes avoidable deaths.

I would agree it's the lack of community care. If you see the lists of patients waiting 100s of days in hospital when no medical requirement to remain, you understand the scale of the problem. But it's not just that beds which could admit people are full. My mum spent a week in hospital because she needed daily care but the wait for a social services assessment was 6 months. Unsurprisingly, she got seriously hurt.

This exactly. Mum mum was held in hospital as her carers took ages to arrange. The wards were all overcrowded with an extra bed in each ward etc. The extra bed had no curtain and they had a portable screen.she could have bed out in a week but was there for 6.

I bed blocked for 6 days...I was waiting for an MRI but was told all 10+different medical staff I saw "The MRI team do their own thing waiting list wise. If you go home it could be months. You need to stay in so you get it." 6 days of me in a hospital bed which I probably didn't need. During this stay I saw at least 3 others in the same situation. Waiting for an MRI. As soon as done...discharged. Ridiculous waste of resources.

My entire knowledge on this derives from watching Ambulance on telly….Having said that I don’t entirely understand why the ambulance crew has to stay to “hand over” - why can’t they just pass on notes from obs/ecg/whatever in electronic form to be used by the medical team as and when they get round to the patients, in the meantime HCA can monitor the patient re any deterioration. Genuine question!

Where is this location wise? Sounds awful so they just have to park up as there are no staff to see her? Or no beds? Is she OK OP?

Ive just realised I was in hospital last year I was put on a women’s ward and it was like a care home, 8 of us and I’d say 3 were older ladies 80+ were having full time care after falls, they all wanted to go home but due to steps in their house or nobody living close they weren’t being sent home.

it hadn’t really registered how thar would then impact a&e, my god they did everything in their power to turf me out! But unfortunately I had to keep being readmitted.

Ive just realised I was in hospital last year I was put on a women’s ward and it was like a care home, 8 of us and I’d say 3 were older ladies 80+ were having full time care after falls, they all wanted to go home but due to steps in their house or nobody living close they weren’t being sent home.

Yes, I was in hospital recently overnight and was the youngest by far & im not young. One got out of bed in the night and had another fall. It’s not sustainable.

Often they aren’t even inside the building, the patients literally can’t be brought in because there’s no room. The paramedics can’t just dump them on the driveway.

Space for one ...
No space to observe patient , no space to start investigations
..
Usually ambulance crew hand over to an experienced a&e nurse who decides if patient needs to stay in dept or can go round to waiting area
If patient needs observed in dept whilst they wait for the dr... nurse needs to find somewhere to place the patient that is safe. I.e does patient need to be on a monitor.. By a suction point.. on oxygen

What happened here was they unloaded all the people into a tent in the hospital grounds which the hospital wouldn't/couldn't staff and a couple of senior paramedics did. DH was sometimes one of them. All the paramedics hated it as it was a huge responsibility for a load of very sick people. And the patients hated it as they could see that they had been dumped in a tent for hours, 12 or more hours at sometimes before they even made it into the hospital. It didn't last long and has been disbanded now.

That’s downright bloody dangerous!! 😱