To think this is why our A and E are failing?!

[DaisyLilyFlower]

Currently in A and E with suspected ectopic pregnancy (told to come here from 111) and current wait is around 4 hours, already been here two.

I’ve been sat by triage next to the reception desk, so not deliberately being nosy but in the last hour two patients have come in with

One with an ear infection
And another with a ingrown toenail

Cannot believe it! Reception asked them both if they’d been to see GP or rang 111, tried overnight pharmacy etc and both said no!
I do not doubt that both of those conditions are extremely painful, but I sort of can’t believe that people turn up to A and E without trying other methods first?

I’m probably just being wingy as I’m in pain and the wait is long and ABU, but I guess my question is,

What’s the worst thing you’ve seen at a and e?

Also Name change as don’t want this linked to my other posts but reg poster.

Location matters a lot for access as well as the services that are available. Our GP is present as needed, but the area also has excellent out of hours GP, we can just call and get seen whenever about 10 minutes walk away. A&E are the same distance if needed. The official local minor injuries unit on the other hand is 3 miles away; we would need 2 separate buses, or a long walk from the train, or an annoying lengthy traffic queue for those with a car or getting a taxi. I can't see that many from this area would even consider trying to get there rather than seeing a GP.

The other issue is that the services on offer are perhaps not made clear enough for users. Back in the day, I had a blocked ear and the GP sent me to a walk-in, 2 years later I went to a walk-in with a blocked ear to be told that's done at the GP now, 3 years later a friend went to the GP to be told it was the walk-in again. Fair enough, different CCGs have different service structures and processes change, but a really clear list for each area about where to go for different issues in/out of hours (pharmacy, GP, OOH GP, well-known clinic, minor injuries clinic, GUM clinic, A&E etc) would be very helpful rather than expecting individuals to know where to go.

I ended up in A&E a few months ago following a minor accident. I rang 111, which was a waste of space. I rang the GP who advised that if I was still in as much pain the following morning I was to go to A&E. They were fantastic and the only wait I had was the following day when I had to return for a scan. They even called me the evening that I’d initially gone in to check how I was getting on.

The accident exacerbated a pre-existing but at that point undiagnosed issue. It took three months for anyone to see me about it and in that time I have been sorely tempted to take a hammer to the afflicted part just so that I could legitimately go to A&E and be seen about it.

YANBU. I have a relative working in A&E. People come in with slight headaches looking for paracetamol.

Much of this is problems with GP surgeries, some, like mine, are virtually impossible to get an appointment at.

The worst problem, though, is booze. Especially at the weekends.

Would ectopic not be handled by the early MAU unit?

technically you could argue you are also in the wrong place as A&E dont deal with pregnancy issues and arent equipt (hense why you are sat there for hours) and your not really suppose to go to them with it, the MAU will organise anything medically related.

A lot of people dont know where to go though, like you with my first pregnancy I went to A&E, no one there told me I was in the wrong place they just kept us sitting for hours then sent us away with a 'talk to the midwife'.

Same when I went in for a neck injury after landing head first from a height (was diagnosed with whiplash), I assumed obviously you go to A&E but they actually arent suppose deal with neck and back injuries (I didnt have any signs of concusion just unable to move neck and shooting pains in arm) unless it comes with physical paralysis or incontanence.

On the other hand an infection from an ingrown toe nail can be a serious issue in a diabetic and can class as a reason to attend A&E.

what we personally deem important isnt usually inline with where we go to get treatment so your judgements on what A&E are for are usually wrong.

Unless its an obvious life or death emergancy you cant even get into A&E here due to covid rules without a referal from a doctor or 111 currently so I find it odd you say these people got straight in without being at minimum phone triarged first.

Infections can be fatal. Ingrown toenails can be hideously painful and can also get infected. The problem is A&E isn't people using it! It's the problem with the entire NHS - it's basically totally falling apart.

Some people have no 'real' concept of what warrants an A&E visit. You will always get the ridiculous ones, the ones who have unseen problems which could make their injury worse etc.
I think at the moment people are struggling to get appointments with their GP, they phone 111 and they advise A&E if the problem is serious, which to the person its happening too, it is.
It's almost like you need a nurse/Dr at the door to sift through people before they can even book in, it would stop the ridiculous ones taking up time and space.

Hope I never need to go on a Saturday night where the drunks are wasting NHS resources.

I’ve worked in AE. A verruca at 3am was a real low point.

Issues that start as minor have chance to escalate and set off a chain of further and more expensive investigations if they are not caught at the minor stage (most logically by the GP).

What started off as chilblains in the winter led to a GP consultation by phone on NYE for my Mum (had filled in the many web pages for her to get a call back from the surgery, cannot now phone directly, and the GP got back to her 2 days later). Photo of the problem shocked her and Mum sent to A&E at about 6pm (with NYE no different options for another couple of days. Great...)

This resulted in getting advice to stay bedbound for 2 weeks with antibiotics and a warning that she would need more injections after that. That period went on to affect her mobility very much, which is still not right, and we're at the physio, podiatry and circulation scan stages now. More pain this side, possibly less successful outcome, more expense, above all, for the system.

Hope you're ok OP. Very frustrating that others seem to be there with minor problems that a GP could have dealt with. Having said that I guess we don't know their history, might be GP can't help them any further and they need xrays/treatment.

DD needed emergency surgery three times last year. She lived in two different areas during this time, in all cases GP had problems getting holds of surgical assessment teams, so she referred herself in via A&E. I have to say in all cases A&E were brilliant, they had her referred to surgical assessment team within an hour each time. Even though she was 18 so an adult, the first time hospital phoned apologising that they'd just taken a life saving operation in, but DD would be next on the list. Second time they phoned again at midnight to let us know she was coming round. She was in a lot of pain on all three occasions but not life threatening, and was operated on inbetween 4 and 9 hours each time.

@WrongWayApricot

My neighbour told me his a & e story a few years ago. He had twisted his ankle and 3 days later thought he should get it x rayed. I was sympathetic but I feel if you've walked on it for 3 days it's probably not an emergency. Although I did know someone that broke their ankle and didn't know until later in the evening, so I could be wrong.

Ear infections can be really bad though so I wouldn't think that was strange or time wasting. And the ingrown toe might have been stubbed today and got really bad?

You'd be surprised.

I once cycled to A&E with what turned out to be a fractured foot, and then cycled home again (I just made sure all the work was being done by the OK foot - it was easier than taking crutches to the bus stop!)

I also have a repeated history of telling myself that a broken bone is "probably just a sprain" and "it'll be better in the morning". It never is. On one occasion I'd driven home (not entirely safe tbh), made a basic dinner, slept, sorted the dog out, showered, dressed and done my make up before going to A&E the next day - with what turned out to be a bone so badly broken it was pinned back together under general anaesthetic.

We are blessed with a marvellous Minor Injuries Unit which does all those minor things and basically anything that isn’t a car crash or heart attack. Just as well as we are an hours drive to the nearest A&E.

However we had to fight for it as the NHS wanted to close it down. They realised they were wrong when the numbers using it went public.

17,000 users a year to our Minor Injuries, did they really want them all turning up at A&E which is what would have happened.

The NHS needs to put more Minor Injury units in place to take the pressure off A&E’s.

Are you OK @DaisyLilyFlower?

Just have a bit of a deep theoretical moment - Maybe what we need to do is stop trying - and failing - to control people's behaviours and instead deal with the way things are.

People for all sorts of reasons are going to A&E when maybe they did not need to so lets develop A&E units so they can deal with these people in the way a GP surgery would - instead of taking up the expensive A&E specialists

Many countries do not have any type of GP system and people always go to their hospital and see the relevant specialists maybe this is the way to go - use the money currently being spent on GP's and provide more accessible specialist services

This cannot be achieved quickly but my understanding is that the GP system is being looked at as it is unsustainable.

I think as always we are trying to change behaviour to make people fit into the system instead of changing the system to fit the way people behave.

Ear infections are incredibly painful. For all you know, the person concerned cold have tried unsuccessfully to see a GP, got onto 111 and told to go to A&E.

The NHS needs to put more Minor Injury units in place to take the pressure off A&E’s.

Our minor injury unit are brilliant. They have an x-ray machine and I have avoided a&e a few times over the last couple of years by going there for problems which needed to be seen by a HCP. Not usually a crazy wait either - a couple of hours each time to be seen, x rayed and treated.

Last year I had to take my daughter to A&E with what turned out to be a kidney infection, she had been unable to keep down even water for hours.

We turned up at about 7am and the doctor that saw us said we were the first case of genuine A&E need he had seen all night.

I think if people are in intolerable pain they are left with A&E as the only option they have even if realistically there is nothing A&E can do on the spot.

I do think pain should be treated as an emergency if it is severe enough. When I had a tooth abscess I was in so much pain that I felt like ending it and I have a friend who has felt similar with a pain issue...

Just FYI I took my 11 month old to A&E several months ago in the middle of lockdown due to 'an ear infection' he was swiftly admitted & on IV antibiotics as he had sepsis and could have died if he didn't get hospital treatment fast. I'd seen GP 48hrs earlier but he wasn't improving despite antibiotics and had a temp of 40.9.

Kindly fuck off judging other people. Are you a doctor? No? Then keep your nose out and stop being unkind to other people that are just as entitled to be there as you.

[quote TatianaBis]@Tiktokersmiracle

Hmm If they’d thought it was chronic appendicitis they’d have taken it out anyway to avert acute, surely.

When I had appendicitis - while there are no direct tests - there are key tell tale signs - pain that starts in the middle of the abdomen then moves down to the lower right, fever, nausea, vomiting, diarrhea/constipation. There are indicative tests - when pressure applied to the abdomen is as or more painful on release than the pressure itself; ultrasound; blood tests showing inflammatory markers are high etc.

I don’t think they would have released you if your blood tests indicated you might have appendicitis.

Mine was taken out the next day.[/quote]
That's the point- they didn't release me. I walked out after 6 and a half hours of being spoken to like shit and mixed up with someone before me whose name was still on the board behind my bed.
As it had calmed down, my GP said she wanted me to go back but I refused. I had gone through enough

I also knew that on a previous occasion, I had gone to A+E with DS who GP wanted to be looked at and kept in due to his lung conditions. Git to A+E, they got bloody stupid about it, said they would out him on nebulisers "if the ward manager thinks so", who then didn't and sent him home. GP rang to check in, when I said they sent him home almost instantly, she rang. We went back in and the snide behaviour and abruptness was disgusting. They were just so rude, it was in the manner of a kid who has had another kid grass them up to the Head

So I really didn't fancy it again.

It's very difficult to get a GP appointment.

Some do probably abuse A&E but actually I can't think of anyone who'd happily sit in A&E for hours if they didn't need to be there.

Infected anything is extremely painful and if people cannot get antibiotics from their GP where are they going to go?

Sometimes people get to the end of the rope with the GP system too. Handing out painkillers without investigating and getting to the root of the problem. And that's after they've managed to actually see the GP. People waiting months for MRI scans, to actually diagnose the problem.

Triage by computer is far from ideal. 35weeks pregnant and running a temperature - I was asked if I had a swollen abdomen. The mind boggles!

The whole system needs a rethink.

Do you now know how hard it is to see a doctor OP?

🙄

Kindly fuck off judging other people. Are you a doctor? No? Then keep your nose out and stop being unkind to other people that are just as entitled to be there as you.

Exactly!
I've been to A&E - plenty of times - with happy looking, bouncy toddlers who have ended up being admitted.
Keep your beaks out, eh?

My son had an ongoing issue with an ingrown toe naill in lockdown. His GP refused to see him and kept prescribing diff antibiotics for the a infection. In the end I had no option but to go to A & E. He could hardly walk and the redness was spreading up his foot. The A & E consultant said he needed an urgent podiatry referral to remove it but they refuse to see him also (COVID) The consultant emailed our GP and said ihe should have been seen and it was so nasty he was close to getting Sepsis. Our GP called us then and had a go at us about this email
In the end we paid for a prviate treatment as we were going round in circles. So why can a private podiatrist operate but not an NHS one?
GPs really need to get their act together

@mam0918 an ectopic would be dealt with by EPU in the early/suspected stages. If it’s ruptured, you need emergency surgery and should be seen by the gynaecology dept (you get sent there by A&E you can’t refer yourself). A suspected, ruptured ectopic is life threatening and you absolutely should not wait until EPU is open.

I’ve seen this said a few times on this thread - that OP should have waited for EPU. So will include a link for NHS advice, which details when emergency help a&e/999 should be sought for a suspected ectopic.

www.nhs.uk/conditions/ectopic-pregnancy/

@Idontknowanymore05

sorry you're going through a rough time but others have just as much entitlement to go to A&E as do you. An ear infection is considered dangerous. Maybe they felt okay during the day but really ill this evening.

I hope you get seen soon.

Is it? Why is it considered dangerous?