In Thinking That Our Local A&E Are Letting Kids Down & Want To Do Something About It?????

[rockinhippy]

& if IANBU - asking if anyone know WHAT & HOW I can try & change things ????

Back ground??

Locally we have a new state of the art Childrens Hospital, but no separate Kids A&E - We DID have a separate DCs A&E which was fantastic BEFORE we got our brand new shiny & fantastic Childrens Hospital

Now all DCs have go to the same A&E as adults & very often there are NO experienced Paediatric staff working there at all, something I've seen cause problems on a few occasions over the years & I've been left arguing with staff to get DD seen by a Paediatric Nurse - who saw even from looking at her at a distance that she was seriously ill & ordered chest Xrays - turned out she had double pneumonia & wouldn't be here now had I not been a bolshy cow & argued with the A&E nurse was going to send her home

The Saturday before last DD had a nasty fall & I had to take her to A&E again - by the time we got there it was 9.45pm - & from there onwards started to fill up with drunks from falls & fights, including a large group of very drunk, loud & very dramatic TVs - not bothered by them being Transvestites, but the conversation & shockingly the racial abuse aimed at an Arab looking guy where bang out of order - generally typical Saturday night A&E in a City known for its party crowd & NOT in anyway suitable for Kids

But it took until being seen by the Nurse before we were passed through to a Childrens waiting area - that took an hour & a half, as the Nurse owned up to them alternating seeing one DC & one adult - so you can imagine by that time it was NOT a suitable environment for kids & was getting worse by the minute

Nurses words at that point "we'll put you in the Childrens waiting room now, as its hell out there & the drunken transexuals are making it worse, so not a suitable environment for Kids" -

I was very grateful to be moved into a safer area, but I pointed out there were 3 other DCs in the main waiting area, 2 much younger than DD - yet it was another hour before the first one came through to the DCs waiting area

Surely it can't be too difficult to organise sending DCs straight to the Kids area when they sign in??, nor is it too much to ask that they are given priority over none emergency adults ???

thats let alone the worry no properly trained Paediatric staff on duty.

DD turned out to have a fractured foot & ligament damage, but took over 5 hours to get through the system - yet she would have gladly given up her slot for the poor mite of about 3 who was in obvious severe pain & wailed & shivered in another room - I'm sure most adults would have done too :(

DD was left without a cast, but given crutches & a fracture clinic appointment - that they A&E admin got wrong - so we missed our correct appointment - meaning that she went 5 days without seeing ANYONE who could properly read her Xray - A&E staff were honest about the fact they couldn't & that they didn't know what to do for her - this meant despite being incredibly brave [very proud emoticon] she whimpered, screamed & cried in her sleep in pain, through pain killers every night :(

The fractured clinic put her in a cast straight away, she is coping MUCH better now & we've all had some sleep :)

Okay I understand in this climate of cut backs that its not the staffs fault there are no paediatric staff on duty & don't doubt A&E is one hell of a place to work - especially weekend nights

but AIBU to think that this is just unacceptable

• there were 6 DCs in pain there that night - our 5 hour wait wasn't the longest

& if IANBU - any suggestions on what to do about getting changes made - its actually scary to think thats what we have for our DCs

thanks :)

Recent experience at A+E at a paediatric "centre of excellence" really wasn't and better TBH.

I knew exactly what DD2 needed and it wasn't much. I had good reasons behind requesting what I did too (blood tests and very simple antibiotics to prevent a potentially fatal complication) but we were in there 5hrs and the dept was pretty quiet.

(and the staff were discussing the nights pizza, details of other cases and all sorts where we could clearly hear).

DD was a bit dehydrated when assessed at the GP out of hours and they knoew that but she wasn't even offered water whilst in the dept from 9.30pm- 2.30. No wonder she fainted when her bloods were taken!

CBA to complain as no doubt no breaches of standards occurred Time wise but is was a pain, for something that really could have been easily done in an hour or 2.

Now we have to try to find out if the took the correct bloods as follow up tests due end of this week...

Our A&E has a play area but no seperate area for kids although kids aren't usually at A&E in middle of the night as they tend not to break things at night and illnesses go through OOH GP system which is separate. Casualty docs and nurses see all patients who can be referred to an on call paediatrician or sent on to the children's hospital if necessary. Children with pneumonia would normally be seen by the OOH GP service not casualty which is mainly set up to deal with trauma.

Our local hospital has a separate paediatric A and E staffed by paediatric nurses and doctors. If it's an OOH case the triage nurse sends them over there (over the corridor.) And vice versa.

The waits are really long (3 hours after our bus crashed) but I'd prefer to wait longer and be seen by a paediatrician than not.

FFS, my local A&E has no childrens' bit, nor do most other NHS hospitals.

What do you think the parents in all these places do FFS??

Thanks everyone :)

So seems a separate waiting area ISN"T to much to insist on, even if in the current climate of cut backs the rest is - the room does exist, in fact theres more than one - they just aren't using it until AFTER the triage send DCs there

& for those that ask, the Childrens Hospital is at the back of the main hospital- when we've been in the past, weekends etc its a separate area which is also the OOH GPs - emergencies are sent through to the A&E as are drunks so its a different atmosphere in there all together,

dubbsgirl - you're using the same hospital so its good to know at least babies go straight to staff who DO know what they are doing :) though IMHO I think it should be extended to toddlers at least as the set up is obviously there, so makes no sense having such small DCs, who can't express pain/symptoms etc properly being seen by staff who just don't understand Paediatrics.

2rebecca you make a good point over OOH & Kids not going through casualty later at night :) & I think for most places that makes a lot of sense - but we live in a "holiday" city, so seems that bit hasn't been taken into account with out local health services - kids ARE up out & about later in the Summer - 2 of the others in A&E that night were on here holiday - one commented that they could have driven home & been seen in there own A&E quicker than the wait - they were still there when we left at nearly 3 a.m :(

& sadly in our case when DD had pneumonia we had already seen 5 GPs including 2 OOH, NONE of whom diagnosed her correctly - she was choking by the time we hit A&E - thankfully it was November & freezing outside, which according to the Paediatric nurse who DID spot she was in real trouble, was probably what saved her life - that & the fantastic Paediatric staff of course :) - so A&E IS needed when other routes fail

Someone mentioned casts not being used due to swelling (sorry lost your post & struggling to follow thread -

again a good point I hadn't thought of - though sadly it could have saved DD a lot of problems, as she was given no strapping of ANY kind, as the staff said they didn't know what to do for her - when the Fracture clinic DID put her cast on, which is for the ligament damage more than the fracture, because her foot hasn't been supported in the right angle position it needed, they had to try & force it back, she was in agony & nearly passed out & its still not now set in the correct position, which the DR said could cause more problems & make it longer healing :(

thanks again everyone

I wish there was some sort of local e-petition type thing as that would be a good way of getting our MPs to take notice to implement some quite minor changes - even just flagging DOBs at booking in point & sending them directly off to the Kids area would be a good start :)

Never heard of a hospital having a children's a &e, we have to travel about 10 miles to our nearest a &e. There is a playroom where kids can wait after they've been seen by triage. Our town has a minor injuries unit but they won't treat under 5s.

that should have read DAYTIME weekend & early evening OOH

we (me and the baby) have been ambulanced from our local hospital (on oxygen) to one where they can treat him but is a big journey (for us) with a baby with breathing difficulties. we go there, they stabilise him,we are admitted to another one. it's shit but what can you do.

We have a separate A&E at Kings (the hospital featured on that brilliant Channel 4 series 24 hours in A & E) and I am very grateful for it. Kings gets lots of stab wound and gunshot wound victims and plenty of drunken idiots.

Separate children's A&E obviously.

We Have separate childrens A&E here. It never occurred to me that any place with separate childrens hospital wouldn't have a separate A&E.

I think YANBU to want separate waiting area and Paediatric staff on duty.

I work in that A and E dept. You must have been there on a very busy night and I am sorry you waited so long. The children's area is not staffed as such anymore so only once you have triaged and it deemed safe enough for you to be put in the children's area will you be put there. It has no camera's or staff going in and out unlike the minors waiting area. Children do not take priority over an adult unfortunately. Sick patients take priority and I have never in the many years I have worked there ever see them alternate between adults and children. I do try where possible to jump children up but if it is very busy this is impossible to do as we have to try and get people seen and transferred or discharged as close to 4 hours as possible. Gone are the times when people would be constantly put to the bottom of the pile because a child had come in meaning they could be waiting 12 hours.
The old hospital did not deal with traumatic injuries, they got transferred to RSCH.
Casts aren't always put on if they are only thinking there might be a fracture or it is only a small fracture and even if a cast had been put on then your daughter's foot would have been forced into the right angle position causing her pain. That happens to all casts put on lower limbs apart from achilles tendon injuries.
5 days is not an unusual length of time to wait for a fracture clinic appointment, they can be up to a week, sometimes longer.

I amazed that the drunks weren't asked to leave. I am very quick to get anyone removed who is not the patient and who is being noisy/aggressive/abusive. Actually I have had patients removed for those reasons. I am sorry that they were allowed to stay.

I think you will find that there are not that many childrens nurses that can deal with traumatic injuries to children. Unlike the nurses working in the A and E they know how to treat injuries both child and adult as dealing with it day, day out. I know I would certainly want my son being looked after by the adults nurses if he had suffered any trauma than a childs nurse with little experience of it. It does not matter whether a child's nurse or an adult nurse if a nurse is more experienced they will pick things up quicker. I can identify a sick child however, a fairly newly qualified childrens nurse may not and I am not paedriatric trained.

Sick children are seen and now can be sent to CASU but have to have to be triaged first by an adult nurse during the night

However, you will be pleased to hear that they are changing how it is being run and soon all children will go to the Alex although I still think trauma will have to come through A and E. However, I had a very poor experience of the Alex with my DS and would much prefer to go through A and E. Unfortunately when places are very busy you will have to wait to be seen and wait for treatments.

We have a totally separate paediatric A&E with it's own waiting paediatric doctors and nurses etc. I don't think it's unreasonable to expect that. Children can present very differently to adults and A&E can be a volatile area. I usually end up at minor injuries. Much quicker much nicer and much less costly for the NHS.

RVI by any chance rockinhippy? I know they're only staffed by paeds part of the time, I'm not sure why but could try and find out for you?

The only time I've taken my daughter to A&E was when she clonked herself, all other times when it was something which needed medical care out of hours I've taken her to the out of hours GP, which conveniently is located right next to A&E, but usually has less waiting time because you've already been triaged on the phone.

Keeping an extra A&E department open just for paediatric patients sounds not very economical to me.

Im sure a newly qualified paediatric nurse would recognise a sick child actually Happy, as they do actually work with many of them during placements! They are also more experienced in common childhood illnesses and complaints.Its not a slight against adult nurses but paediatrics is a specialism.

We are lucky we are only 5 minutes away from Alder Hey Children's Hospital and they have an A&E dept.

From what you describe it sounds more like they have a triage problem TBH - surely they shouldn't be doing one adult then one child?

Some may not, the same as some newly qualified adult nurses might not recognise a sick adult. I have seen both paed's nurses fail to recognise how sick a child is the same as I have seen adult's not recognise how sick an adult is. I was mearly pointing out that just because they are only adult trained does not mean they can't recognise a sick child or care for a child while they are in A and E.

We've got a separate Paediatric A&E. They just use the waiting room used by the CDC (chidl development clinic) and share in the day, they stay open until 3 am then close until 6am thereby avoiding most of the pissheads. We ahve a dedicated recptionist BUT that's just one less person needed on front desk.

It's not a whole different A&E but deals with the issue perfectly. We never had one where we come from and first time it - wow.

We do also have a paed nurse in A&E on triage but tbh I just think that's due to the sheer volume coming through and area we cover; more like 50 than 5 tbh. Regional hospital.

we live rurally so minor injuries unit / out of hours GP is 17 miles away nearest A&E is 32 miles and if under two go to yorkhill childrens hospital in glasgow over an hours drive away its has about 3 parking spaces (ok slight exaggeration)

No it doesn't but the gold standard of care for children is being cared for by paediatric trained staff and to not have ANY in an accident and emergency department is not giving children the standard of care they deserve

YABU. We are all really lucky to get access to free medical health care and in cases of emergency, that a priority system is in place so that the worst are seen first.

It is a a shame that such facilities are abused by drunks.

I'm an A&E nurse (adult), and we have a separate childrens' A&E. On booking in children are sent straight there for triage if they are under 16 and there for a medical problem, or under 13 and there with an injury. Resus facilities are shared, but a child in resus is treated by doctors and nurses from the paediatric department, with the adult trained staff providing fetching and carrying services to help. I naively thought it would be the same at all hospitals, as I would not be comfortable treating children! I trained to treat adults, who have different 'normal' ranges for vital signs, methods of administration and doses of medication, etc., paediatric nurses train to treat children, don't understand why (bar financial reasons of course) any hospital would want staff to provide treatment outside of their field of expertise?!

Just a point I feel needs making again though - your idea of 'non-emergency' and mine may differ enormously. Just because someone looks well doesn't mean they are well, I've seen people who looked fit and well walk into my triage room only to find they are deperately unwell and have required some fairly hefty medical intervention at a rate of knots to prevent them dying!

I don't care how an illness or injury was caused, whether or not it was self-inflicted, caused by booze, drugs, dangerous sports, etc. All I care about is the patient's current condition and how urgently they need treatment. If they are abusive, violent, etc. there are procedures to follow, but again this is not always black and white - I've been called all the c*nts under the sun, spat at and punched by a patient.......... who was a dear little old lady with a nasty uti!