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?

It's nonsense to suggest A&E is only for life or death cases. My last visit to a proper A&E was when my son got a deep cut on his hand in a school sports fixture, away. Another parent took him to the nearest one which is one of the biggest/busiest ones in London - had I taken him myself I would have probably gone to the minor injuries unit closer to home. After several hours there the wound was thoroughly cleaned and stitched and the lovely doctor was so apologetic about our wait. He reassured us that unlike a LOT of what they see, DS was exactly the type of case that should be seen in A&E. It was nowhere near life or death!

The paediatric waiting room contained more than one group "outing" with one poorly child and mum, gran, aunty, mum's friend all there as well.

I was sent to A&E once by a GP, or rather a GP receptionist. I had a tampon stuck and despite trying for hours, couldn't get it out. I went to a GP, no appointment, just walked in, whispered my problem to the receptionist, receptionist went to have a word with doctor. Receptionist came back to tell me that doctor said they would remove it there but don't have the tool they needed and that I had to go to A&E, and to go now, don't leave it for later.

I was fine, in perfect health, still visited A&E though.

The paediatric waiting room contained more than one group "outing" with one poorly child and mum, gran, aunty, mum's friend all there as well.

This happens all the time. It's a trip out.

I also think that we should have half way house system for the elderly, where we would build in effect a hotel with kitchenette as well as bathroom to the rooms. The staff instead of being waitresses would be care workers

This would then be a place to place old people while there needs are assessed before they either go home, go into a nursing home or a care home/sheltered accommodation.

This way it would stop bed blocking, give old people somewhere safe to be with others around and people to give a certain level of care.

Although it would cost money to set up, it would ultimately be cheaper than bed blocking, readmission by ambulance and hospital care costs

If they do away with the 4 hour limit for treatment and discharge/ admission then non urgent patients will have an interminable time to wait, which will get rid of them - in the 90s I twice took DCs in after sports injuries and both times waited 5+ hours, getting home at 2am in one case. Awful, facial injuries so didn't want to leave them to the next day.

I'm currently blocking a cubicle in the minor section of our ED, no beds in majors, no beds to move me to when the surgeon asked for me to be admitted, same in the next door one too, thus half of the places to treat things are blocked and the nurses are having to care for us as well, frequent ones and drugs, stopping them from triage work

The halfway house is a good idea, Ivy, but I imagine it eWorld be even harder to get them out of there- no 'emergency waiting for admission' to speed them along.

The problem is complex but a big factor is an ageing population putting strain on services across the system and funding not keeping up. Underfunded social care meaning they stay in hospital longer than needed bec nowhere safe to discharge them to. Not as simple as 'other people use A abdE as a social club'
Otherwise you'd not have people dying in the corridors on trolleys after A&E has determined they need hospital admission. The hospital system needs more capacity and to be able to move patients into the most suitable form of care asap which is not always possible. The solution is political.

Why have we so many foreign workers- surely it's due to bad working conditions, so locals don't want the jobs. I doubt many of the foreigners are over 60, the locals have prob given up exhausted by that age. The wages are better than they would get at home. Go back to the 3 shifts a day for nurses instead of 12+ hours and more would stay on until they are older and be able to fit shifts round childcare.

Irritating to see on FB last night a quote doing the rounds of supposed time wasting visits to A&E over Christmas, it was something like 12 pointless visits to A&E. I'm pretty sure it was from the Daily Mail. Anyway more blaming the public and people falling for it. sigh ......

The halfway house idea is not new. In fact, there was a net work of such places, they were called "cottage hospitals ".
My mil, after a particularly bad fall, was in hospital for several weeks. When she was well enough to start rehabilitation she was moved to the local cottage hospital, leaving the acute hospital bed free for the next emergency. At the cottage hospital she had occupational therapy to help her get back on her feet, there was even a kitchen for practicing simple cooking a tea making. Her needs were assessed and a care package put in place before she was sent home.
This cottage hospital has been closed, the local SS department has had its funding cut and guess what, the local acute hospital complains bitterly about the bed blocking elderly.

Mm, most people want there own home, sadly many die with 12 months, and homes would be found and people moved in any case just like they are now

So if I break my arm am I not allowed to use the toilet in a&e? Have a bar of chocolate while I wait? Talk to my friend who would've had to drive me due to said broken arm?

I really don't see what the facilities in terms of toilet/vending machines has to do with anything. There are few people who think the idea of a fun day out is waiting in a&e for 5 hours.

I do think there should be more minor injury/walk in clinics however and perhaps the triage service could be beefed up and time wasters be sent packing

Is medication still free if you go to A+E? It certainly was the last time I worked there - we'd have people requesting paracetamol, babies nappies, baby formula 'Because we've run ot' and so on.
Medication should be charged for (no more freebies).
There are many who are taking the piss, they should see a pharmacist and start taking more responsibility for their own health.

And don't get me started on bloody drunks 😡

P1nk Poppy, yes the waiting for hours to get free paracetamol, Calpol etc does happen. I didn't know until DD, who's a HCP told me. I know the NHS is cash strapped, probably has too many senior managers and not enough clinicians, but we can do our bit too by using GPs when we can. I don't go often, but the last few times I've been in, flu jab, BP check with nurse, the list of missed GP appointments has never been less than 50 for the month. Some may be genuine, but in this age of technology, it's not hard to keep track and cancel. No wonder some people can't get appointments!

Medication isn't free unless you don't have to pay for it in the first place.

As for the drunks, the most frequent visiting drunk patients have MH issues and are being failed by the mental health services. The ones who don't have MH issues and have fell over and smacked their head deserve to be there just as much as all the Sunday football lot with their broken bones.

We have quite a few drunk regulars for sure, they don't make me angry. It makes me sad. What a way to spend your life and very few get the support they need right now.

They are an easy target, people love to get angry at all the 'drunks' waisting A&E time. It's so much more complicated than that, as you should know if you worked in A&E yourself.

I don't go often, but the last few times I've been in, flu jab, BP check with nurse, the list of missed GP appointments has never been less than 50 for the month. Some may be genuine, but in this age of technology, it's not hard to keep track and cancel. No wonder some people can't get appointments!

The last clinic shift I worked had 4 people DNA in the space of three hours. I think two called in, the other two didn't. It happens quite regularly on an extra cold day it seems. I have never worked a clinic shift where there wasn't at least two people who DNA and didn't call.

It's not good enough, these appointments are like gold dust.

I don't understand the original complaint? My husband went to A&E when he shut the boot on his thumb and it went through to the bone. No doubt for the 4 hours he was waiting to be seen he was walking around, going to the toilet and the vending machine. Doesn't mean he didn't need to be there?

I've no doubt there are people there who don't need to be seen by A&E but a lot of that is sympomatic of other issues in the social/health services.

Annoying though it might be that a whole family, mum, dad, aunt, gran etc have turned up at A& E, as long as they are not all demanding to be seen for minor issues it should not make a difference to waiting time, since they are all there for just one patient, the same patient who would still need to be seen if they were not all there. If they are using up seats and other patients can't sit down then maybe yes it is a problem, but surely the A& E staff need to ask them give up their seats in that case. They might get the hint and go home!

Dd and I have both been to A & E recently, she with concussion after a fall down the stairs and me with bleeding. Between the two of us:

*we did not see a single drunk though we clocked up a total of 8/10 hours at A & E between us, most of it in the evening

*we saw several people with broken bones, several people on trolleys including some who were semi-conscious, some who were confused and at least one already on a drip, a baby with a high temperature, and several more people in severe pain

*dd, like many of the other patients, was accompanied, as she could hardly sit safely on her own in the waiting room while confused with concussion

*her dad did use the vending machine as he had come straight from work and missed his supper and knew he might end up spending many more hours there

Dd and I are lucky enough to have access to a walk-in clinic connected to a smaller local hospital unit; it is open at all hours and you will get seen there. However this clinic:

*cannot do any x-rays due to lack of trained staff: the person trained in using the x-ray machine is only in for a few hours a week for her own clinics-by-appointment
(apparently dd struck lucky once and got her broken thumb x-rayed there, as the lady happened to be both present and free)

*cannot do ultra-sounds for lack of equipment/trained staff

*can only do limited blood tests

So anyone with a suspected fracture/cyst/polyp etc has to be sent onto A & E.

During my recent trouble, I:

• rang 111 in the morning

*was told to go to walk-in-clinic

• went to walk-in-clinic and was seen by mid-afternoon

• was told to got to A & E

• went to A & E and was seen by mid-evening

• had various blood tests taken and was able to go home in late evening

• was told to see my GP for an urgent referral

• went to GP next morning, got an urgent appointmet and was given an internal examination

• was referred back to hospital where I had a thorough examination including ultrasound and biopsy (within the fortnight stipulated so they were very good)

Can't fault anyone who dealt with me, but looking back it does seem like an awful lot of people's time I wasted- and yet I followed instructions all the way.

"I have never worked a clinic shift where there wasn't at least two people who DNA and didn't call."

Was this a gp clinic or a hospital clinic U2? If a hospital clinic where appointments are sent out, it's possible the dnas didn't receive the appt letter until after the appointment. I have heard of this happening on occasion.

Think I have mentioned it already, but texting reminders the day before does apparently reduce dnas - and some places do seem to do that.

Have also been in situation of appointment simply not coming through the post in time for appointment.

And in the case of elderly/disabled people, appointments may also need to be sent out early enough to arrange transport/escort for any medical appointment. A friend of mine manages voluntary hospital transport: it's a very complicated task and takes time. And then drivers pull out at the last minute for personal (and often perfectly valid) reasons leaving the patient stranded.

People suffering from MH issues may have other reasons for not being able to keep appointments.

Hospital clinics.

We do get sent a text/phone call a couple of days before the appointment as well.

This clinic isn't a clinic where you see elderly people. It's mainly child bearing aged women as it is a very specific test. I have worked in a variety of clinics and yes, transport for the elderly and disabled can be a nightmare.

However there are still far too many people who DNA. Of course there might be very valid reasons for many of them, but probably not all of them.

I work in a GP clinic and DNA's are a real problem. These are appointments the patients have booked themselves too.

That is less understandable Pat, but if a patient books an appointment a couple of weeks away I suppose it is easy for them to forget about it if the problem's resolved - do you do a text reminder the previous day?

Another possible reason for not cancelling (ie if you're now better) - can't get through on the phone! A good solution to this is automated phone bookings/cancellations - but the patient does still have to remember that s/he has an appointment to cancel!