To ask what A&E docs do when they are not with patients?

[coffeeforone]

I recently spent a night in the children’s section of my local A&E, and spent some time observing the docs/nurses work whilst DS was asleep on a monitor.

There were 4 nurses and 2 doctors sat behind a long desk (plus a registrar that seemed to pop in and out occasionally - busy elsewhere I assume).

It wasn’t especially busy. We were there for 6 hours and in total about 5 or 6 children came in and were seen by one of the docs (after waiting about 3 hours). After triage, we waited about 3 hours to be seen by a doctor. It seemed like they had an awful lot of paperwork/discussions, but didn’t have much time to consult with the actual patients. I did wonder what was taking up all their time. AIBU to think they could have had a more efficient system?

You said you'd been triaged and your son was on a monitor. I'm going to assume nursing staff were recording his obs regularly also. His condition was stable. He was being monitor to see if anything changed.

Can I ask what you thought seeing a doctor sooner was going to accomplish?

I've spent a lot of time in a and e with my toddler as he has a heart condition. I must say I've always been really impressed with the drs. Often they will stay close and constantly check on us to ensure there have been no changes to his condition.

Clumsy duck I waited in what appeared to be a quiet a&e for 3.5 hours waiting for a Gynae doctor to see me having had a ruptured ectopic pregnancy. I know they came to see me as soon as they could as they know me personally. Also having done the job I am aware they could have been in theatre doing a cs or delivering a baby.

If you had a surgical problem you would have been waiting to see a surgical doctor. Often there is only one person on call covering theatres and all the other surgical patients in the hospital as well as seeing all admissions. Clearly you were treated appropriately as you got the op and have lived to tell the tale. Did you have somewhere else important to be in that 5.5 hours? If not then what is the issue? Perhaps the doctor who needed to see you was dealing with someone sicker.

There were a number of cardiac arrests on my shifts this weekend. That meant a few less sick people had to wait a bit for non urgent issues. I know which patient i'd rather be.

At lease 3 of the 6 children (including us) were not urgent emergencies and were directed to A&E by 111 docs

111 isn’t staffed by Doctors. 111 isn’t staffed by people with health care training. It’s a call centre staffed by “trained advisors”. It was brought in to replace NHS direct which was largely staffed by nurses because it was cheaper to run. If your issue is with 111 you need to take this up with the government. Sometimes 111 does direct to the out of hours GP service (or a nurse or paramedic), but the 111 service is not run by doctors and people advised to attend A&E by 111 aren’t being advised to do this by a Doctor.

That’s aside from the fact that it can be hard to assess people over the telephone and the person performing the assessment can only do so based on the information they are given and obviously need to err on the side of caution and also that people’s symptoms do sometimes change over time so maybe whilst A&E was felt to be necessary at the time of the call things might have improved subsequently.

If you have all the answers, then go ahead and fix it yourself. The reality is not as straightforward as you seem to think it is.

but you need to raise this with your seniors

Unfortunately whistle blowing does not go down well in the NHS. Senior managers know how bad things are, that people are run off their feet, but anyone that dares to highlight the issue can find themselves in a whole lot of trouble.

@Bombardier25966 someone working without adequate breaks to the point that they miscarry due to lack of sleep, food or water actually needs raising. It's dangerous. For Mother, for baby, for patients.

Also when I worked in A&E as a junior doctors I expected it to be all dashing around to emergencies like on ER. I was surprised how much sitting down writing or at the computer there was.

And also surprised how slow it could be to get things done sometimes. I'm sure somebody could improve the workflow and efficiency with a time/motion analysis of something, but it wasn't that we were being "idle" by being at the desk for ages, or taking a long time to do admin tasks, the tasks genuinely took a long time.

And also when you are working long shifts, and night shifts in particular, with no daylight your efficiency really slows down. I found at times during night shifts i struggled to do even simple tasks at a reasonable speed. I ended up double checking lots of things (eg in guidelines databases online) to ensure I didn't make a mistake, so it would have looked like I was googling! But otherwise I woke up in a cold sweat the next day worried that I'd made a mistake at 4am.

Write everything in the notes (bearing in mind you might be reading it out in court one day!).
Order tests using multiple slow user-unfriendly computer systems.
Log that you have requested these tests in a separate auditing computer system which keeps crashing.
Check hospital protocols/ national guidelines to ensure you have done correct things if unsure (yes we do Google them as now you access information online rather than textbooks).
Check the drug doses for children (online resource for this usually used).
Maybe telephone senior doctor/ specialist to discuss patient.
Keep checking computer systems for results as there is no notification system.
Write everything down with times as constantly drummed into us "if you didn't write it down it didn't happen'
Then write up discharge paperwork to send to GP.
And update A&E audit computer system.

And maybe you are also reviewing results that take longer to come back for patients who were discharged earlier, and contacting them if abnormal.

Yeh I get that honestly I'm not complaining I can understand that people were not just stood about doing nothing it was more like I say there was hardly anyone there that made me wonder how it would be if it was busy ( from a "how the system works " point of view rather than the staff themselves )

I imagine if he was on a monitor then they were waiting for a period of time before he could be discharged, by the Registrar (that's the one popping in and out, probably between dealing with seriously ill and dying patients, by the way). If the (presumably very junior) docs you're talking about had seen and discharged your son immediately and he'd worsened in the following 2 hours at home, you'd be complaining wouldn't you?!! Sadly often the very junior Dr's do have to do some watchful waiting, the most critically ill patients need senior care and senior review - rest assured OP, that most a&e Dr's are worked into the ground, don't get breaks and rarely see their families - to the point that my husband being an a&e consultant has destroyed our marriage. Now that makes you feel better, doesn't it?

Oh random I really really hope you’re not
Awful

Notes. Arranging investigations. Checking results. Contacting other specialties. Contacting other colleagues.

Plus not every doctor in A&E is an “A&E doctors”. The medics will be covering the wards. The mental health staff will be covering other units too. Etc etc.

I can guarantee they’re not sitting back eating hobnobs anyway. They’re working their asses off like you wouldn’t believe.

You said you'd been triaged and your son was on a monitor. I'm going to assume nursing staff were recording his obs regularly also. His condition was stable. He was being monitor to see if anything changed.

Can I ask what you thought seeing a doctor sooner was going to accomplish?

yes...as his temp had reduced we wanted to go home so DS could rest better. We thought a doctor would be able to agree to that...but turns out they couldn't (they just said its a sore throat but his HR is a bit high)...waited another 2.5 hours to be checked again...then a further 90 mins before they could speak to registrar and agree.

DS has a natural high HR, same as DH and most on his side of the family (120-140 for 22 month old DS, 100-105 resting for DH).

Not that relevant but DH and I also have bad colds at the moment, I'm also 12 weeks PG with bad sickness especially at night, so by 3am we were both exhausted and wanted to go home and sleep. Granted, this may have skewed our opinions once we knew DS was fine and kind of regretted going in the first place.

random hope someone is taking care of you, and thank you and all NHS staff for your work.

No I am. Negative pregnancy test, heavy bleeding and cramps. Believe it or not, we doctors are human and most of us bust our balls trying to help ungrateful people like the OP. Thankfully most of the genuinely sick ones seem to think we do an ok job.

coffee I appreciate that you were concerned about your DS and followed 111 advice and you have relayed your observations on this thread.

It may be a bit harsh, but your lack of response to the last sentence in the comment by random would suggest a lack of empathy.

You win OP. They were doing fuck all. All of the time. All of them. Obviously to inconvenience patients as the sole aim. It’s how they get their jollies. There is no way you will ever believe otherwise.

So basically, OP, you wasted their time, cost the NHS money it can ill afford, your child is fine and you're complaining.

It can be frustrating waiting to be seen or discharged but doctors don't just sit around doing nothing and you dont know what they are doing or what's waiting to be done. Your son was ok, asleep and that's the main thing.

So sorry random i really am. What can I say? The pressures you’re under are immense and the political climate makes complaint almost impossible from within :(

I think I may have almost hugged the doc who ran across the hospital to get DS breathing properly again. All staff docs, nurses, Assistants etc were thanked profusely and we were immensely grateful for their help. Seeing my kid go blue is not something I ever want to repeat. Thank fuck for modern medicine and the people who administer it. 💐

random I do hope you're able to take some time off to look after yourself and recover....year ago, I was on call in a dialysis unit and had to go in at 3 am to set up equipment , I then started to miscarry but had to stay on duty until the unit was sufficiently staffed
Unfortunately what goes on behind the scenes is often not acknowledged or appreciated

Random, take good care of yourself, you do a wonderful job and yes, people do often forget we are human

coffeeforone
Unless you have medical training and ALL the clinical information on the other patients, you cannot possibly judge whether they were in the department appropriately or not.

1. May have needed an x ray so entirely appropriate for her to be there. Arranging the x ray, the patient going to and returning from X ray and reviewing the result takes time

2. serious allergic reactions should be seen in A&E. Even if not serious, there’s a possibility of concern that the child may have had a delayed reaction. “Playing happily” can sometimes equate to an important assessment that there isn’t anything seriously wrong. However if the child had developed anaphylaxis and breathing problems then it would be possible to deal with it quickly in A&E.

3. sometimes part of the management for asthma is a period of monitoring once treatment has been given to ensure things don’t deteriorate. He may well not have needed to be seen more than once by a Dr in 6 hours, but the nurses are likely to have seen him and fed back to the Dr on his observations.judt because a Dr hasn’t physically been to see him, it doesn’t mean they’re not involved in treating him.

4. Vomiting sometimes requires a period of observation as part of the management to ensure fluids are being kept down and that baby is weeing. Just because baby doesn’t need a drip/tube inserted, it doesn’t mean nothing is being done. It’s quite it’s entirely appropriate for 111 to send them to A&E for assessment.

5. Could have been anything from a small bump to significant trauma. It’s quite possible the child was either admitted or taken to the area for more urgent cases. Or maybe the cut on his head needed stitching which required admission and doing under anaesthetic.

I’ve also worked in A&E departments and can tell you that it’s the hardest, busiest and most antisocial job I’ve ever done so yes, YABVVU. Do you think there’s a major recruitment crisis in A&E because it’s a great job which everyone wants to do? Maybe while you’re solving the problem of how to make it run more efficiently, you can also solve the recruitment crisis.