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

The one time I got sent there by my GP I was sent with a letter, and they must have called ahead because as soon as I handed it over I was taken straight through. The joys of suspected sepsis over a decade ago, prob wouldn't happen now though. Had a few visits with my son, and luckily all of those we were told to go straight to the separate kids assessment section

That's what frustrates me. Those of us that are actually sick get the metal chairs and no T.V because they want to deter people hanging around. Yet don't think about those that are really poorly, we would like to be somewhat comfortable during the 12+ hour wait... Longest wait was 72 hours waiting for a bed on the ward, 47 hours on metal chair before I got given a trolley, I was connected to IV etc, why shouldn't I be able to watch a bit of TV in that time?!

At my mother’s local hospital you can’t even speak to the receptionist but have to log your symptoms on an iPad. If you make a typo on any of your personal details it resets the whole thing. My mother had sepsis but we didn’t know this, she was just poorly. The computer decided she wasn’t urgent. I tried to get help from a human 3 times before a passing nurse saw how poorly she was and rushed her in. She ended up in septic shock but thankfully recovered.

I’ve always thought it’s to discourage people from going and costing the NHS money. Seriously, who doesn’t think twice about “whether it’s worth it”.

The issue is also nobody dealing with family members hogging all the chairs. I stood for over an hour in A&E with blood dripping from a head wound and my nose following a fall. Not one person offered me a seat and I was struggling too much to ask.

Yes to be fair they provide us with a "passport" but I went straight from GP and didn't have it on me. Someone with the same condition as me has said they have an explanation of their difficulties as a screenshot on their phone and I think I am going to do this (I have a lot of details in my medicalert account but theres no phone signal at the hospital a &e)

I’ve had both terrible and excellent experiences in A&E. I had to queue once when I had severe asthma from an infection and there was no urgency at all from the reception desk or triage team. I spent hours wheezing and coughing until I saw a doctor and was admitted. I spent over a week in hospital after that episode and I thought I was going to die at several points. Another time I’d had an accident and had broken bones and severe bruising. I was taken in by ambulance, whose medics didn’t think I’d broken anything but I clearly couldn’t move, and was taken to a cubicle and given some pain killers. They then asked me to go and sit on a chair in the main waiting area to wait to be seen for tests. I couldn’t even sit up so I refused. I’m also immunosuppressed and this was before the vaccines so they eventually found an empty office and wheeled my trolley in there, which was somewhat surreal. The care, when I got it, was generally very good but not always.

I slid down the desk as I couldn’t stand, I was having a bad allergic reaction. At the point I was sliding down the desk to the floor - they agreed my do could take over giving the details. The triage staff came out put me on a chair with wheels & took me away 😂

it was comical that it was only after I’d started sliding down the desk they allied my do to take over 🤣

I would be glad not to have to watch a football match .... But....

TV can actually be a really good distraction and pain reliever/anxiety reducer for someone who is very ill. When my son was desperately ill in HDU they gave him an iPad with lots of films loaded on it and it was the only thing that really distracted and calmed him

I've spent a lot of time in a and e with my elderly mum recently and while it's never great our local hospital does try. If they're busy they ask relatives not to wait in the waiting room unless you need someone to advocate for you and they also ask them not to take up seats if patients are standing. They try to get you out of the waiting room into pods as soon as they can and they bring chairs for relatives. They bring tea coffee water and biscuits round every couple of hours for those that can have them, and always offer to relatives as well. They have charging points for mobile phones, vending machines for fruit, nuts and snacks plus drinks. There are wheelchairs at the entrance for anyone to use. However it's always really busy, usually a lot of very drunk or drugged people, always a lot of police officers and usually a few handcuffed prisoners too, so the loos are always pretty gross (don't think it's easy to pee neatly if you're handcuffed) and the poor staff are run off their feet and having to cope with abusive patients.

The worst experience was when my very young grandson burned his hand and I brought him immediately to A&E. He had been dousing it with cold water at home but when we arrived the staff declined to give him any water for it until after he was seen- and it was still burning him. He started crying in the corridor with the pain and fortunately another patient gave us his unopened bottle of water and I took my grandson outside to pour it slowly over. We nearly missed being called in for triage but at least he had some relief during that time. I thought it was incredibly callous of the staff just to say there was nothing they could do when all he wanted was some cold water.

I was that person two weeks ago. Taken in by ambulance as a sepsis risk, but needed to eventually be put into a&e as ambulance needed elsewhere. I was just in my nightie, outrageously ill and tested positive for Covid in the ambulance. Literally sat in my nightie feeling iller than I ever have in my life. For hours.

If I waited until I was so ill I needed an ambulance I would almost certainly bring going straight to ICU and a ventilator and costing the NHS a vast amount more.

As a mum with children with anaphylaxis I don't like to call an ambulance unless I have no other choice

Oh no, that must have been utterly horrible and scary

I find it bizarre that they don’t have the facility for sick people to lie down while waiting.

I slipped down icy steps and broke my tailbone. Couldn’t sit on it so I went to hospital lying down on the back seat of a taxi.

I was unable to sit so I lay on the floor. They told me off - said I had to either sit on a plastic chair or stand up. I said I can’t sit at all and I can’t possibly stand for 5 hours! They shrugged and said you’re not allowed to lie on the floor so you have to either stand, sit or go home.

So I stood until I fainted. They got me up and said the same again - if you can’t sit then you have to stand, if you can’t stand (because I just bloody fainted) you have to go home.

So I got sent home with a broken tailbone and no treatment or medication, because I was physically incapable of sitting or standing for hours on end, and they wouldn’t let me lie down.

On a later visit to the same hospital I told the staff a woman was passed out in the toilets. It turned out she was perfectly fine, she was
just lying on the toilet floor where they couldn’t see her and tell her to get up, because they wouldn’t let her lie on the waiting room floor.

The kids A&E at the same hospital has no plastic chairs, just long vinyl covered benches. They’re still washable and hygienic but much better because patients can lie on them if necessary. I don’t understand why they don’t have the same in the adult waiting room?

I was in A & E last week. Horrendous environment.

They now have self service check in/triage screens. So many questions on this screen, very clunky to use and when you are feeling poorly, not what you want to be doing. Lots of people were frustrated with it, many needed assistance because they were not tech savvy. You have to stand for 5 mins whilst going through all the questions and many struggled.

That's not even including the uncomfortable chairs, little cardboard hats with sick and urine under the chairs (I counted four), some unpleasant acoustics which made it much louder and the harsh lighting.

I tthink some of the quick changes made during covid haven't been rolled back, plus no-one does a 'time & motion' study of the patient's journey through A&E. It's also about space & infection control.
Interestingly the Design Council did some work with hospitals in the past to improve A&Es - don't know whether the improvements are still in place.
Improving patient experience
Reducing violence in A&E
Overview of NHS design projects (edited to sort out links)

I would be great to have LOADS and LOADS of money to build a new hospital from scratch.
Our is a Victorian building that needed replacing many many years ago but has been patched up on a shoestring budget.
Receptionists sadly need physical protection nowadays with screens. Chairs need to be as cheap as possible, same as everything else.
Private hospitals are probably very lovely (obviously don’t have A&E though, but you get the point).

It was. I’m large chested and didn’t have a bra on. Too ill to care much, but it felt very undignified. I was also anxious I could be infecting vulnerable people.

I realise the receptionists need a screen but all I expected was some understanding that some people presenting are a& e will not be able to speak clearly or loudly (or stand up for a period of time)

I fully understand about costs having managed budgets in the public sector (different field) but some of the changes that could be done wouldn't run be about cost at all. Eg. People could be given a number and sit and wait to be called to check in rather than standing in line.

I read once that they've got the management of A&E the wrong way around. Instead of having the nurse do triage then you wait for the doctor, you should have the most senior doctor on duty do the triage. They can then send half the people home straight away, or with medical advice. The rest go back to the waiting room and wait for more tests/care.

Lets all move aboard then and sit outside for a few days before we get seen to. If we get seen to or pay private.£300 it cost to get picked up by ambulance to be taken to a & e in France then 2000 for treatment count your blessings you live in the UK !!

Eg. People could be given a number and sit and wait to be called to check in rather than standing in line.
I don’t see why you can’t go and wait in your car if you have one, and receive a quick phone call when it’s your turn. It would clear the waiting room and people would be more comfortable and actually able to lie down a bit.

A and E design was fine when A and E worked properly. You were checked in quickly, and if it was something even semi serious you waited for 20-30 minutes to be taken through to the cubicles. The only people who used to wait a long time should not have been there.

I am not for a moment slagging off the NHS. Because my condition is rare I count my blessings every day that I live in England and not somewhere with a private system. Many people with my condition, even those with good insurance, end up bankrupt in places like the US

I am asking specifically about the design of a&e and whether there are examples of good ones that haven't involved meaty cost implications