To be cynical about empty A&E

[Cinders29]

So my son has to come to A&E / be admitted to children's wards fairly regularly and usually children's A&E is HEAVING , wards are busy etc however came yesterday and completely empty. Literally just us ( big city hospital )

AIBU to think this proves that people totally misuse the NHS and come in when they really don't need to.

On a plus PICU is really quiet due to lack of accidents etc so it's great to see they're not stretched. The staff from PICU are helping out on my sons ward due to lack of work.

Lots of the elderly are not out and about, lots of A and E minor beds are usually taken up with "elderly, collapse? cause".
Of course this isolation is probably having a terrible effect on their mental well being and sense of isolation though.

I have also heard people are bering just told not to go...that no one will see them.

Yes, it is over used as doctors have been saying for years. I have hardly ever been but when I took my head injured unable to speak or write daughter (i.e. serious) they took her right in under triage ahead of everyone else at that time (a while back) as head injuries need to be seen straight away.

I can tell you where they all are. The local community pharmacies.

We are on our knees.

I doubt it. It’s probably more likely the case that people are being treated at home by paramedics when possible whereas before they used to tell people to come in for even fairly minor things.

YANBU.

I was in A&E just over two weeks ago with my Nan who was seriously ill. I popped through to the general waiting area to use the coffee machine as I was there for a long time and it was empty. Same later -2 people in there. So, even though we weren't in lockdown then, people were clearly thinking twice about going.

That said, majors and resuscitation (where we were) were packed out but at least it was with people who genuinely needed to be there.

Wards are hugely understaffed due to staff sickness and people self isolating.

My friend is a consultant in A&E and says its the calm before the storm and they're all bracing themselves and doing as much as they can to get ready. Its quiet because most people are being sensible and staying home. A good proportion of their patients are usually those drinking too much in pubs/clubs, road accidents, sporting accidents etc and these have obviously dropped off.

Absolutely agree!

@Cinders29 I am so sorry your son is unwell, I hope he recovers very quickly.

I had to go into A and E on the weekend, under normal circumstances I would have been monitored for 12-24 hours - I was offered discharge after 2 hours, the Resus bit was full, but the waiting room was empty. I think with the extra capacity beds they are getting people out of the waiting room quickly.

Despite being offered to go home and to come back if I felt worse, I was then asked to sign a self discharge form - which would have gone on my records (I did refuse to do this). I do wonder how many GPs are getting letters saying their patients have self discharged from hospital when actually they are being advised to leave earlier.

I have totally admiration for NHS staff - my partner is one, but I don't all think it's down to "time wasters" not showing up - I also think many of those in that category have underlying needs and are sadly repeatedly failed by services.

For those asking why everyone is saying the NHS is already overwhelmed. Some areas are. I know my trust is trying to clear beds where possible, either discharging or moving to less dependent areas which is creating a lot of work.

But also 17,000 beds (I think that’s the right number) were cut from funding in the last decade or more which means less beds over all and less staff to do the caring. Which means we’re playing the juggling game of trying to discharge or move people to less critical areas so that beds can be opened up in the case of a flood of corona virus victims.

For example, I learned last week that the birth rate in the UK has fallen every year for the last 10 years but no one would ever say we have a surplus of maternity provision; they’re overstretched because funding has been cut to lower than the birth rate is falling. The same has happened everywhere

It takes 8 members of staff to regularly turn an intubated patients safely - doing that every 2 hours is physically hard work, mentally stressful as you worry about COVID and takes up huge resources - there are people doing jobs they would never normally do to maintain safe care.

So yes ED is empty for injuries but they are still happening - they just come in delayed presentation as they do at Xmas and NY.

I also think 111 are no longer telling people to go to hospital, whereas before this was quite a frequent occurrence.

On the weekend when we tried 999 two people were on the phone for close to forty minutes, and there was no pick up - in the end they flagged a random stranger down from the road and he kindly drove us to A and E.

@stuffedpeppers really, 8 members? I have been intubated six times in the past twelve months and I never ever knew this. With Covid the recommendation is face down is it not, so they would not be turning patients?

I agree.
Personally I believe that the services offered by the NHS should be cut. People need to learn to manage themselves better.
I’m not talking about everyone here but I know people go to A& E for the most stupid , trivial reasons.
I also think people are taking far less risks now. Pub closures will reduce alcohol related accidents and I imagine the number of car accidents will be greatly reduced.
Also people won’t want to be around other ill people so will stay home.

I don’t know if I agree that it’s “mis-use” where children are concerned do parent snot generally just think “better to be safe than sorry” ??

Last time I took DS to children's A&E after he bashed heads with another boy and needed his eye brow glued together, there were another 5 or 6 children in the waiting room with us. Every one of them was there for glue/stiches or injured ankles/wrists that needed x rays etc. Not one was actually sick. It was lunch time on a week day and except for the toddler, they were all wearing school uniform. So I do think there's a drop in the sorts of accidents that require A&E.

But there's ALSO a drop in people going to A&E because they have a bad cold and their GP won't give them antibiotics or whatever. And maybe, just maybe, if we're lucky, those people will learn some useful lessons for when this is all over.

I think there should be a rule in A&E that you are not allowed to be accompanied by more than one person. Everyone else has to stay outside (or at home). It really is like a family outing in children's A&E sometimes.

Equally (and I'm sure I'll get hammered for this) if everywhere is so quiet then why is the media making such a big deal about the overworked healthcare teams hmm

Many ICU staff have been made to cancel all annual leave and are now working a military rota of 12 hours every day. An ICU nurse usually provides 1:1 care for patients - it’s currently 1:6 in many units.

Yes a lot of A&E departments are quiet at present. Think of it as a tsunami - we are currently in the part where the tide is receding and the beach is calm. But we are standing waiting, knowing that the surge will come.

25% of all Covid-19 cases in Ireland are healthcare workers. I think they are entitled to have a moan!

@fairynick it's called "Waitless" but I think its only available in certain areas.

No sports
Fewer cars in the road
No pubs open or all day drinking in the park
Not icy
^That must account for a massive amount of normal A&E custom

I used to work in an on-call clinic dealing with patients referred by A&E/OOH services and our workloads usually had a seasonal pattern to them with the sorts of injuries we would see.

Winter/icy weather - lots of elderly patients with injuries related to slipping on ice. Sledging injuries.

Summer - cycling injuries, DIY and gardening injuries.

Weekends and bank holidays - sharp increase in alcohol related accidents and injuries caused by people doing stupid shit while drunk.

School holidays - sharp increase in the number of children with play related injuries.

3.30pm on school days - sudden influx of children who had hurt themselves at school and been given a wet paper towel for it but whose parents now wanted it checked over by a doctor.

Year round was a general parade of injuries relating to car accidents, alcohol, sports and hobbies, kids being kids, and slips, trips, and falls.

No schools, no play parks, no soft plays, no kids clubs/activities means far less of the injuries usually generated by these.

Less cars on the road means less RTAs.

Pubs and clubs closed mean less alcohol related injuries and the people still drinking are doing it privately at home with a limited supply and no one to get into fights or silly situations with.

Cafes and restaurants closing means things like less food poisoning and accidental allergic reactions.

People self-isolating means less germs circulating in general so less people getting sick from various bugs.

Lots of GP surgeries have switched entirely to telephone appointments for the majority of their patients which, for various reasons, is often faster than seeing a patient face to face so less people going to A&E as they couldn't speak to their own GP.

People with chronic conditions are being directed elsewhere. My father has a medical condition and can have episodes that are considered medical emergencies, the usual process would be that he is taken to A&E, stabilised, and then moved off to the relevant ward for assessment and treatment. His consultant contacted him to advise that from now on he has to go directly to the ward, we should ring ahead to tell them we are on our way, and they will do everything there instead. From speaking to friends in similar circumstances, they have been told variations of the same.

And then of course the people who probably shouldn't be in A&E and know they shouldn't are either staying home or swamping the pharmacy.

@catwithnohat that is a rather goady comment but one I feel that needs answering as it's also a valid question...

I'm an A&E nurse and yes it is more civilised than normal. The 2 weeks in the run up to the outbreak (actually it's much, much longer but I'll use those 2 weeks as an example) were horrendous. We have had to employ "queue nurses", nurses responsible for the care of patients stuck in the corridor, and we were having to stop incoming ambulances when there were 19 patients on the corridor (a daily occurrence). Now this has stopped, something that is a hot topic of conversation in the staff room, and many areas are empty.....proving that most of what was coming through the door was wholly unnecessary and inappropriate.

NOW we have seen the acuity of patients, how sick they are, has increased massively. The people that are coming in are much more sick and need much more intensive care than before.
The infection control measures now in place, quite rightly, are very stringent. Tasks that could be carried out with one nurse are now taking a minimum of 2 nurses because you need a "clean" nurse and a "dirty" nurse. Sometimes these tasks can take 3 nurses, like helping somebody onto a bedpan, which will take almost half of the work force of that area. Also, tasks that would usually take no more than a minute, taking an IV bag down for instance, now takes much much longer.

So yeah, we don't have as many unnecessary patients coming in but the workload has increased. I hope that answers your question.

Also, to add, I do not know a single nurse that is isolating. Not one.

@Whatevah I am currently and we have several in our department who are also in isolation

With pubs closed no drunken idiots on a Friday night. Win win