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.

Also, patient for in on ambulance trolley, they need it back so until there’s a bed or trolley free, they can’t take it back while someone’s on it.

That makes some sense: but they could have a stack of empty trollies to swap back in to the vehicle?!

Understood - if even the corridors are full then I get that

The other issue with a&e is the number of people who wouldn’t be there if they could get to see a GP in a timely manner, or access a decent out of hour system evenings, weekends and holidays.

On Friday my DD developed a temp and I could smell that and had a throat infection. With her health (life limiting condition - she’s been in ICU twice already this year) and tendency to go downhill very quickly waiting until today wasn’t an option. In years gone by I’d have been able to access an OOH GP (many moons ago it would have been one of thr Drs from our own practise and they’d likely have given a prescription based on info alone) and sorted her that way. As it is atm we had to spend 7 hours in a&e. At one point there were 16 children waiting to be seen and from chatting with others at least 6 would previously have been seen by OOH GP or minor injuries (and I’d bet a few more of the other 10).

The other issue with a&e is that DD was sat in a waiting room full of unwell people which may in time also mean she needs seen again by someone as she’ll pick up anything anyone there had that is remotely contagious.

Resident doctors are on strike today, that probably didn't help.

I'm not in UK but it's the same here. One night my friend was there with her mother who had a stroke. Paramedic spent about 6 hours with them waiting for handover. He knows who is who, and was able to comment at one point that there were now zero ambulances available and was hoping no one had a serious accident. I think people die from this a lot more than we realise. It's scary and depressing

I don’t understand why they can’t unload (at least some) of their patients to a&e. If these people had made their own way to a&e they’d just be waiting on trolleys without 2:1 medical supervision.

of course I understand some patients this wouldn’t be suitable for (although you’d expect them to be triaged as emergencies and treated quickly) but surely not all?

Well yes, but it's also dangerous having ambulances off the road. No easy solutions it seems.

I recently watched an A&E documentary where a paramedic was filming and it was shocking to see an A&E corridor full of people on beds with ambulance staff waiting with them as they cant leave them and more ambulances outside with patients & staff in them just waiting for space. No wonder when you phone for an ambulance you can be waiting hours!

When your mother is ready to go home, you or other family could support her until a care package can start (if she needs one). Its called bridging care.

This prevents her having to stay in hospital on a ward, so someone from A+E gets her bed, so an ambulance can unload their person into A+E. Or realistically dozens and dozens of ambulances as some patients wait weeks on a ward for care and 70 percent of A+E patients can go home from A+E.

Of course this isnt practical for many people, but even if some people did this it would help the NHS a lot. We could fix care in the community by having paid carers on standby, or cottage hospitals/ care homes just to do discharge, but those are expensive options.

Please don’t call them bed blockers. It’s not their fault they’re there.
I guess I was essentially a bed blocker if you like in icu as there wasn’t a specialist ward bed for me. That situation wasnt my choice.

The best thing you can do, after granny has had her (probable) operation, go and see her every day, make sure she is doing her physio and take her home and look after her as soon as possible so that her bed becomes available for a person blocking A&E.

Of course you might not be able to look after her so instead move heaven and earth to get a care package in place.

Seriously hope she recovers well but it's an end to end system problem.

Well we know the solution, sort out community care. Yes it will be bloody expensive, but there really is no choice! Why do successive governments ignore this very large very obvious elephant in the room!?! As a nation we have to
A: demand it
B: accept that it has to be paid for somehow.

accept that it has to be paid for somehow

Because people want someone else to pay for it & not them.

Sadly this is very common. My daughter in law is a paramedic and spends hours outside A&E while listening to the control room desperately trying to get an ambulance to a red call. We need better social care so people can get home when they are medically fit.

Well ive seen other posts saying that if you do this you wont see SS backside for dust

MN Too many ppl are out of work and economically inactive,
Also MN take your elderly relative home and look after her till care can be sorted.

Another option is reducing treatment of very elderly people whose quality of life is poor and won’t be improved by medical treatment

Yes but quite unpalatable

I wonder why (yes it's not the most dignified) we can't open a field hospital like triage just outside the hospital- and pay for nurses/paramedics/doctors to staff to let ambulances go back out on the road.... Because seriously the system is broken- and we can't have elderly waiting 9hrs for an ambulance on the floor. .. or like my husband having tonic clonic seizures 3hrs to arrive as there are no crews

Part of the issue is about how in some areas ambulance services don't have community care options or are so risk averse they don't leave patients at home with worsening advice. There should be other options than conveying to hospital.

Friend is an A&E nurse - has had to deal with people turning up needing food as diabetic, sore fingers, mental illness crises (no care in the community), lots of small issues that once would never had crossed the door, but then sees issues ignored and admittance as emergency, dealing with surgical cases released too early, and yes elderly where the care home has no qualified nurses and uses A&E as a resource. Needs someone to get off their backsides, roll up sleeves and deal with what ails us, including empty posts, but nurses desperate for jobs, but no budget, yet we awarded a contract to a US company!!

That already happens by the commissioning of intermediate care beds in community hospitals or care homes but these can be time limited and then the delay is sorting out the care support packages for people being sent home. There are so many gaps in the whole system and it often comes down to funding, who is paying for it (nhs v local authority) and how the funding is allocated centrally in that some of funding is only available in each financial year and has restrictions on how it can be used by the NHS 😡

A mental health crisis is not a small issue it’s an emergency and very likely to be more of one than an elderly person who had a fall

The other issue with a&e is the number of people who wouldn’t be there if they could get to see a GP in a timely manner

This and also people go to A&E inappropriately for reasons other than not being able to access a GP. I think inappropriate attendees should be turned away.

Obviously there is a crisis in primary care too, it’s impossible to get a GP appointment at my practice and DD has just been told there’s an 8 week wait for a routine appointment to discuss contraceptive options after the birth of her baby, and then she’ll need to go on a waiting list for a coil fitting. It’s insane.

Another option is reducing treatment of very elderly people whose quality of life is poor and won’t be improved by medical treatment

My Dad was 88 and in poor health when he died. When I got to him he’d already died, he’d been down at least 45 minutes, but still before the services arrived they were telling me to give him CPR, and the paramedics would have done it if I hadn’t literally shoved his DNR under their noses. Imagine in the very unlikely event you manage to resuscitate someone like him, and the extra resources it would take to care for someone who was naturally at the end of their long life.

I’m not convinced that helps (although I agree with the sentiment), because they will still likely need help at home.