To think this is a fucking joke - A@E wait?

[CanNeverThinkOfAName]

So our local hospital serves 350,000 residents from a large area.

Arrived at A&E at 11pm. Expected it to be packed and to have a long wait. There were around 15 patients waiting. At 3am there were 4 still in the waiting area plus us.

From that time only one person has been called to see a doctor and at least 10 people have gone out after being seen.

Ambulance staff check patients in near where we are sitting and only 3 have checked in since we got here.

Obviously not a busy night.

AIBU to think this is totally piss take and the staff must be on a bloody go slow or something?

As a doctor I find your attitude and post a bit upsetting and disheartening actually. ‘On go slow’. You really have no idea

Nailed it!

Unless dropped off, real trauma doesnt come through the same entrance as you and they won’t be checked in at reception. Sometimes we don’t even know their names. There are always doctors rostered in ED, they just might not be seeing you. As others have said, the consultants cover ED and the wards.

Just be thankful that you haven’t ever arrived at ED, no matter what age your child is, and been rushed through at the mention of their name.

As a GP who works for a UCC attached to a busy A&E, I can tell you there is lots of misuse. Recently I've had:

1- child spiked a fever last night. No fever today but not eating at all. Now child running around the consultation room, pulling down curtains and drumming in the bins with a mouth full of haribo.
2- 20 something year old going on holiday. Had surgery to remove her tonsils a month ago. Coming in 'just to check' everything is in order before her flight tomorrow. She has no symptoms.
3- multiple family members presenting with minor symptoms because one family member was sick enough to need a&e. But 'given we're already here' might as well get the whole family checked. No, never tried to see their own GP about these symptoms.

I'd say around half of what I see is very minor, long term illness (with no acute presentation) or not illness at all. Bear in mind these are the ones triaged to me, which is around a third of those presenting to the a&e. The sicker ones will be triaged to majors, paeds, etc.

Luckily my a&E has a good triage system and, as above, a lot of this stuff comes to me. As a GP I can see most, treat and discharge in 15 minutes. Still, people get upset and up in arms that I'm not ordering blood tests and x-rays for minor ailments or conditions they've had for years. 'Why did I bother coming to accident and emergency?' they say. I'm not sure myself, given it's not an accident or an emergency.

I think you maybe have a rosy idea of how many doctors are on duty in A&E overnight in smaller hospitals?

When I did A&E, I was by myself as an SHO between 10pm and 8am. So one sick patient would mean nobody else got seen until that patient was stabilised.

It’s also highly unlikely the ambulance crews are checking resus patients into A&E reception next to you - that’s usually done separately in resus itself. Phoned through in advance, if it was a resus call. And you don’t know who is on a trolley in resus/majors who has been there all day waiting for a bed, and so still A&Es responsibility to manage, who may now be unwell and need medical attention.

My kiddo (now 3) has been a frequent a&e visitor for breathing issues since 7 months old. The 4 hour wait (for us) is often intentional to monitor our child's sats and vital signs over a long enough period to determine whether he is stable enough to go home or needs admission / additional support. I'm sorry you've had to go through this too - it's terrifying having a little one that's struggling to breathe

You're right people don't, one reason I'm leaving the NHS and don't care anymore. People are generally ignorant to what actually goes on which is fine, i don't know all about everyone else's places of work (admittedly I don't speak about them as if I do but there we are); but you'll always get the charts about funding and staffing pulled out and how this proves staff are crap. It's not worth it anymore. Let the public have cut price lesser qualified PAs flooding the system as the government are doing, qualified and experienced doctors and nurses can have a better life and work life elsewhere.

You may have actually experience of working in A&E but sorry, OP has been waiting in one so knows more than you.

I would like to know how a and e works too. I took my son in and we’re in children’s a and e last week, as we sat there they were just not getting through the other patients, there weren’t many there the problem was it was so slow. Are the staff expected to run an and e and work in other departments at the same time? This is the only thing I could think of as to why no one was being seen with any ‘urgency’ for want of a better word. There were 5 other kids there and we waited 3 hours.

I’d be dealing with my almost unconscious child to be fair…not sure I’d think ‘well, I’ll get on to MN about this…I mean, what the hell else can I do?’ 🤷‍♀️

There may be seriously ill people arriving by ambulance that you are not aware of and don't see.

Oh my! How on earth can there be no doctor?! That's beyond comprehension.

Yes famously, a couple of hours sat in a waiting room means you know more than a doctor who has spent years training in a specialty 🤦‍♀️

OP, I really hope your DD has been seen now. It's crap to have to wait so long. FWIW, at the ED in my hospital, the paramedics will run patients straight through to resus (the ones that need to be seen right away), so you wouldn't see the major cases being checked in by paramedics at reception. Doctors may be pulled from A+E to other wards, or the A+E patients maybe waiting for specialty teams (surgeons, ITU, anaesthetists, gastro, paeds, urology, gastro, resp etc) who may be attending patients in other parts of the hospital. If resus or majors is full, then the staff could very well be in there attending to patients. They can't leave those critically ill people until they're stabilised and it is safe to do so. My ward patients are level 2 and when they deteriorate, you have to work quickly and stay with them until they're stabilised.

I work on a (very busy and acute) ward, as a senior nurse. If you see me sat at a desk or on a computer, it would be because all our notes, drug charts etc are on computers. Legally, I have to document everything I've done with a patient: so all referrals, notes, plans, updating handovers/charts etc etc. I have to sign the drugs I've given, on a computer. I also have to use the computer to arrange porters, order items/drugs/ward supplies and deal with staffing. So it might look like I'm doing nothing (and I bet that would be really annoying to people!) but believe me, I'm working. I imagine that it would be the same with the staff at your A+E.

I can't speak for other hospitals, but I know that where I work there is a massive push for speedy patient flow and making sure beds are freed up promptly to allow people to get through the system quicker (I understand that hospitals can get fined if there are delays or breaches). Bed moves and transfers will happen at all hours of days or night (there used to be fewer moves at night time or during meal times - so patients can sleep/eat - but that's gone out the window now). We often have patients boarding in corridors on our ward (not nice for the poor patients at all - we care for them as best we can). We battle to make sure we get patients to our ward so that they can have prompt treatment, but also to make sure that patients don't get discharged too soon. On the other hand, there are delays for patients needing care packages and placements as there is not enough in community, so often they will have to stay in hospital.

All of the above won't help you guys, and I'm sorry for it, but I do hope that it does give you a bit of a picture of what goes on behind the scenes. I wish you guys all the very best and that your daughter has a speedy recovery xx

PS I work in an NHS hospital, and yes, we're also short staffed for the acuity/dependency of patients that we have on our ward.

Presumably DD is waiting on a paediatrian to assess her? In my hospital - paeds are spread thin across maternity, NICU, the paed wards, paed ICU and A&E. So they don't just hang around A&E waiting on a child come in. They're exceptionally busy and under huge pressure.

You have no idea why you've been kept waiting. Are you just assuming the staff have spent the night refusing to work? Why would they do that? I appreciate you're stressed but your DD will have been triaged and clearly is stable for now.

I really hope you're still not waiting OP?

If she's in a lot of pain, you could ask again re painkillers. It makes sense she can't have oral painkillers but there might be other things. I had a perforated intestine and I think I had a suppository and then IV. That was years ago and I suspect the whole experience would be worse now - i dread to think really. I really wish her the best and hope she gets some treatment soon. I'm glad she has you with her.

It does vary a bit by Trust, but generally what people don't realise about A&E is that the triage is only a part of it. There will be children already being monitored in bays awaiting review by a doctor or having to have x hours of observation if administered medication etc until its decided they'll be admitted (and have to wait for a space on the ward) or whether it's safe to discharge. If these beds are full then unless an emergency that can't wait comes in then unless it's something that can be quickly dismissed as needing intervention there's nowhere for those in the waiting room to go. Nursing staff will also be transporting patients to the ward they're being admitted to in most cases and do a mini handover; this takes time. Staffing issues, lack of actual space, lack of ward beds, people misusing A&E, the unpredictable nature all makes for a perfect storm unfortunately. And yes doctors and other staff can be pulled to other wards if need be.

I think it's great for people who have a genuine need to go to a&e to be seen but how many times have people advised to go to a&e constantly

'my child sneezed'
'If it was my child I would race to a&e and get seen too asap'

On here let alone in normal life, sure if you to need to go but if everyone goes for everything no wonder why there is a long wait time

It’s hard to believe what a&e is really like now UNLESS you experience it. It’s truly shocking and actually the more people talk about it, the more chance of action & change.

Ambulance staff are NOT checking in any sort of actually ill patients - I’m surprised they are even leaving minors patients (putting trust in what you are saying). They will handing over with the patient and doctors directly. It’s not a kennels where they wander off to do a bit of admin once the patient is off their trolley.

I wonder if you are in a minor injuries area or even GP waiting - if majors is maxed out staff will be moved, or it’s not unreasonable for them to be less staffed out of hours when you’d hope people are at home and waiting for day to come in. GP wating certainly won’t have more than 1 doctor on after 11. The Nhs is not 24hr as it claims to be. It’s too short staffed and doesn’t have enough money for that.

I'll never forget the wait in a&e after a nasty fall and black out in 2023.. sat in the waiting room with my head swelling up by the minute and my eyes closing due to bruising-developing as I waited. Took over 4 hours to be triaged.. told I needed bloods and a CT scan and to sit in the waiting area, 19 hours later there was a panic as I'd passed out and someone called for help in the waiting room. I don't remember much (fortunately) but thank goodness that person see the danger because by this time i was so exhausted and disorientated it was scary. I was then rushed to majors things started to move more quickly. There were some elderly people dumped in wheelchairs that day when i arrived - totally forgotten about. The NHS is completely broken, you simply cannot blame funding or the government. years of poor senior management being paid serious money - now mostly on the sick draining the life out the funding they do have is a huge factor!! I've since taken out full bupa health care for me and my whole family as i have absolutely no faith in the NHS.

You have no idea what is going on, that you can't see. YABU. Rooms/cubicles might still be full of very poorly people, who have been there, since prior to your arrival. Waiting for beds, surgical review, etc.

How do you know what the doctors and nurses are actually doing? How can you conclude they're not busy?

You’ve made far too many assumptions about the workload you think the staff have so yes YABU!

In the last couple of years I have never waited less than 12 hours from arrival at A&E (In Ambulance- took 7 hours to come for my broken hip/shoulder) to being seen by a doctor/medic who is fixing the problem. This is in one of the top NHS hospitals in the UK! Sometimes you will have x-rays/ scans by then, sometimes not. Even in the middle of the night it's like this. Same for rest of my family. Even in Resus with a major trauma the person was lying around being ignored for 10 hours after the initial assessments, despite having been blue lighted there pretty swiftly (ambulance came in 30 mins).

They missed the fact the person had a perforated lung and there was 2 litres of blood in there, so they could've died. The NHS is broken. I really don't know if booting the Tories out can even save it now. It's really sad.