To wonder why A&E seems to be designed to be the worst possible place you could possibly be when ill?

[CassandraWebb]

My GP asked me to go to A&E and while I was waiting I was just struck by how it was a pretty unpleasant environment to wait in for the family members of the ill and injured but utterly irrationally poorly designed for people who are ill or injured.

Firstly you were expected to stand and wait to check in, I explained I couldn't and they grumbled but accepted my explanation but a lot of people with obvious leg injuries or desperately ill were being made to stand and wait and then stand to check in and then move and stand in another line to speak to an initial clinician.

Then there were people clearly in huge physical discomfort sat on the world's most painful chairs with no way to get comfortable for a long stretch.

Plus people were explaining why they were ill and giving their symptoms and contact details and the receptionist was literally announcing them back loudly to the whole room, I think there was some sort of microphone so her voice could be heard through the glass. And no microphone going the other way so she was getting irritated with me because I was hard to understand (my condition gives me dysarthria when I am having a flare).

It just seemed mind bizarrely poorly designed for a place where unwell people go.

I realise cost is a real factor, but some simple changes like chairs while you wait and a privacy screen so the whole room doesn't hear your symptoms and address /living situation would seem like a good start.

Maybe it's just our local a&e but I was totally puzzled by it.

I would love to hear if other places have really good tweaks to make it more bearable though.

(And I would add that the clinical staff were absolutely brilliant and very knowledgeable and switched on about my rare condition and also very kind and compassionate despite an obviously busy evening)

It frustrated me just seeing people suffer but it also frustrated me because the process of waiting and dealing with that made me more unwell

I used to work in a kid's hospital, and often thought the same.
The A&E was small, but when you have an ill child... then the whole family comes, including their siblings. They are racing about and playing on the toys that are everywhere anyway, whilst the ill child is being soothed by a parent on the edge of a tiny plastic chair.

Mostly infection control.

There are many poorly and injured people in A&E.

Just think of the amount of bloody fluids that those surfaces get covered in: blood, vomit, piss, shit, pus, discharge, skin.

The more equipment/furniture you have, the more difficult it is to clean properly.

Wow you are so right, I had never considered this before but why on earth are they so badly designed?

I once had to wait 8 hours with my finger hanging off, blood all over my arm and legs, just holding it up with a bandage from home wrapped round while blood seeped out. I fell asleep at one point and woke up with blood all over my face where I'd been holding my hand against my cheek.

All so unhygienic. I could have had any disease for all people knew.

I assumed it was partly to keep you awake to hear your name being called (and because it is hard to instantly distinguish someone having a nap from boredom from someone dying).

how utterly maddening.

Yes the clinical staff were really apologetic because they could see how much I was struggling (I have weak muscles when flaring so struggle to stand or hold my head up etc)

I now have a "hospital" pillow that I take in to a&e with me. It gets hot washed and then put back ready for next trip. I don't like going in, but the joys of being very poorly means I'm there regularly. I have a go bag with essentials and also a large jumper I can unzip to use as a blanket, and my hospital pillow to make the chair more comfortable until I get a trolley.

Yes I am immune suppressed too so it was a really tough judgement call for the GP to send me in, not something he did lightly. Thankfully there was noone with an obviously contagious condition but it was a big worry.

Although I know when my daughter was sent with very severe chicken pox as a baby they whisked her to a side room straight away (but I think that was partly to keep her away from several children who had measles!)

As a nurse in a&e I completely agree, especially about the triage nurse and privacy aspect. I find it so awful that women are telling me they are miscarrying through a screen or that a whole waiting area knows someone has a massive anal cyst. We have brought this up NUMEROUS times and nothing changes. Chairs are shit aswell.

Yes my mum has told me to sort a hospital bag as I am likely to need to go again in future, a pillow and blanket sound like good ideas, and also a card or something to explain that I struggle to stand /talk clearly

I am considering writing in to PALS , would that be the right route?

Yes that's what shocked me too (particularly as a data protection practitioner). I don't mind chatting about my condition but I am sure some people go with things they would definitely not like a roomful of people to overhear!

I agree, I have collapsed off a chair in A and E more than once, it's so silly when some people will be fainting/collapsing, I saw a man with a bad head injury collapse and hurt himself further, it's not a good place for the quite ill at all, ideally the severely ill go straight through but at ours pretty much everyone ends up in triage even if they are practically dying, unless they are unconscious.

There's also no pain meds, so you sit there with your broken body part getting more and more swollen, potentially moving it about to go to the loo, getting no pain relief and worsening it, I've wondered if a long wait injured me further.

Ours is pretty good once you get going, the triage is efficient, there is a GP for minor issues, and the A and E staff themselves are great, it's just the initial waiting area that is so awful.

@Rocksaltrita ours has kiddie murals, even in the teen wards where everyone is there for overdoses or eating disorders, it's very childish! The staff are great though.

I notice the staff are very good in most places, but the places themselves are not very well-designed.

I had to take my young adult to A and E recently. They have "revamped" it and it did work better, albeit we still had long waits.

Initially you were in a triage area. From there you were allocated A and E or "urgent care" which was like a walk in centre I guess, with GPs. That got rid of a lot of the people with minor sprains, tonsillitis etc. They had a tracker who called people in groups through to urgent care or A and E, so it was never too packed in any one zone. The trackers also took roll calls intermittently - presumably to ensure no one had left or died waiting (sadly not joking).

This was way better than everyone packed into one space like last time I went.

I very recently had to go to A&E four times until I was admitted with an abscess in my spine. I waited 10 hours for a bed and by the evening the security guards were dealing with rowdy family members who just wanted to fight and people who were completely inebriated. There were bodily fluids on the floor, rubbish and sick bowls. Honestly it was disgusting. The staff were too overwhelmed to do anything about it. It was a desperately sad state of affairs. There was also no where to sit. It was like an extremely busy bus shelter in the middle of London.

Sound a bit like the Norfolk and Norwich

And their phone number.

They are rubbish places to wait. I think it's a combination of infection control, things having to be robust against vandalism, cheapest bid wins, space efficiency....

If there were comfy reclined cushioned chairs they just wouldn't last.

I agree, though I have huge sympathy for the staff working there. I recently went to my gp with O2 sats in the high 80s after a couple of nebulisers had failed to make any difference. I refused to go to A&E for further treatment as I just couldn't face gasping and wheezing on a hard chair with people crowded in around me. Fortunately I gradually picked up. Thank god the Tories are gone and hopefully this situation will improve.

Like others have said maybe it's to deter people from attending unnecessarily.

My friend works in a&e and switched off one of the England Euros matches in the waiting room - he said if people are sick enough they'll wait and if not they can leave and watch the match!

Is there a charity linked to your rare condition? I have an "alert" card and information sheet from the charity which I can hand over to paramedic or receptionist etc. Maybe there is one for you. We shouldn't need to find ways to deal with a&e being so uncomfortable though.

lots of input from hospital facilities staff, healthcare staff etc

From personal experience, I doubt healthcare staff are asked at all. Or if they are asked, it is pure lip-service

It is a disgrace. Not fit for purpose. Totally shameful.

Completely agree. DM(92) post surgery for a broken hip was sent by the GP for a precautionary scan following a fall. We were there for 6 hours, a catalogue of errors, miscommunication and complete compassion fatigue among the staff. DM was struggling to sit for that long post op and all I wanted was for her to be able to sit in a comfortable chair in a quiet area but it was an impossible request. Eventually I said I was taking her home and even then I was sent round 3 different nurses none of whom would take responsibility for her self discharge. By this time DM was visibly exhausted and her risk of another fall increasing. We were then told her scan results (even though we were told it would take up to an hour to get the results back) but were then informed she needed an X-ray of her hip. We took her to X-ray again but she needed to be on a trolley...they put her on the wrong sort of trolley. Post X-ray there were no porters so radiographer pushed her back into A&E.

The positive was that DM had someone to advocate for her but there were lots of other vulnerable patients in there alone. I worked in the NHS for over 30 years and I was appalled and saddened at the overall experience

To put it the other way round.

A&E departments were never deigned for the people they are being expected to see today.

Peopel were either brought in by ambulance and on a trolley or were brought in (generally) having had some sort of accident or emergency - having fallen and suffered an injury, or medical emergency such as severe allergic reaction or heart attack.

Now for, far too may people, they are seen as somewhere to go because the GP service no longer suits their needs/desires AND just as frequently because 'oh i'm uncomfortable/hurting, I'm going to A&E' (It doesn't need to be many of these to fuck it up for everyone wlse who is there legitimately.

Most people do go with the right mindset but 10% overreacting and 10% using it as a GP (along with it not keeping up with needs) leads to nearly 50% oversubscribed and staff becoming frustrated too

Yes to the problem of giving details to staff. I went with a serious nose bleed, no way to speak without nose actually bleeding. I hadn’t checked in so they didn’t give me anything to help even a bowl/more paper
despite the obvious biohazard and mess of me bleeding at the reception desk.

Maybe a voluntary NHS card with name and DoB and photo that would show known long term conditions and known allergies. It would all have to be checked as things do change a lot. Keep it as basic as that rather then trying to link to full Gp or hospital notes.

Chairs and clinical areas I think is deterring people, especially numbers accompanying the sick person, cost and ease of cleaning. In theory you should not be there long as it is only for very serious illness/accident but the NHS is a mess.

I did recently have brilliant treatment from reception all way through for a different illness and will sending thanks.