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 ?

I recently fell and damaged my ankle. Those around me heard a loud snap.
I was taken to our local A and E/MIU/Urgent Care /OOH- here you walk in the same door and are triaged by a 'Clinical Navigator'.
It was a Friday night - about 8pm by the time I got there. I was assessed as needing MIU which operates 24 hours here. I was also told it was at least a 5 hour wait to be seen initially as they were very busy. I was advised to stay as it was likely to be broken and needed an Xray.
As I sat in the waiting room I watched a stream of people come in. Most had been sent by 111. One poor chap had come from a town 20 miles away where the MIU only operated during the day. The one that really astounded me was the chap who came in at 11.30pm with back ache. I was sitting right in front of the Clinical Naviagtor so, while not deliberately listening, I heard most of the conversation. He had been suffering with backache for over 6 months and had decided he needed to be seen. Couldn't get a GP appt for a week so rang 111 who sent him to OOH. He was a bit miffed there was a 5 hour wait.

I was seen by a nurse at about 1.00am, sent to Xray, break confirmed, booted and sent home about 2.30am.
The broken bone healed quickly - the ligaments not so fast!

The staff were busy all the time. There were several angry people there who found it hard to understand that their injury was not as bad as the people being seen quickly.

I don't frequent A and E often but I do think our local system is good - you go in one door and are quickly triaged as to which service you need. Also the staff are not slow to make it clear if you are using the service inappropriately. They never say anything but the looks and tone of voice are enough!

My dd has a chronic nasty illness. Whenever she needs treatment we are told to access the hospital via A and E. I get some funny looks taking my cheery well looking DD in amongst the crying feverish toddlers, until she comes out with NG tube placed or somesuch.

I have not read the whole thread but where I live (in London) we don’t have a minor injuries clinic or anything like that. So it’s either GP or A&E.

A few years ago I had what seemed a minor infection. It was very painful but seemed minor. I did what seemed sensible and got advice from a pharmacist. It was misdiagnosed and I ended up in A&E as something didn’t seem right to me based on dr google. If I had followed the advice on the nhs website I could be dead now.

@wheresmymojo

Personally I don't go to A&E with straightforward breaks (e.g. my broken foot).

I go to minor injuries the next morning - it's much quicker to be seen there.

I'd go to A&E with a serious break (e.g. main leg bones) or a complicated fracture.

But unless the bone was sticking out, how would you know if it was complicated, or indeed a fracture, off what treatment is needed?

I'm off sick at the moment with a fractured shoulder after I fell off my bike. At the time of the accident, while I knew I was badly injured and needed medical attention, I didn't know what the problem was. In fact I thought it was dislocated. No way was I going to face about working out where the nearest minor injuries was, when i knew where a&e was.

As it was , it was the right call. My shoulder was fractured in 3 places, and a bit of bone was the wrong way round. I needed surgery and am now bionic.

Nobody at the hospital indicated there was an issue with my decision.

Faff about not face about.

Our local A&E has actually rebranded and removed Accident from its name. It's literally just Emergency Department now. Hasn't seemed to have any impact on the amount of people still coming through the doors. A lot to do with failure in local primary and social care as well as the continued building of huge housing estates in the area without the health infrastructure to support them.

Where we live the out of hours GP has a clinic next to A&E. if you rock up with a non emergency you get punted over there to be seen and it gives a clear message to the time wasters.

That is a shitty way to frame it. If you turn up to A&E with something the out of hours GP can deal with, you are sent to their clinic. This is actually how the system should be set up. It is how our system works too. Every A&E should have a minor injuries and OOH GP on site. That would cut A&E waiting times and free up the resource. But that’s too simple a system for people to get their heads around.

I think the confusion comes because there is A&E, Urgent care, Minor Injuries and Walk In Centers

No confusion round here. A&E is all there is. We don't have any of the others within an hour's drive.

I’m surprised at those saying breaks should not go to A&E.

We used to have a walk in centre but it was only open office hours and now you need an appointment.

I’ve been sent there for x rays by the GP but I wouldn’t go with an obvious break.

@JayAlfredPrufrock

I’m surprised at those saying breaks should not go to A&E.

We used to have a walk in centre but it was only open office hours and now you need an appointment.

I’ve been sent there for x rays by the GP but I wouldn’t go with an obvious break.

I think people with good and varied services are very oblivious to how bad provision can be some place else and that A&E is all there is.

@MrsTulipTattsyrup

This is what the NHS says on its website. Pretty clear, really. Accidents and emergencies.

what about broken bones?

You go to A&E when you feel like you need to.

Don't ask others on their opinion.

Trust your own instinct.

I was with my dd at the gp when dd fell on her chest onto a wall. The gp told me to me to a&e in the lockdown part of last year.

She had nothing on the NHS list. I really wouldn't have though twice about her fall but I didnt want to ignore the gp. So where does those situations fit in? Fallen hard from 3 foot onto your rib cage. No pain, no blood?

It's no always quite so simple

I've been with my child to A&E yesterday. Something that felt quite frightening symptom wise, and I wasn't sure what to do.

Called 111. They decided the child needs to be assessed within 2 hours.

They tried to get an out of hours GP, no luck, no places.
Tried to arrange a call / video consultation, no availability.
Tried to get an urgent appt at a hospital, no luck.

So they sent us to A&E, it was the only option. At the end, it was nothing and we just wasted everyone's time.

Ive never been to A&E for myself.

I have however been several times with my 3 children and every single time ive went ive felt like we have needed to be there.

As a mum ive navigated through many illnesses with my children without going to a&e however there have been times where ive felt they have been particularly ill, or had accidents and i dont feel equipped enough to decide whether they are "life threatening" or not.

Ive only ever went when my GP isnt available (outwith mon-fri 9-5) and my out of hours clinic doesnt see children. Ive also only ever went after being told to by 111.

90% of the time everything has been fine and no further action has been required so am i a time waster?

@ginnybag

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....

Yes, this. Very sensible.

Everything that is not a life threatening emergency, but still has to be seen quickly, at the moment is "homeless" in the existing structure.

An unwell child with a bad fever (say suspected ear infection or sore throat) is offered a 7-days wait at our GP before the first appointment is available. Or the alternative is that you should call in every morning to check for last moment cancellations. How is it even remotely sensible?

We have both an Urgent Care / minor injuries department and A&E within about 10 miles. My DS had an accident playing rugby - basically got a kick to the head that resulted in quite a decent sized wound. I could clearly see that it would need stitches so took him to urgent care in the first instance as my understanding was that this was what they dealt with. After a long wait we were sent packing as they felt that it was too much for them to deal with and were told to go to A&E. We had another 8 hour wait in the children's area during which time we saw lots of kids come in with very minor issues. I'm can only assume that the parents couldn't get a GP's appointment and were concerned enough to feel that they needed to see someone. To my mind they would have been better off with Urgent Care but had gone instead to A&E.

Personally, I'd have to be really desperate to attend A&E but sometimes there's no choice. Apart from the lengthy waiting times, it just seems to be in complete disarray. We ended up staying quite a bit longer than planned as my DS's stiches were accompanied by a shot of penicillin which he's unfortunately allergic to. It was on his notes and mentioned several times but the Doctor was clearly juggling lots and lots of things.

I’d only go to A&E if there was an imminent risk of serious health issues. I’ve been for chest pain, OH has been for unstable low blood sugar. Kids have been in for breathing difficulties. Broken bone suspected we make an appointment with 111

We’ve been for non-urgent reasons.

For example the epilepsy clinic wanted a ecg for my child, to check there was no link to heart rate issues causes seizures. Not a recent seizure, no emergency or accident. However our hospital has no other place that can do an ecg on a child, nor does elsewhere. So we are sent to A&E with a note to bring back to the clinic.

We’ve had it for other reasons similar when consultants want a check of some kind but can’t do it in children’s outpatients and don’t have a referral route.

We’ve also been sent by a GP for a check that wasn’t strictly urgent, there’s some gap- particularly for children in the system.

So- it’s complicated from what I’ve seen.

@forinborin no that would be bloody awful for people with chronic health issues and those with serious mental health problems.
I partly care for a relative with szichophrenia. No way can someone meet him for the first time and accurately assess what he needs. And tbh I probably couldn't get him to go to meet a random person each time.

I have a chronic and rare health problem. I don't want to spend twenty minutes of every appointment explaining what I have and that no it is not like that other illness you have heard about even though it sounds similar. I always see the same GP for that unless it is an emergency.

Yes earaches, etc I will see anyone and walk-ins would be fine for that. But for serious illnesses GPs are crucial. People would die under your plan. And yous imply don't understand the management of serious illnesses that GPs do.

And I have attended A and E and been admitted. Once sent by a nurse via ambulance, once sent by GP. I have also been there for a broken bone and a burn.

We've had to go to A&E with child with Lego up nose. Although not an immediate emergency you need the right kit to avoid making the situation worse. A&E Dr was very happy to easily remove the offending Lego jewel with the special grabby things rather than have to refer on to urgent specialist ENT surgery once it had been forced further up. Local urgent care don't do kids other than "medicine" type cases so we get sent to the children's hospital A&E.

Also when children are unable to keep any fluids down when vomiting bugs hit. DC went through a phase of being unable to stop vomiting once she started but drs needed to rule out rule out actual life threatening emergencies (intestinal blockage) before dealing with the symptoms. Couldn't keep any water down - we had a lot of practice with the fluid challenge!

@Gin4thewin4

You go to A&E when you feel like you need to.

Don't ask others on their opinion.

Trust your own instinct.

This.

[quote julieca]@forinborin no that would be bloody awful for people with chronic health issues and those with serious mental health problems.
I partly care for a relative with szichophrenia. No way can someone meet him for the first time and accurately assess what he needs. And tbh I probably couldn't get him to go to meet a random person each time.

I have a chronic and rare health problem. I don't want to spend twenty minutes of every appointment explaining what I have and that no it is not like that other illness you have heard about even though it sounds similar. I always see the same GP for that unless it is an emergency.

Yes earaches, etc I will see anyone and walk-ins would be fine for that. But for serious illnesses GPs are crucial. People would die under your plan. And yous imply don't understand the management of serious illnesses that GPs do.[/quote]
The proposal from the poster was exactly for one off issues to be dealt in walk-in centres, and for people with chronic problems to have a continuity of care from their GP. No one was suggesting that schizophrenia should be medicated by an on-duty nurse in a walk-in clinic. But one-off ear infections / childhood fevers / minor injuries (presumably representing a massive % of workload of any GP), why on earth not? It is bizarre that the same booking / waiting system is used for someone with asthma / diabetes who needs a medication review, and a strep throat.

When I broke and dislocated my leg, I called 999. They sent an ambulance and I was seen at A&E immediately. Given that I was in hospital for the following 4 weeks seems to indicate it was the correct decision (bone did not puncture skin).

It’s not a cut and dried decision.