To think the a&e crisis is largely our own doing

[Diemme]

So much on the news at the moment about unacceptable waiting times in a&e departments. And it always makes me think about the few times I've been to a&e in the past few years, and noticed that the waiting room resembled a social club! Full of people eating, drinking, chatting and walking to and from the toilet, vending machine etc. Aibu to think that educating the public to stop inappropriate a&e attendances would come pretty close to sorting the problem?

@ciutadella

Trouble is sometimes they don't actually inform you of the need of a review until you order a repeat. Which of done online takes 3 working days so any time up to three days later you get a phone call. Then of course you have no choice but to get an emergency first thing in the morning appointment.

If there's going to be a review they need to actually inform you of it befire you get stuck with one days worth of pills left and have to faff about

I am lucky with my GP surgery they are fab. Not sure if being in Scotland is different?

My GP surgery does two drop in sessions a week. As long as you are prepared to wait, you know you will be seen that day.

I had to call 111 on New Year's Day. We were on holiday in the Scottish highlands. I'd had that cough that was going around for a few weeks and had coughed solidly for 20 hours. I was becoming struggling to breathe, disorientated and feeling dizzy. I thought if they could tell me where I could get an OOH chemist I might get something to stop the coughing at least to get my breath back.

Told me to go to A&E where I was met by a nurse who took me straight into a clinic. I was on a nebuliser within 20 seconds. Diagnosis was an asthma attack and possibly pneumonia. (First asthma attack ever). I was given an inhaler and antibiotics and told to see my GP.

Went to my GP a few days later who agreed with pneumonia diagnosis and sent me for an Xray which I got an hour later. No appointments, no faffing, just turn up at Xray unit with GP letter.

I do realise I've had a very good experience but it does seem a world apart from what we're reading about the NHS down south.

Most people who go to A*@E* won't have taken themselves there so I expect most of the walking/talking/eating people are with someone else and waiting for them!
I so think that the closure of walk in clinics has been a major benefactor, i took my kids to the minor injuries in our town a few times for head cuts that needed glueing, suspected fractured fingers that needed strapping, bangs to the head etc. Now that it has been closed I will have to take them to A&E.

I have a connection with our local NHS Trust ( deliberately vague) and have seen the A&E stats - around 60% shouldn't be there, this goes up to over 70% at weekends
However, having just spent a ridiculous amount of time trying to get a GP appointment for my son I can totally understand why it happens.
It's not A&E that needs more resources it's the Primary services

How ironic I'm reading this after spending last night in A&E with a suspected fractured hip. I'd slipped and fallen on some mud, landed very awkwardly on my right side, banged my head on a curb and knocked myself out for a few seconds. I was picked up by two lovely ladies in the car park who waited with me until H picked me up two minutes later. At home, in a great deal of pain and vomiting, I called 111 who wanted to send an ambulance to take me to A&E. I refused, and was told a nurse would phone me back, which they did, and they also wanted to send for an ambulance. Again I refused, and went to A&E with H.

I know there's something on a flowchart that triggers an ambulance (probably the degree of pain, knocking myself out and vomiting in my case) but there's nothing a paramedic could do other than take me to hospital. They are not taxis, they are emergency first responders, and at around £700 a time for a call out I think they need to be used a lot more wisely.

No fracture by the way, just very, very bruised and swollen, and I've been given crutches to help me walk for two weeks as apparently the pain and swelling will get worse before it gets better.

Hopping when you say 'didn't need to be there' does that include those that after diagnosis it turned out to be nothing Eg someone with chest pains going to a&e quite legitimately because there is a possibility that it's a heart attack.

Or is it that 60% of people are turning up with symptoms that in no way should ever have been a&e issues, Eg a cut on the knee.

They could solve the problem by making working in a&e for drs more lucrative. They can never fill posts. And it doesn't matter how many nurses etc you employ eventually most people have to see a dr.
And why would you work in a&e when you can have a nice cushy job as a dermatologist or something sat behind a desk, day time hours and opportunities for private work.
They need do do something like a golden hand shake to encourage training in this field they way they did for maths teachers and commit to a long term pay increase specific to a&e drs.

Yes Giles, I would have thought it would be possible to set up a text or e-mail alert system to tell patients if they need to book a review. If it cuts down on emergency GP appointments being taken up it could even save money, as well as hassle. A few patients would be unreachable if not on e-mail or mobile, but the majority I think could now be contacted in that way.

Agree Cory and Brie, the coffee and walking around may be being drunk or done by a relation or friend!

Appreciate what you are saying and i partly agree

But when dd broke her wrist you would have seen us chatting and laughing and going to the loo and everything...she was 6 quite stoic and i had already left it for 4 days

when she fainted she was taken in by ambulance and you wouldn't have seen her at all

So you are a little bit unreasonable

I suppose it's also easy to point the finger at 'drunks in a&e' and assume they're time wasters who are there because they've drunk too much. I know I'm guilty of being a bit sniffy about them.

But if you happen to have been drinking alcohol , which isn't in itself wrong, and then take ill with something unrelated (heart attack, kidney stones etc) then presumably you're included in the statistics of 'at a&e under the influence of alcohol'.

treacle
I'm sorry I should have said they don't need to be in A&E, rather than that they don't need treatment at all.
There are a few categories for this

1. Too minor to need A&E but the patient doesn't realise/has panicked
2. Mentally ill or drunk
3. Can't get an out of hours appointment with a GP
4. Completely entitled idiots with nothing actually wrong with them.

Hopping I was just wondering, not trying to pick holes in your figures.

So the hypothetical chest pain that turns out to be a pulled muscle wouldn't be classed as 'shouldn't be there'?

RE having A&E and OOH in the same building, my hospital is like this. All services- A&E , out of hours , minor injuries, fracture clinic, etc are all in one building. If you walk in a nurse triages you and you're either sent through to A&E majors or told to wait either to see a GP, nurse practioner or the fracture clinic, or sent home.

GPs can arrange a direct admission to medical or surgical receiving , which helps stop queuing of patients from care homes etc.

It's relatively new , started in 2011 or 2012 but it works fine and no one can get into A&E queues who shouldn't be there.

Children are treated in their hospital next door with separate A&E (although shared resus) but I think the process is fairly similar.

I'm in Scotland as well and maybe that does make a difference , I'm not sure. I should say though that A&E covers a 45 mile radius.. the next one is 45 miles north or 50 miles south . Most towns have a casualty department for minor injuries (although few can x ray out of normal hours), out of hours services and life support but an ambulance if time was allowing would just take you to the big A&E. So it's not as if that hospital covers a small population.

I think the answer is to have an out of hours GP service run next to every a&e department, then those that need an doctor can go there and have no waiting limit, those that need a&e can be seen. A triage system at both departments would also help confusions as to where people should be.

I thought exactly this when I watched the news item about the crisis. Two departments, one triage area to send you to either A&E or minor injuries/OOH doctor. Then the people making the decision of where you should be are actually medically trained and noone ends up in A&E because they can't get a GP appointment.

I was there only a few months ago when DD had a particularly nasty fall where she's smacked her head off the floor. She'd complained about dizziness and a headache so we went to A&E. there were a lot of children who seemed like they'd have done better with a drs appt the next day.

HungryHippo- to be fair you don't know what was wrong with those children. My daughter was taken in to A& E having had an epileptic seizure. She fell to the ground during the seizure and bashed her shoulder & head on the kitchen unit on the way down. After she had come round from the seizure I took her to A & E to get the shoulder looked at and the head injury checked . She would have looked ok at the hospital, walking, chatting , probably eating something from the vending machine. But she would have needed to be seen just as much as your daughter. But you probably would have judged me for not having taken her to the Dr's the next day instead.

Also, I personally would not have the confidence to glue/stitch a deep wound, its great that you do but not everyone can and I don't believe that comes under 'self care', it is a job for a health care professional. Otherwise where does it end- patients expected to perform their own surgery?

Problem is that the system doesn't always work. Took my son to a walk in recently, but there was no triage nurse, so were told it would be 3 hours before anyone would see him. As there was a possibility it was an asthma attack, we had no choice but to take him to a and e. He was seen by the triage nurse within half an hour, and then admitted relatively quickly. Okay, so that probably means that the walk in would have sent us up there anyway, but i was genuinely surprised that there was no initial assessment, and prioritizing of cases, at the walk in centre.

treacle no, we don't mind those and of course worried parents are always welcome too but if there was a walk in GP service ( which there isn't here) perhaps some of those people wouldn't be at A&E either.

I don't actually work for the NHS so I have no agenda in defending it but for very vague reasons I do have access to a lot of information not generally in the public domain ( think high level voluntary position)

soup
That's actually what our local Trust is trying to do but to do it they need to downgrade the A&E in one of the hospitals.
All the local media and community can hear is "closure" and a huge campaign has started. Totally understand the panic but there is a bigger picture and long term having seen the detailed plans I believe that if it's done properly with adequate funding ( there's the rub) then long term the situation here will get much better.
In the meantime people are recording charity singles and marching through town - totally their right and I understand the concern but change IS necessary.

I honestly think the problem goes way deeper than A&E. We need to start investing more money in the health services as well as health and social care to cope with the challenges of an increasingly obese and elderly population.

They triage properly in our local A&E and those not required to be seen further by emergency care (or those that should just feck off to their GP or the walk-in clinic) are told exactly that. Thus the wait times are almost always pretty much decent and acceptable.

Areyoufree, that's so weird. The whole purpose of a walk-in centre is for them to triage and treat. What a bloody weird centre you went to

EusticeClarenceSCrubb- not at all. There were children singing and dancing and running around the kids A&E.

My daughter would have looked like one of the need-not-be-here's. She looked physically fine, but I think that if children are running around an A&E, they probably shouldn't be there.

few times I've been to a&e in the past few years

What were your attendances for, OP? Life or death issues?

You know those people sitting chatting ,could well have been someone accompanying an ill person, who weren't ill themselves

We live in a busy urban area. The other night an elderly neighbour had a fall while trying to put the bins out. He was left with bad cuts, his feet just inside the front door and the rest of him lying very awkwardly on steps.

Despite all the horror stories, the ambulance came within half an hour. Dh went with him to the hospital - his wife is too frail - and he was seen and dealt with pretty promptly. He spent the night there, in the clinical decision unit where they ran various tests to check on him - and we brought him home in very good spirits yesterday.

Knowing how busy and overworked they all are, we were particularly thankful for such good care.

With reference to abuse of A & E, yes, I think it does happen, particularly with people who have merely drunk far too much. There ought IMO to be hefty fines for people who end up there merely because they are drunk and incapable.

Having said that, I have every sympathy for people who go because they cannot get GP appts, or whose GP cannot or will not accept that there's anything much wrong. A friend of dd ended up at A and E because her GP repeatedly refused to accept that there was anything much wrong with her baby. That baby ended up the next day in intensive care in a bigger hospital for a fortnight, with a serious liver infection.

Few visits to A&E. Visit 1: grass seed stuck in eye out of hours, MIU has no slit lamp so refers to A&E - can't really wait until morning as would get worse. A&E with correct kit solve quickly...

Visit 2: I scrape my eye on DH's beard. Blurry vision that eye, really sore. Attend MIU, diagnose scratch, AB gloop prescribed, told A&E if worse (which it does) A&E rex and flush with local anaesthetic stuff, which breaks the cycle of inflammation and suggest the AB gloop is causing a reaction so AB drops instead - all fine.

Visit 3/4 cuts involving glass - 1 medically trained DH panics about fat prolapsing out of cut finger - his species don't tend to do that unless cut is v nasty. A&E x-ray to ensure no glass then stick steri strip on. 2 - glass smashes during washing up - deep cut near finger joint (in a surgeon's right hand) - again x-ray/probing required!

Visit 5. Broken arm. Only one of the bones but complete/displaced. Taken in by boss (splinted). Waits ages post triage as stable enough, gets pinned 1 week later for clinical reasons.

Visit 6, chemo patient with temperature just over cut off plus increased hr - never sat down, having walked in looking fine!