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.

It will help the immediate problem of ambulances being stuck at the hospital rather than out on the road helping other people though, won’t it?

We have an offload in 15 minutes policy where I work. Sounds great but just shifts the patients in to the hospital without the care they need / deserve, but it does free up ambulances. The whole thing is crumbling as we just can't people discharged in good time. And of course the bloody Dr's strike!

Absolutely that key to this is getting care in place so elderly people can get out of hospital and home as soon as they are fit enough.

I watched my poor Dad stagnate and go into a decline he never recovered from after suffering a stroke which largely took the use of his legs. He was stuck in hospital for nearly 2 months virtually ignored in the corner of the ward whilst waiting for a care package which I was informed had been 'put out to tender' with local care companies. They simply had to wait for someone to put in a fair price for looking after him - absolutely awful. Like a piece of meat up for auction. He eventually came home depressed, withdrawn and a shell of his former self. The care he was sent home with was seriously lacking and 3 weeks later we had to put him into a nursing home. He died 3 weeks later. The last few months of his life were awful.

Care for our elderly is absolutely dreadful - i wish there were dedicated hospitals for the elderly with proper, prompt attentive care and a much higher standard of home care on release from hospital. This would free up space at general Hospitals for everyone else. It's obviously down to money though. I dread the day my 88 year old Mum needs hospital care - i couldn't bare seeing her stuck in an ambulance or a corridor for hours whilst waiting for a bed - i feel it's inevitably coming......☹️
I hope your DH's granny gets better soon

More people would take relatives home with them if doing that didn’t then mean all help, support and planning disappeared.

When FIL needed full time care we were warned by the hospital and the social worker not to take him home from hospital as they’d all then no longer be involved in trying to get home a suitable care home placement.

As a family we were willing to do it as a stop gap measure as it was summer holidays and a number of us work in schools so were free for 4/5 weeks.

very often pitching in to care for your relative in the short term actually harms them long term because of this.

I was recently admitted to hospital via A@E, I made my own way there, so no experience of ambulance situstion.

My clinical treatment was excellent and timely.

after a five day stay the consultant told me, at 9:00 am, I could leave after I'd had an iron infusion "so by lunch time" he said. I contacted my adult child who kindly swapped meeting around in their diary to be ready to collect me between 1 2:00 and 2:00.

by 11:30 I asked when exactly the iron infusion would take place. I'm still Waiting for an answer.

at 1:30 I started kicking up a fuss (politely, of course 😁) by 4:30 I eventually got out.

so I was sat t here, effectively bed blocking, for half a day.

When you see recordings of patients being treated in corridors and then realise , there must be more like me who are just day waiting to go home, but the processes seem unable to speed our discharge up.

i think this is a very common experience but also maybe not related to bed blocking

not all wards have demand sitting in a&e. “Bed blocking” (sorry I agree it’s awful language) tends to refer to high demand geriatric wards where discharge can be difficult due to the patients ability to manage their own aftercare. This isn’t the case as much the case in say, maternity, surgerical ward etc

but also bed blocking doesn’t usually mean literally a bed. It means that there aren’t resources (usually staff, but maybe specialist equipment) to accept patients. You laying in a bed needing nothing and creating no care demands isn’t really “blocking”

for example there might not be a “bed” on recovery- that’s not literally, there is no empty bed in recovery, it’s that there isn’t the nursing care etc for a further person

You are so right, it is a no win situation sometimes. I didn't go into details but we have had the in/out of hospital cycle with both my DM and MIL.

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?

This is in Scotland, 30 mins from Edinburgh.

She is as ok as can be, she's on morphine because she's broken her femur. She'll need a hip replacement.

We'll be getting her home and doing all her care- luckily we only live 10 mins away- and will get carers too if needed. She hates hospitals so we'll get her home as soon as we can.

There are so many 92 year olds now. Sadly, that is part of the ‘problem’. Modern medicine keeps us alive longer but we are often frail, demented and in poor health unable to manage at home. We fail to plan for old age. Sometimes insistent on living in unsuitable living circumstances, refusing carers, in and out of A&E like a revolving door with numerous ailments and repeated falls. Patched up and sent back home still unable to cope, slightly worse, until the next time. Multiply this by hundreds of thousands. Day after day.
Filling beds, delayed discharges mean wards cannot transfer up from A&E which remains full, cannot offload ambulances into A&E which then queue up outside, leaving us all waiting much longer for 999, including many other 92 year olds led on floors somewhere.
Nurse of 37 years, very many in primary care. This is the unpalatable impact of an ageing population. It’s not the only contributory factor to this mess, but we all want to live to 110 so…

my lovely friend just lost his parent in a country with a paid healthcare system. He said that after years of poor declining health, no quality of life, that in a way it was a relief that the treatment has to end when the money ran out.
He’s lived here for 30 years and is sure the treatment would’ve been continued here under the nhs.
When something is free at point of service, demand is limitless.

of course, the counterpart is the small number of rich people who can keep going, but they're a minority.

Absolutely this. It would free up hundreds of acute beds.

My friends DS is a police officer he gets to spend many a shift in A&E while with people in custody, they have to go as a duo as well because of the risk. I was in A&E a few months ago at one point 6 police officers were with 3 different patients. One was handcuffed and really kicking off, was awful. That’s probably half an entire shift for a section, not sure of numbers. They have to take anyone who says they feel ill or says they have taken drugs. Some do it to time-waste. I asked him after I saw this that night.

@DemonsandMosquitoes My Father refused treatment for cancer in his mid eighties, the hospice nurse said she wished more were like him. It would have given him maybe another 18 months. My MIL has had an op but has refused further suppressing meds, she is 83. When she told me it felt like she wanted a fuss made, I just said if you were 30 I would be arguing with you to take them but your not so I’m not going to. It did shut her up for a change.