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

Research into medical bankruptcy in the US.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366487/

Yes I know many previously comfortably off professionals now struggling hugely financially either due to big "co-pays" or insurers refusing to pay for treatment that I have had no issue getting here on the NHS.

And I saw an instagrammer with MND posting the other day about how to shop around to keep the cost of medication as low as possible, and it's quite clear she comes from a wealthy family and she had a very good job yet still the cost of her condition is a huge source of stress.

And of course, there's getting diagnosed with the condition in the first place, and often with our rare condition it can be a battle to get the necessary tests so in the US people often pay our thousands.

No I didn't start this thread to slag off the NHS, I feel grateful for it time and again. But sometimes I think things could be tweaked for a very minimal cost to make the patient experience far more tolerable

I thought this was an ER/A&E design topic? I’m just sharing my perspective.

If a walk in you pass security (bag check and metal detector) and go to a window. You check in and the take your name. Triage is next which is its own room where you have vitals taken, immediate treatment and more detailed information taken. Then you wait until you are called, (current wait 88 min). Most ER’s have an A and a B side … B side being for non-emergent things (sprains, cuts, sore throat, etc.) A side for gun shots/stabbings, car accidents, strokes, heart attacks, etc.

If you are brought by ambulance (most response times averaging 6 min) you will be brought to an exam room or waiting room depending on your symptoms.

As I mentioned, free valet parking for the ER, so there can be a little bit of a wait there if it’s busy. Wheel chairs available for use in the entrance if you need one. The chairs are soft-ish and I’m sure seating gets a tight on really heavy nights. It’s been clean every time I’ve been in. Soft lighting. Visitors also get checked in with a picture name badge/sticker identifying you to a patient if they are already in an exam room otherwise you get that after they’ve been taken back. Visitors in the exam room are limited.

Then you’re brought back into an exam room. Each room is private, depending on what you are there for you’ll get painkillers, they’ll bring ultrasound machines, to the room when possible, otherwise you’ll be brought to different areas for Scans and X-rays. At some point someone will come in to see if you have insurance, get details, etc.

Usually w/in 4 hours of being admitted to the ER you’ll either be in surgery, admitted to a floor, or discharged. If discharged you’ll have someone come in and help coordinate after care if needed (finding a doctor if a specialist and making an appointment, helping with a PCP/GP appointment, helping to get medical financial aid if needed).

The last 3 times I (or someone I’ve taken) has been a walk in there was literally no wait. All ambulance arrivals have also been the same.

Medical issues have included the following: Stroke, dog bite, suspected kidney stone, severe ‘something’ that presented as very ill, painful cyst in a very unfortunate piece of anatomy.

But sometimes I think things could be tweaked for a very minimal cost to make the patient experience far more tolerable

With respect, you’re asking to rearrange the deck chairs on the titanic. 4 hour wait times should be a busy Friday or Saturday drunk fest. Granny should not be in a chair with stroke symptoms for 10+ hours or thinking it’s better to stay on the floor at home with a broken hip for 20+ hours! (The response time for my neighbor at 1 am on a Friday night from an ambulance was under 10 min. He had pain meds administered immediately and from what we heard was treated immediately in the ER and admitted to the hospital within 5 hours. )

You should not feel grateful for a plastic chair for an 8+ hour wait to be seen by a doctor. You should feel outraged.

Free healthcare that you can’t use isn’t better than expensive healthcare that everyone gets (but you may have to figure out later how to pay for) IMHO.

Actually noone in a & e had a horribly long wait that evening (despite a serious road traffic accident clearly having taken place and air ambulances arriving)

And the clinical care I received was excellent.

And I see world leading experts for my condition and have a specialist nurse who contacts me regularly.

The issue was the design of the room and the system. The standing and queuing to check in, in particular, seems nonsensical to ask of ill people

I don't think the NHS is perfect, I am not disputing that some people have had a horrible time and there is lots of work to do, but I am certain that I have a much better experience than people with my condition in the US. I see their posts and pleas for help. It's clear that there are just as many issues and problems with healthcare over there.

Glad you’re happy with it , and I truly mean that. And yes there are many people who struggle in the US, And there are many more that are happy with their care.

A & E is now so crammed you can go in with a broken leg & leave with covid or a stomach bug, there doesn't appear to be any form of germ control.

Last time I went to A&E there was a woman lying for the floor covered in her own vomit, still vomiting now and then, and staff kept coming and standing over her asking her to get up and sit on the chair (which she clearly couldnt) I felt awful for her.

I agree but I doubt anything will change. The whole vibe is'why are you here?'!!

Comfy chairs would be set on fire/stolen/used as a weapon in our a&e

Agree the conditions are really bad. Would like to see if people take longer to get discharged the longer they have waited on A&e chairs. If you were looking for an environment to make people sicker sat on hard chairs potentially sharing a drip stand would be it.

I always feel the chairs should be numbered to avoie the ammount of staff searching for patients. I once collapsed while waiting, ended up with a 17 day admission. Staff dient know who i was as had no nameband and people had gone home as was worried a 10 hour wait through the night would just make them sick. be

I was once in A&E (told to go during an appointment with my GP) and a chap in the queue behind me was having a fit in his wheelchair and fighting for breath.

The TWO nurses checking people in were doing such a good job of pretending the queue didn’t exist, it was only when we all started shouting at them that they looked up from their envelope stuffing to see someone close to dying six feet away from them.

I realise we are never going to get real comfort but I think it is more that sense of what tweaks that cost little might make a huge difference.

At the neurological centre I go to in the same hospital all the chairs have high backs. They are still very much wipe clean and fixed to the floor for people like me with muscle weakness it means I can at least prop my head up a bit

I've never been to an a&e that didn't have chairs. If they made them nice then people might go more unnecessarily (like people who cba to see or even register with a gp, not people who genuinely should be there).

If you’re so sick that you can’t sit or stand in the waiting room, they tell you to go home and call an ambulance. So you can lie in the ambulance outside while you wait. Ridiculous and a total waste of an ambulance - basically using it as a bed!

Deterrence by design seems like a particularly grim justification given how much it adds to the suffering of people who genuinely need to be there

My sister subscribes to a medical app. She can make an appointment to see a doctor via Zoom within 24 hours. They can’t do repeat prescriptions or anything that needs an in person examination. But they can give one off prescriptions for minor things, like antibiotics or creams, and they can give advice, and they can do referrals to specialists.

I needed to see a neurologist, the NHS GP said the waiting time was about a year. So I got my credit card out and in exchange for £250 the waiting time magically dropped to three weeks, in a plush little private clinic where I was greeted by a member of staff and given coffee while I waited in a proper waiting room with leather chairs and coffee tables.

It’s a two tier system and money talks. The rich (or those who can stretch to it) get treatment quickly. Everyone else has to wait months or years for treatment, getting worse or possibly dying while waiting. I know a number of people who’ve sold their tv or jewellery etc to see a private specialist because the NHS said they’d have to wait for a year. My neighbour sold his motorbike to get a private autism diagnosis for his wife because they were saying she’d have to wait four years.

So not a french citizen then? Friends of mine who are french citizens have majority of healthcare covered through contributions/ insurance they take from wages

Good design of A&E is so important. It should have at least 2 waiting areas, so the young and elderly attendees, don’t have to wait in an area where drunks are swearing and scuffling. My dd had to sit and breast feed her dd, while police were trying to deal with drunk and drugged patients in the same small area (should mention she had to sit on the floor, while the aforementioned patients were taking over the waiting room). There should be a private area, where patients can book in online (if they are able too) and are triaged, so no other patients can hear what is wrong with them.

However A&E isn’t the only area to be considered when designing hospitals. Other things that should be considered, is where the clinic bays, and more especially, where X-ray is. Our (newish) hospital has X-ray almost as far away as possible, but has a back way in and out, which is less than half the distance patients are expected to walk to get there and back.

Then next should be where the wards are, again in my hospital, they are so far away (think down a long atrium, then a long corridor and another shorter one before reaching the ward entrance, then if you’re unlucky right down to the end of the ward). However the admin and executive’s offices are up one flight of stairs, or a short lift journey,at the entrance to the hospital! Things like this mean that people, like myself, have to rely on volunteers to wheelchair them. If it’s busy you have to wait in turn to be taken to where you want to go to, or try to walk there, so you’re not late for your appointment. When my late husband was in hospital, he was the furthest away it was possible to be, so I struggled to even visit him.

Another thing to look at is the size of the car park. Again, our hospital car park is too small to handle all those travelling by car, which you need to do, (especially if you are disabled like myself), as it is quite a distance from the nearest town. If you need a disabled space, good luck in finding one. Staff aren’t supposed to park in the main car park, but they do, taking up over half the spaces. Who can blame them though, the executives have their own named spaces in the main car park.

It was already not fit for purpose, before it even opened. It was so bad that the old hospital had to be kept to use for several specialities, as well as having to re-open one of the wards and last winter a second ward. The number of staff that applied to be transferred back there (think 30+, for 1 healthcare support position) showed how much even the staff disliked the new hospital.

Like when?! I can remember hours waiting before the current ( last) Tory govt got into power. It may not have been as long as now but certainly not 90 mins Was working with the elderly and often spent majority of an 8/9 hour shift at hospital with someone who had a fall.

@Bellamari annoyingly it can't be done privately

I mean it probably could if I was celebrity money rich but NHS originally sent me via Spire and they won't touch me
It needs a bowel surgeon as well as a specialist endometriosis surgeon because it's so advanced

Thanks to the doctor that told me nearly a decade ago when I suggested I might have it "well if you don't want the pill we can't do anything else"

If it was a pleasant comfortable place to wait then more people would attend so I suppose it's a way of cutting out the time wasters.

I spent a Saturday night in A&E with what turned out to be a retinal tear, was eventually seen by on call eye consultant and laser repair done the next morning so all worth it.

The wait was uncomfortable but fascinating as could hear every word when people came in to register with receptionist, lots of drunks with injuries, a limping woman complained that her friend disrespected her so she kicked her in the head and fell over!

Nz too!

I work on the ambulance, our local A&E does this as well! But if you're well enough to make your own way to and from A&E then likelihood is whilst we certainly might take you back to A&E (after you've waited 2-3 hours for our arrival), you'll be well enough for self handover - we just point you to reception there's no handover to clinical staff at the hospital just "reception is through there to book in, all the best".

Handover times from ambulance to A&E are so extended now that we'll normally only wait with you if you're so unwell actually couldn't sit in a chair - honestly as horrible as it is if you made it to and from A&E then it's quite unlikely (but I agree certainly not impossible) that this will be the case. The other reason is that you lack the capacity to give your own details/history to staff.

I don't know why the A&Es still do it, by going home and coming back by ambulance liklihood is you'll be back in reception just 3-5 hours will have past. It's awful when people realise/they rightfully upset. But ultimately we can't wait with you for comfort reasons as there's a massive queue of people waiting for ambulances out there who are also waiting hours but some of them will be barely breathing, elderly with multiple fractures from falls, collapsed from chest pain unable to stand, had a stroke. There're all out there waiting for us so if you can walk and talk the guidance for ambulance staff now is point them to reception, clean the ambulance and get back on the road.

Mind boggling

I would never want to use an ambulance unless absolutely necessary, it shouldn't be a taxi service. Madness that people are pushed to that

I agree with the OP.
I was in A&E for 7 hours, back in January, awaiting some help after a fall (turned out that I'd broken two ribs). I was struggling to breathe and every movement hurt. I was sat on a hard backed chair for that full 7 hours with nothing more than 2 paracetamol offered during the initial triage. There was a single hot drinks machine, the output of which looked like dirty water, but it tripped the electrics twice during my time there so they ended up turning it off. There were no other drinks or food facilities without walking outside the building, up a hill and into another hospital building (not possible really as you'd likely miss being called through and I hurt to much anyway). There was no water cooler or anything like that. So, I sat in pain for 7 hours with nothing to drink. I felt absolutely rotten when I was sent on my way a few hours later.