What exactly is A&E for?

[AccidentallyOnPurpose]

Inspired by a current thread , but this has been bugging me for a while.

No matter how serious the situation or symptoms, there are always plenty of people telling OP she's a time waster, she's fine,her kid is fine etc. To stop being so silly and just wait for the GP or ask a pharmacist. If they're feeling particularly generous maybe ring 111 but God forbid they take it seriously and send an ambulance. Then you're the reason an old person is lying on the floor for hours waiting for help and a father of 4 died of a heart attack.

Fainting, bleeding, high fevers, sudden or continuous increased pain etc none of them are good enough. I'm surprised no one suggested to put a wet paper towel on it. It works in schools.

So what exactly is the A&E department for ?

In my life I've used the A and E for/ended up in A and E for:

Spiked drink (found unconscious, face down on the floor after hardly anything to drink)

Severe migraine with a BP of 180/100 and after exhausting my own self med medications. My symptoms mimic a stroke and I hadn't had a migraine in years so they took me in as a precaution and I was home within 6hrs.

@ClumpingBambooIsALie the AandE person was right: if there is an option to see a doctor outside of AandE then we should avoid overwhelming the hospital

I actually think we need to abandon the current model altogether, starting with the GP as the 1st point of contact.

Walk-in centres should be the default norm, and 111 should move to offering e-consult as well as phone. Huge chunks of the population see GP's for one off issues - minor illnesses, minor injuries. These can all be handled via the walk in model/111.

So all the kids with fevers, ear pain, minor cuts, utis, burns, scalds, twisted ankles etc would just go straight there. Set them up to be able to xray and do basic bloods, administer pain relief - and staff them properly. Staff for Psych as well as medical issues. Open 24/7.

This cuts down on stress on GP's, who can go back to managing patients who need overview or repeat, scheduled care, follow ups, etc - now chronic conditions are monitored properly, med reviews get done, people can get access for flare ups in asthma, eczema. More importantly, elderly people, who are likely to have multiple ongoing issues, can access someone with all that information who can support them when things wobble, rather it being left to deteriorate.

It would also drop strain on A&E as having access to help easily would mean a lot of people would go there when they were worried or unsure. Efficient GP access would reduce the amount of things deteriorating to urgent. Get the whole country used to having an annual review with bloods drawn prior - so many things are so much easier to treat if caught early.

A huge issue at the moment is that lots of people feel there's nowhere else to go but A&E. Combining this with 'Save the NHS' and GP's who aren't functioning effectively is dangerous.

I'm currently in hospital, and I spent Friday night sat on a chair in an A&E triage cubicle on an IV while I waited for a bed. It was eye-opening. Yes, a few timewasters, but far more who'd been 'sent' by GP's (including the chap with a dry throat) and a lot of worried people with moderate symptoms who all said the same thing - I'm not sure it really needs A&E but somethings wrong and I didn't know where else to go....

The receptionist at my GP practice has made it clear they don’t do emergency same day appointments, they only do general appointments. So if someone needs to see a doctor urgently, but it’s not an emergency, they really are left with no option…

My stitches burst. I tried to fix it with duck tape, but the incision was deep. I was a bit reluctant to stitch it myself because I didn’t have the right needle/thread. We have majors and minors, so I was directed towards minors.

I assumed that this was a legitimate use of a and e.

@dentydown

My stitches burst. I tried to fix it with duck tape, but the incision was deep. I was a bit reluctant to stitch it myself because I didn’t have the right needle/thread. We have majors and minors, so I was directed towards minors.

I assumed that this was a legitimate use of a and e.

Were you in the middle of the jungle?! your stitches broke with a deep cut and you thought best NOT to go to the hospital?!

According to my doctors receptionist Its for everything ! I'd actually like to know what the gp is for these days because the receptionist was refusing to book an appointment for my 7 yr old with suspected ear infection and told us to go to a& e !

[quote grey12]@ClumpingBambooIsALie the AandE person was right: if there is an option to see a doctor outside of AandE then we should avoid overwhelming the hospital [/quote]
Sure, and I was happy with seeing the GP — he was able to do an examination quickly and reassure me I wasn't dying. The way that OOH/GP service worked was that either you got an appointment directly via 111, or you saw the A&E triage nurse who directed you to the correct service. I'd already spoken to 111 who told me to go to A&E rather than giving me a GP appt — I guess they thought it was best if someone could actually see me did the triaging. It was just a bit embarrassing, because until 5 minutes before I'd been in so much pain I thought I might be dying, and to then get dressed down at the door (literally — they weren't letting anyone in so they had a nurse on the door) for bothering A&E with a tummy ache…

Currently in a and e with my Child. Sheffield children's hospital infact
It's empty bar me and 1 other person. The lights were of at 6am when we arrived. Only reason I'm still here is because my 7 year old doesn't feel well and has so far refused to do a urine sample and her temp is rising even though has had brufen.

Empty

@Twofurrycatsagain

I'm fortunate that I've not been to A and E for over 49 years. But the lack of frontline services sends people there who shouldn't be there. A few years ago I had an allergic exemca type rash on the palm of my hand. Painful and raw. I treated it at home with things like savlon, antihistamines, lanacane and oatmeal. When it was getting unbearable I rang for a drs appointment. 3 week wait. I went to the pharmacy to see if they had anything different to what I was using. The pharmacist took one look, said he wouldn't sell me anything, I needed to see a Dr. Rang the Dr and explained I had an appt booked but the pharmacy said to see one now. No joy there. So I went to the walk in centre and was prescribed a high dose of penicillin. That walk in centre has since closed. If this happened now I'd be at A and E.

I think this is the truth of why many people are in a&e who shouldn't be - unacceptably long waiting times for painful but non-life threatening conditions. 3 weeks in pain risking secondary infections is not good enough.

My view is that along side the lack of funding primary care is simply not structured properly. We need more truly nationalised primary care providers.

Our hospital has now established an Urgent Treatment Centre, Same Day Emergency Care and OOH GP on site, and emergency triage can divert to any of those services.

We have mainly been patrons of paediatric A&E, and usually on referral - concussion, the time DS2 put his teeth all the way through his bottom lip, suspected meningitis.

111 has been about as useful as a chocolate teapot on numerous occasions so having a single in-person triage service they sends you to the right place (and can escalate you quickly if it was a wrong call) is a relief as it takes so much of the guesswork out of what care is needed.

It seems like a much better model than the A&E or nothing which now exists in much of the country (and recently had my poor MIL waiting for 7 hours in the waiting room on a Friday night, tried to convince her she should go home and see her GP on Monday, which she nearly did as she’s stoic and doesn’t like to be a bother. We convinced her to stay and thank god she did as her appendix burst.)

A huge issue at the moment is that lots of people feel there's nowhere else to go but A&E. Combining this with 'Save the NHS' and GP's who aren't functioning effectively is dangerous.

I think this is right; it’s all very well excoriating people going to A&E ‘because that’s not what A&E is for!’, but when the other parts of the system aren’t working or are absent, people can find themselves in a Kafkaesque loop of trying to get an urgent GP appointment, but they don’t exist, but not bad enough for A&E, so urgent care? But that closed due to budget cuts, but A&E will shout at you and send you away, so 111, who tell you to call your GP…

My DM (in her 70’s who I’m a bit concerned about) only rang and told me last night that she’d felt so ill with her chest, bad cough etc, she decided a trip to her GP was needed! Of course I told her off for not going sooner!

GP has prescribed antibiotics and an inhaler, sending her for a blood test and mentioned a chest X-ray, but hasn’t given her the paperwork for this - I’ve told her to call first thing Monday morning to query why!

GP told my DM that if the antibiotics hadn’t worked to call 111! Why? Why does she not need a further GP apt and a referral if needs be? We’re both puzzled by this? Is this the norm now?

I’m concerned about her and don’t want her to feel she’s wasting anyone’s time (which she has always been guilty of, hence only just going to her GP)

@balonsz

I've been to a&e because I didn't feel right, both times admitted straight away. You don't always know you're in danger.

I did the same thing. I'd been sick and had awful stomach ache but I felt it was more than that and asked DH to take me to A&E. it's a good job I did as I had pancreatitis caused by gallstones.

I don’t want her to have the runaround from both her GP and 111 if she needs further investigations!

@Justanotherquestioner

I called the gp at 8am once and firmly requested to be seen immediately. As in....the very first appointment of the day. They understood I was being serious. GP saw him. Called an ambulance for him there and then. We were taken into resus. I totally and completely misjudged it and still feel awful. He was only 2 then and is now nearly 5

What did you misjudge? You were unsure, you insisted on seeing the GP instead of waiting..

I just want to say- as someone who has worked “adjacent” to emergency medics for many years-

Please please please if you’re reading this thread and wondering about “what’s for A&E”- if you, your child or loved one ever red flag for SEPSIS - PLEASE go in. Or call 999. Don’t mess about.

www.nhs.uk/conditions/sepsis/

Sepsis is hugely on the rise and has been for a few years, but lots of people still don’t know the signs or appreciate how serious it is.

It can come on after relatively minor injuries or illness- my friend had it after tonsillitis. Another friend had it after she pricked her finger (quite deeply but honestly it was a “nothing” injury) on a lapel badge she was pinning on someone.

Just wanted to say that.

There are no prizes for meeting the “Mumsnet” gold standard for going to a&e. It’s bollox- this is a forum full of strangers who will not be there to comfort you if you lose a loved one because you wanted to prove a point about a&e usage. They will not sit next to your bed in hospital when you’re wondering why you left it so long.

And they certainly don’t fucking know your circumstances when you call that ambulance.

So yeah- trust your gut, then your doctors and not ever a Mumsnet forum- when you have questions about your health, or that of someone you love.

here endeth the lecture

I actually had this discussion with my 7 yr old DD when we were in A&E a few months ago when she broke her wrists - she asked what it stood for and when would you have to go there.

We don’t have urgent care or minor injuries units so it’s always A&E for us, but over the years things I have taken my children for are: various broken bones, fall on to a hard floor and hit head, unable to walk - turned out to inflammation in a joint, then my youngest a few times for breathing trouble which he was admitted for each time, eventually diagnosed as asthma. I’ve never had to use A&E for myself though.

I think every town needs a minor injuries centre and then A and E could just be for serious accidents and life threatening emergencies. It will never happen though.

I was at a minor injuries centre earlier this year and an elderly lady came in with quite a large head wound which was bleeding a lot. I was sure that did qualify for A and E but maybe minor injuries was nearer. Tbf she was seen very quickly.

My dad had several trips to A and E in the years before he died, mainly for infections. We took him once and several times he was ambulanced there. But I was quite surprised in one A and E, to see a poster asking if you would recommend them to friends and family? As if you would look up various A and Es on trip advisor and choose the best one. Surely in the event of an accident or emergency you would simply go to your nearest one!!

@foolonthehill

An A&E department (also known as emergency department or casualty) deals with genuine life-threatening emergencies, such as: loss of consciousness. acute confused state and fits that are not stopping. chest pain. breathing difficulties.

NHS website

That can't be a definitive list. My broken wrist fits into none of those, but definitely needed a and e.

I ended up in A&E recently due to an acute gallstone attack that decided to happen at 11pm on a Sunday. I didn't know it was gallstone related at the time, and I'd have called a GP or urgent care except - 11pm on a Sunday. Did get seen and an ECG as the pain was in my chest too.
Ended up referred to the surgical assessment unit who decided that my gallbladder needed removing pretty sharpish.
Yes I'd rather have not bothered the nice people in A&E, but due to my body being very inconsiderate due to the time of day, I was stuck. No painkillers at home would touch it, even the oramorph they gave me in A&E had no effect.
Interestingly, where I was waiting left me able to hear the triage nurse assessing people. That was.... interesting.

I have despaired of 111 most times I've called. You explain the issue and then they have to read a set of scripted questions, majority if which have no relevance to the problem you have just described. I'm pretty sure 2 of the questions are
Are they conscious and
Are they breathing?
If I was caring for someone who was neither conscious or breathing there is no way I'd be fannying about calling 111 and waiting for their list of scripted yes/no questions!

In some areas broken bones are dealt with by minor injuries, @knittingaddict

@VaguelyInteresting I agree