To have discharged myself from A&E?

[AandEnightmare]

As the username suggests…

I attended A&E with numbness is my hand, pins and needles in both arms and legs, blurred vision and extreme stuff neck pain.

Stroke nurse was happy it wasn’t a stroke but wanted an MRI as did A&E consultant.

Both concerned about MS and tragically I then urinated myself in the A&E waiting room where I was left on a wooden chair for 8 hours.

i asked for a change of clothes, just a hospital gown and was told until I was seen by a neurologist who agreed to book me in; this wasn’t possible.

I have long covid and extreme fatigue and pain at the best of times and I was in tears in the waiting room crippled in pain and exhaustion and was just told repeatedly that only a neurologist could determine if an MRI was needed as an emergency or as an outpatient and on the time of leaving, after 7 hours, I was number 13 on the list so expected to be seen by this evening.

I will ring my GP as soon as open but I’ve never had such a terrible experience in a hospital in my life!

i feel shocked

My rather was left in his feaces stained clothes in hospital for hours during admittance. I kept asking if he could be helped and was constantly ignored.

I mean I work in healthcare and so understand from our side how dire things are and how everyone is doing the best they can (well, most). But it doesn't mean that we should view experiences like OPs as acceptable, its outrageous that an adult in this country who is already struggling, anxious and scared should be left humiliated and sat in urine soaked clothes for hours because computer says no. There are always gowns about, we would have found one and seen if OP was able to safely get to the toilet to get changed if nowhere else.

Hopefully this isn't a double post.
I am sad that the NHS has apparently broken down. Less than a decade ago I took my DS18 to Charing Cross and they could not have been kinder or quicker helping him. Within 10 minutes he was in a bed and on a drip. It is a reciprocal arrangement with Australia - so you British people would get the exact same treatment here. No cost either way. I'm surprised that things have gone down hill so fast .

That's only the cohort in the waiting area - they would have had resus full of very very ill patients, plus majors and minors plus corridor patient who were all possibly more ill than those in the waiting area and so would have been a priority

So sorry you had to go through this, OP, it was appalling.

But it's made me wonder just why A&E is so stretched these days, and whether the difficulties people experience in getting GP appointments means they end up at A&E in desperation.

There appear to be problems at the other end of the process, too. Many patients can't be discharged as soon as they're medically fit because they're awaiting social care assessments and care plans. Adult social care is also under huge pressure because of staff shortages and budget cuts, so that can take several days (although I have heard of one case taking 6 weeks, that's beyond my comprehension).

Every day that someone medically fit for discharge is occupying a bed unnecessarily, that's a bed that can't be used for someone who needs admission, and ultimately that can mean another person stuck in A&E unnecessarily. And while they are there they will need staff to monitor them, which makes inroads into the time they can spend on other patients.

None of this is actually new. A friend of mine spent 36 hours waiting on a trolley in A&E because there were no beds in 1995.

Imo, the whole process, from A&E to admission & discharge needs to be looked at.

The nursing staff should have been told by the receptionist. There should be escalation systems in place - this is basic management stuff.

And you should have responded to the OP with compassion, or not responded at all.

Perhaps you responded as you did because you are exhausted and burned out, though, and are also in need of compassion.

Yet, you can decide you need an MRI, fill a form in online and pay for it and have one privately within days with no Dr involved at all.

My neighbour has just done so. Is on a waiting list for an appointment (referred by practice physio) re:hip. GP has not seen or spoken to him. Waited 6 months so far. Nothing.

Went online, private MRI £500. Slots available at our local hospital. Filled in form - gave reason 'hip pain'. Had MRI days later at 6pm. 3 days later report arrived. Seeing consultant (privately) to discuss results today . Whole process has taken 2 weeks.

No involvement of a Dr at all so far.

How old are you?Worth seeing your GP for an urgent MRI of head and spine abd referral to Neurologist, as ED will unlikely make this referral.

Gp should do urgent referral to neurologist. That is if you can get near a gp.

On the question of MS. These can be symptoms of a relapse yes. But I imagine could also be many other things too. IF it is MS it is important to diagnose asap - someone up thread said that it’s a slow progression but actually the sooner diagnosis and access to medication, the better prospect of delaying progression. I would suggest going through your GP and requesting an urgent MRI.

The state of the NHS now, we accept the wait even if we're not happy about it.

What you must not accept is being left in your own urine. It would have taken nothing for them to let you change into a hospital gown. That is so so awful, I'm so sorry.

It's humiliating and inhumane and absolutely warrants a complaint. There's no excuse, I don't care how rushed off their feet the nurses were. To chuck you a gown and show you where the loos were to clean yourself up isn't exactly asking for the moon on a stick.

You wouldn't get an MRI scan done as an emergency during the night - a Ct scan yes - are you sure it wasn't a ct scan you were promised ?

I don't think people realise the state of A&E at present, where I work there is a 14 hour wait to see a Dr!

Oh I can believe it, arrived in A&E mid January 6pm on a Friday night - by 1am they were then just taking me seriously with a second doctor, (thank the lord) admitted to a ward at around 5am Saturday morning. My poor Dad sat with me this entire time. This was an express service compared to the time before. MRI Saturday next day at lunch time. Fortunately the suspected Cauda Equina turned out to be Cervical Myelopathy (sorry OP it all started with one moment of a stiff neck before going on to be present as a sore back)

When I went to A&E evening previously on 1st January (really didn't want to but bodily functions down below failed me) it was said 30 hours if a bed was needed.

All look very stressful to me and I just remember the GP saying in early January (regardless of the hospital referral made which just got batted back as I did self referral to physio) if it gets worse you do have to go to A&E.

Im an A&E nurse and pressures are higher now than they ever were even in covid. Waiting hours and hours in waiting rooms is sadly the norm these days and completely unavoidable.

However, you 100% should have been offered a change of clothes and facilities to clean yourself up a bit and assistance if needed. As well as the standard gowns, my dept has a store room full of donated clothing for patient who dont have suitable clothing to return home in. It is very well stocked with generous donations from the community. Please, please complain about this as that needs to change in your local department.

Awaiting a consultant to make a decision is also the norm - as in your case a consultant w3ould need to review those scans before you left. An A&E dr would not be able to read and give a diagnosis like that, it would have to be neurology, so neurology would have to site the scan. Only neurology would have their own ward of patients, own surgeries, own clinics and out patients, so waiting for them to make a decision on whether they can fit you in there and then is the only way. Nights often only 1 neurology dr would be on call to cover the wards and emergencies. So frustrating for you as the patient, i fully understand, but A&E staff couldnt do anything other than wait either in that situation.

As far as the post asking why it takes so long, its not just down to drs in A&E, its flow throughout the entire hospitals. Dr's need a private area to see a patient when they walk in (so only considering walk in patients) this area generally known as ambulatory, if a decision to admit is made, they need somewhere within A&E to wait until a bed is available for them, this is the Majors, they then leave majors to go to a ward. If wards cant discharge, theres no flow through majors, which holds up ambulatory. Even if the person in ambulatory is waiting for a minor injury they could go home with after treatment, that cubicle is needed. And its all good saying, well keep some open just for minor injuries, that is tried, then you have an influx of patients requiring immediate treatments and the rooms have to be used and the minor injuries are left waiting.

A&E department waits arent just down to an increase in visitors to the department, but flow throughout the entire hospital, alot of which is held up by social care - or the lack there of, and many many other complex factors.

But please do not think its just staff not working hard enough, A&E is the hardest job ive had in my life, its the only place ive worked as a nurse where i have truly had no choice but to miss breaks, to work 14 hours with no break and have to be back on shift 10 hours later and do it all again, to go home and cry because i know i havent done enough for all my patients because 1 patient was so acutely poorly but the was no where to move them too and my other 6 patients suffered as a result. To go into work and know im going to get verbal and physical abuse from patients who as so frustrated for reason completely beyond my control but im the only person they are seeing to take it out on. But its also the most rewarding area of nursing i have ever done - when the systems work.

@widowtwankywashroom while you are busy explaining how it is not the fault of the nurses (I don’t think op said it was) you have forgotten that it is not the fault of the patient either.
You are right that it is very unlikely that the team that op needed to see were in overnight but this was not communicated to op (by anyone!). Op was told that she needed further investigation and was left to sit in her own urine. That’s not acceptable.

I love the way people who don't work in the NHS or in A&E all have so many ideas about how it could work far more effectively if we just did such and such, why don't you all come and work here then ????
Tell us how it could all be done so much easier

I am also an NHS nurse and have worked in A and E. What could be done to make it more effective? In this case communication!

OP, have you taken in what people have been saying about weeing yourself without being aware of it can be something very serious? I agree sitting on a hard chair for 7 hours is not pleasant and they should have given you a gown, you could have changed in the toilets. However, if you have something potentially very serious you should go back and stress about not having control over weeing. Take a change of clothes, snacks, drinks and a cushion, whatever you need, but do get that MRI.

I would have left as soon as urinated especially if no change of clothes were avaliable. Or you could have called a friend to bring clothes. You can't blame the hospital.

Too many people turning up at A&E because they can't access a GP. During covid, GP practices discovered that they could avoid seeing any patients at all and have stuck to that role since. Obviously, they're seeing some people, but not as it was before. Some practices are very dysfunctional and there aren't enough GPs in any case.

Your experience OP is awful.

My observation of NHS services I use is that people in it are knackered, overwhelmed and in some cases just not suited to the job.

I've seen the effects of this chronic chaos in the corporate world and the symptoms are generally

• Iow productivity - can't cope so I'll do the least I can as I'm exhausted
• firefighting - I'll do what's right in front of me now or to who shouts loudest
• not fixing broken systems - I'm too overwhelmed to think strategically or plan so I'll move to a permanent reactive mode

This is normal human behaviour. The only ways to address it are

• give people breaks and time off to recoup energy or they break, go off sick and don't come back
• have strategic leadership that takes a long view and fixes the high impact issues first
• look systemically at the issues
• draft in temporary additional resources to free up the people who know how things work, to fix them
• make radical changes to processes.

We are in a state of permanent crisis management at the moment and there is no quick fix.

People saying that labour won't fix it are partially right - there is no overnight fix BUT they are more likely to revoke the ridiculous immigration policies that are stopping / discouraging/ making more difficult for overseas workers to work in the NHS in the UK to help us make a start.

Money will make a difference and there is A LOT of money in this country that could be diverted to NHS.

They can put incentives in place to encourage people to work in the vacant posts through free training.

They can clear student debt for nurses and re introduce the bursaries the Tories got rid of

• they can make sure that NHS has proper supplies in place that are not bought through ridiculously inflated contract prices
• they can (as in the 50s) give financial incentives for overseas people to come and train
• they can build affordable homes for lower paid staff to work in

The cyclical Tory approach to healthcare is privatisation by stealth. They've been doing it for years and years. They know that if they say it outright that there will be uproar so they do it sneakily. They don't care that people suffer. As soon as they need care they wither pay for it or get bumped up the list - remember when Boris fecking Johnson had covid and was put into ICU even though he wasn't Ill enough at the time. But they prioritised him and he got better with early intervention. Something that many were denied. Bastard.

I'd also like to add that as frustrated as we all are with the situation we really must rally behind our NHS staff and complain, complain complain so that the evidence is there as to what is broken, what matters to us and what needs to change so that when the bastard cynical tories are out we know where to start.

I must be lucky where I live - I see posts like this all the time - people not being able to get a GP appointment.
My surgery isn't brilliant by any means but - you can usually get a phone appointment same day - they have patient access app so you can book appointments and they also have a text service where you can message for advice on none urgent care - they also have an option to send you to same day emergency care unit at the hospital if necessary my husband as had to use this in the past- ok the hospital is 20 miles away ! But the service is available and also you can use the text service to send a picture of problem ( obviously not for intimate issues ) - and u usually get a call from gp within a couple of hours- also if you can't see the gp they can usually get u in over the phone with a nurse practioner who will have a gp overseeing her anyway so u can get the dr if needed. Ours is a very busy surgery probably the biggest in town.

I waited in a&e to see a doctor (bloods/ecg) had been done) from around 9pm to 9am on a v uncomfortable plastic chair. At about 7.45am I was the next to be seen, but a Dr came out to say they had to do their paperwork so no patients would be called until 9am. I was starving so dh and I went to get a bit of food, but when I came back around 8.45 I had been called twice - wtf! Eventually was seen with others leapfrogging me and saw a ‘baby’ dr who had no idea what was going on with me but I asked for scan and got it and then waited til approx 11am to get results.
I went to GP and she’s further referred, plus bloods came back w low ferritin so now on iron tabs.
You should’ve been able to put scrubs or gown on if you’d wet yourself. That is dereliction of care, surely.

The fact that the government ordered many A&E departments to shut in late 90’s early 200’s is something that people have forgotten.

Rhe population has grown massively since then. We knew we were walking into a disaster.

Being a human being, I would have gotten up from my desk and found a solution for her, even if it was to give her my own cardi to wear around her bottom half. I've worked in retail before and had lots of customers with medical episodes, including vomit & bodily fluids, you don't just shrug and say "sorry too busy", even if your till queue is full. I'd expect far more critical thinking from someone working in healthcare, even as just admin.