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 wonder how well that even works anymore, if there are no other options.

A colleague of mine was having trouble with her knee. It was gradually (over weeks, not a sudden thing) becoming more and more painful to the point she really struggled to walk. She hadn't had an accident, it wasn't broken, but there was obviously something wrong.
The GP wouldn't see her face to face, just said go to A&E. She didn't want to, partly because she didn't think she needed to because it didn't seem like an emergency, and partly because she knew it would be a horrible wait in a horrible environment. But she went in the end because however much you discourage people from A&E, if they have no other options, they'll end up there eventually. Her GP was just refusing to see her. What other option did she have?

It’s a long list of complaint. Honestly I get it. These places are often hell on earth.

But we don’t visit them that frequently. Or certainly not as frequently as the consultants who work there, or the staff routes through the hospital. So why shouldn’t the consultant who has to walk a route 100 times a day scurrying about have an office located in a convenient place. And why shouldn’t the staff use a shorter internal route to X-ray if it’s available for them (ie. Probably through service area). Same for the carpark!

As you say we can get you a wheelchair and a volunteer to solve your problem. We can’t clone the consultants because they are stuck traversing a corridor for the 99th time that day.

Loved working there but whoever invented those narrow, labyrynthine corridors around which we had to push trolleys clearly didn't think of the staff either!

If space were not such an issue then it would be ideal to have a triaged waiting area. So for those clearly needing a dressing on a cut or something waiting area 1 normal chairs and so on, then for those with suspected broken ankle or more serious problems quiet room with big recliner chairs.
Problem is A&E is not seperated from minor injuries as there isn't one where I live so it's a catch all for all out of hours issues.
So you can be sitting next to the child with a bit of a sprained ankle and the woman who might be having a heart attack.
I don't find the staff triage very well either once took my DD who was 13 with severe abdominal pain, took ages to see her until a nurse realised she was pediatrics and rushed her through. It was 3am by then.
She said oh you are tall for your age we thought you were an adult!

A and E is a nightmare, I had an aunt nearly die after refusing to go because of the way she was treated last time she was in. She was screaming in pain and still would not go. She relented after 4 hours. Other people do not make it easy either.

Last time I was in A and E with my child there was 7 family members taking up seats for 1 child. They did not get up when another parent asked if they could have a seat so their obviously sick child could sit on their knee.

The staff were asked to do something about it but didn’t (prob scared of them kicking off)
They then all vacated to accompany the
child to x ray. They seemed very put out then they got back to the waiting room and found people sat in the chairs they had been sitting on. Funny enough 6 of them left including the dad when the choice was sitting on the floor.

I think the separate urgent care and minor injuries units are brilliant and should be far more well known and used. I had no idea one existed in the next town until someone mentioned it by chance. I've taken my kids to the main A&E a couple of times with suspected broken fingers, wrists etc and had v long waits in unpleasant conditions, well into the night in one case when they closed the paed A&E and transferred us and we went to the back of the queue. The MI and UC units tend to be much less busy and could take a lot of pressure of real emergencies.

Agree. I collapsed at work when 12w pregnant & tried 111/ GP but everything sent me to urgent care, who then sent me to A&E.

I was so dizzy, faint & confused & the room was about 30° (outside was about 15) and incredibly noisy (eg a TV that nobody could hear, names being shouted, people kicking off) There were no chairs & nowhere to sit on the floor. had to go & sit on the toilet because I felt myself fainting agajn. I then obviously missed being called & was put to back of queue. It was horrendous. Frail elderly main with nothing covering him sitting in a doorway on the floor. It was completely 3rd world.

What reasons, especially related to A&E? Is there any consideration given to the walking wounded?

I agree. We get treat like cattle

I am terminally ill and have to go to a&e perhaps a couple of times a year
It is actually the pits of hell 👿

It is a great place to catch disease Ours is often filthy dirty with excrement smeared on the walls and or sick on the floors You may be sitting next to someone who is puking in to a cardboard bucket

A great place to get assaulted whilst sitting there Ours always seems to attract drunks and trouble makers and the last time i was there, someone came in with a cheap bottle of wine and was screaming and shouting, and despite two huge security guard watching, no one removed him. He wasn't there for an illness he just came in to shout and go for a shit in the middle of the floor. Eventually he forcefully threw his wine bottle on the floor - resulting in three people including myself needing stiches

Basic amenities no where nearby to get a drink- whatsoever. There is a canteen at the other side of the hospital which is at least a five min walk - if you leave the a&e dept., you will get shunted to the back of the queue - (last time i was there, i was in for a 14 hour sit on a hard plastic chair) . If you ask how long it may be (so you can work out if you can make it there and back intime) they will say they dont know and have no way of finding out

I think they shouldn't allow family members - as they are taking seats away from the unwell. My A&E constantly make announcements, if you are not the patient please leave, however despite this and the doctors coming out and shouting it, you will always get some who ignore.

This! Sadly it’s also true with other spaces supposedly ‘designed’ for the sick or disabled. The whole thing needs revamping because people are being harmed :(

They really are awful places. I had to attend twice last month as I miscarried and had 2 severe hemorrhages. I was sent to a+e by the early pregnancy unit and they phoned ahead so they were expecting me. I could barely stand, felt dizzy and sick and still was expected to stand in the queue. Staff were desperately trying to clear seats for patients as everyone seemed to have brought numerous family members with them. People were collapsing and throwing up all over the place. The alarm bell rang at least 4 times in the 2 hours I was waiting to be admitted due to patients collapsing. There were people on trollies all over the corridor and also at the back of the waiting room.

Our A+E also has no windows and they are doing really loud building works outside that seems to consist of drilling, hammering and digging up concrete for hours a day. So that's thrilling to listen to. The canteen is shut and the tiny little shop only sold crisps and chocolate bars. The vending machines are half empty. The parking situation is dire.

They really are not designed for the volume of people who are using them. In our area they have built on nearly every spare inch of land but have not upgraded the services. Drs appointments are a months wait, or battle for an on the day appointment, the online system opens at 8, the phones at 8.30 at 8.31 you will be number 80 in the queue. Appointments are gone by 9am. All the Drs surgeries now have a message on their answer phones from 9.15am every morning telling people there are no appointments and to attend A+E.

The last few times I have gone, there seems to be numerous care home residents in A+E with a member of care home staff. Lots seemed to have fallen. I was chatting to one of the staff members and they were there for a medication review, the care home no longer had a visit from the Drs surgery and the surgeries solution was to send all patients from the care home needing medication reviews to A+E.

Yes this is one of the huge issues. Far more people there than it’s designed for.

It is a great place to catch disease yes, this is what always annoys me about healthcare establishments, including the GP. Mixing up the injured with the infectious so the injured end up also infected. I once heard someone say that the best place to get ill in any town is the GP. Mine had no open windows. I still feel bad about all the elderly in the waiting room with appointments for their hypertension/arthritis while I was waiting with a chest infection so bad that I sometimes couldn't breathe. Surely abundant ventilation is only common sense. I have also waited in A&E with a kid with broken foot bone(s) along with people with stomach bugs so bad they have brought along their own sickbowls. Do other countries have somewhere for the clearly infectious to wait?

Reasons for the design of the a and e waiting room?

Well firstly you have the actual building. This room adjoins many rooms ie. Triage, admin, curtain rooms, private rooms, corridors, clean and dirty service routes and sluices, toilets, access to wards etc. Designing a hospital as a whole so everything is actually adjacent to other things it needs is a nightmare in itself.

Then the actual waiting room. They need to be designed for all events. So if a 30 stone man collapses can we get a hoist in here to all locations. Really you’re not designing for the average person. You’re designing for the most impossible situations.

The main thing which makes them dire is the seating. But I challenge anyone on this thread to propose a chair suitable for 24/7 365 use, which is suitable for a single person (so you don’t feel like your sitting on someone else’s chair). Fixed, yet also moveable and stackable. And cleanable in the event someone pisses on it, vomits on it or bleeds on it.

This is also the sort of thing that makes people turn up with multiple relatives - so you can have one to help the person and another to e.g. stay and listen for announcements or go and sort the parking on the car or to go and locate some food once you've been stuck there for however many hours.

I think there should be one person accompanying the patient, though. I disagree only the patient should be there. Often people are too sick, faint, unwell, or just have hearing/sight/dementia/cognitive/brain injury problems that means they can't communicate well, those people should not just be left in a waiting room without someone else to help them to the toilet, fetch food and drink or advocate if they suddenly deteriorate. That would be madness, to take someone out of a home where they have other people to check on them and make sure they are not deteriorating and then put them for many hours in a basically unsupervised environment whilst having an accident or emergency. Very dangerous.

There are no staff supervising the A and E room constantly, if some type of basic nursing care was offered there, it would be different, but they are in their rooms, and only come out to get the patient. Our receptionists aren't facing the main waiting area. You can't leave sick people alone to see which ones sink or swim!

Oh I agree. When I am flaring I lose the ability to speak clearly (or sometimes to speak at all) so I need someone with me. Particularly as with a rare condition you often have to remind clinical staff as to what to think about (although the ones last night were all fully "on it" which was a relief )

Plus if you can't walk or similar how else are you going to move around (before you are admitted I mean)

I guess the main issue is the waiting time. If you were to wait in that type environment for a maximum of an hour, say, it would not be as bad. The fact that others around you are suffering in often quite awful ways, for a long period of time. Just gives this feeling of doom.
That and they sometimes call someone's name who's so sick they've passed out, so they get ignored and even have died on the floor!?

It’s to put people off going, or in the hope that they are so uncomfortable they go home and just die there.

I recently had the misfortune of having to go to A and E for suspected mini stroke in a city centre hospital on a Monday afternoon. I can't believe how bad it was. Far worse than people can imagine. There were no seats. People were lying on the floor. When I did get a seat it was unbearably uncomfortable.
I was triaged and sent to another waiting room as I 'would be seen quicker'. There were about 50 people waiting in there, with curtained cubicles around the outside. The man next to me said he had kidney failure and had been there for 6 hours. He finally left to go home in despair as he couldn't stand it.
People had no dignity in there. One man had something wrong with his bowel, and the whole waiting room could hear what was going on behind the screen. It was awful.
I asked a nurse if she enjoyed her job and she said it was very very difficult. I really take my hat off to people working in these conditions.
It took three days to find out what was going on with me.

I had this exact thought when we were sat in a and e. It also seemed odd there was nowhere to lie down. My son had a terrible concussion and had to lie on the floor as he couldn't sit and some other woman fainted off her chair.

I also agree that mixing injuries and illness is odd. We need injured, stomach, respiratory, rash and unknown!

Agree completely.

I've been a few times in the last year for different reasons and with my son and it's just a hellish place, especially in London. All of the toilets were splattered with vomit and urine and I had to give a urine sample it was just disgusting. They don't even have water machines and I was too ill to walk to a shop, after about an hour someone got me a water. I was vomiting into my hands at one point and no-one even got me a bowl or tissue (I'd had an accidental overdose of medication and I was very ill). I think they make it so deliberately awful to put you off going.

As others have highlighted, it is deliberately designed to be so uncomfortable, degrading and unpleasant, if you're able to walk you will leave. It's a form of triage using the environment. Only those who are truly desperately sick will remain. Anyone who isn't at death's door will take themselves off.

Ours has recently got these areas called 'Safe to Sit' with more comfortable chairs, where they do e.g. blood tests etc and they have supervision and a coffee / tea pot and biscuits

Seems to be for after you have been triaged and separate from the other waiting room which is as mentioned here.