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

My A&E is much better.

you take a ticket as you enter and then sit down. Once your ticket number has been called you go into a private cubicle to tell them why you are there and be triaged.

The seats are still plastic and uncomfortable though.

It’s called triage. The people coming in, hanging to life by a thread get priority.So if you wander in with earache or a sprained ankle - you’ll wait.
I have been to several in various countries - they’re all the same .The most terrifying one was in one of the supposed best hospitals in the USA … it many have been but the ER on a Saturday night was full of gunshot wounds and people handcuffed to trolleys escorted by police and people OFF their faces on god only knows what…

I think they are like this to put off time wasters. Unfortunately,it impacts very badly on the ones who are not.

So what are the reasons for them being designed this way? Why can't there be an alternative to shouting through glass, banks etc have managed it? Why can't chairs be designed to sit in comfortably? Why can't the temperature be managed? I understand why when they're having to do the best they can in old buildings, but why are new ones just as bad?

I just can't see it changing really, it's going to take a real paradigm shift to either meet the demand in a reasonable time frame/the 4 hour target that's never really been met i.e. working out how to provide enough staff and pay for - increased primary care capacity, education so people are more able to manage self limiting presentations, more social care to reduce bed blocking, separate mental health centres so people in crisis don't have to resort to A&E, larger/more hospitals to cater for the population increase....

Realistically how much of that is going to happen....

The 4 hour target was nearly always met in the past. The people that went past were those who should not have been there in the first place.
In the past I never waited in A and E longer than an hour, and sometimes much less.

Don't get me started. When I was 16 weeks pregnant my bladder decided to stop working completely. I had to wait 9 hours in a&e. It was absolute agony. I started to bleed and thought I was losing the baby: still no rush for me to be seen. Worst time of my life. Luckily baby was ok. I think they have made improvements at the hospital now as they have an urgent treatment center but still scarred by my experience

It's to put off the time wasters and from homeless people sleeping on the chairs. Awful for the people who need it though

I had to wait for 12 hours in a&e last year while 19 weeks pregnant with dangerously high blood pressure. I ended up sitting in a corridor as the waiting area was so uncomfortable, overcrowded and smelly. Care was great after though.

My experience with dh, he has prostate cancer and had an operation. Couple of weeks later in absolute agony after catheter removal. Couldn't walk, lips, ears turning blue I thought he was having a heart attack or stroke, called 999, no ambulances call 111 not a chance. He crawled to the car and I got him there. 9 hours waiting before we found out he was leaking urine into his body. They thought he had a urine infection. I screamed at anyone who would listen that the level of pain he was in was not a fecking urine infection. He had every pain killer thrown at him. His operation had failed and he was verging on kidney failure.

Second time he was waiting to go on the ward for an infection in his catheter and needed iv antibiotics. 10 hours. Old people waiting for the same thing 11 hours plus. I had to go to the corner shop to get pain relief for him, I got chocolate bars for the elderly people waiting there to keep them going. One elderly lady said it was the best tea she had ever had. Bless her.

It was absolute hell on earth. It was the middle of summer and I had to go and find somewhere to fill up the water jug so people could have water. Its basic care and it is not fit for purpose.

The chairs need to be compact, easy to completely wipe down, robust (so no moving parts). There's massive amounts of vandalism that occurs - it pretty much rules cushions out - sterile cushions that can be wiped down are expensive, if they get torn and they will within days they'll need costly repairs/replacement.

Part of reception staff role is to monitoring the patients in the waiting room - i.e. notice if someone's collapsed, there's a fight etc - they need to be visible to the room and not tucked away. Privacy is difficult in hospitals - just think on the ward when you're being examined and often quite indepth discussion about your symptoms/history - there's just a thin curtain between you and lots of quite bored/waiting people who are mostly listening in. At least reception is often noisy enough that most people won't hear and generally it's quite minimal history being required - i'm here because i've got a headache, chest pain, a rash....

I had to go recently, for a minor injury, but no minor injuries unit here. It felt ridiculous, so I actually didn't go for 24 hours (and got shouted at for that when I got there), but I'm in good health and wasn't in a great deal of pain, but I felt dreadful by the time I left. It was hot, crowded, noisy, uncomfortable, I spent a lot of time standing or sitting on the floor, leaving seats for people who needed them more. No way to get a drink or anything to eat, without leaving the waiting room and risking missing your call.

It was horrible, but I'm young(ish) and fit and could cope. The idea of going through that when actually unwell....

Quite a while in the past, I think it was 2014 was the last time it was met.
https://www.kingsfund.org.uk/insight-and-analysis/long-reads/whats-going-on-with-ae-waiting-times

They've readjusted the goals now though - there's a realisation that we're never ever going to get back to standards as they were a decade ago so need to have more realistic targets. Initially it was supposed to be 98% in 4 hours, then it was 95%, currently we're aiming to try and get back upto 78% in 4 hours - hoping to achieve this by March next year.

I agree a lot of the people (not all unfortunately) who are allowed to wait excessively, 12-24 hours, and really affect the figures really should never have been there in the first place.

They... SHOUTED at you? What was the story there?

@SleepyRich I know its been a while. The Conservatives destroyed the NHS.

I'd dislocated a finger and leaving it made it harder to put it back, causing ligament damage. The nurse shouted at me for being so stupid and not going straightaway. She was right, I still can't bend it and am having regular physio 2 months later, but at the time, it seemed sensible (to me) to wait until I could find out if there was an alternative to A&E.

Fingers and hands is the one thing you can't leave until later. It is an emergency.

I know that now

Part of the excessive times is the complexity they're expected to manage now. Conditions which people would have been referred and managed by specialist teams before it got to A&E stage are now exacerbating waiting for diagnosis under a team.

i.e. if you goto A&E with the traditional - i've fallen over and twisted my wrist it's really sore ?fracture - clear assessment plan easy to get done/diagnosed. I've got chest pain worried I'm having a heart attack - also relatively simple for an A&E. However what they're now getting is lots of complex multimorbid patients - I've been having abdominal pain for 6 years, i've been trialled on x treatments, had mri, us, bloods, they thought it was this, then not sure, then be referred to this specialist team not heard anything for 6 months now - these symptoms have gotten really bad the last few weeks and I can't cope anymore so here for help.... There's no short cut to jump the queue for the specialist so that probably still wont happen, but now the A&E team have to run multiple different tests to consider lots of different dx, they won't have the specialism of the Drs you're waiting to see, they probably won't be able to work out what the cause is so ends to time being a diagnostic factor - run x tests, then run them again x hours later - no change then discharge back to GP. It kinda works because A&E really only need to know if it's something that needs immediate treatment/surgical emergency - if there's no change over a long time period then likely not and whilst the cause is still not properly diagnosed everyone is happy it's not an emergency and you can go home. But because you're never admitted that most likely means waiting in the WR...

I don't think that is actually reasonable. I always hear about these "family days out" at A and E but I've never witnessed it.
I did accompany my nan WITH my dad once. She was very VERY unwell and actually died in A and E a few hours later. My poor dad was her only child and was too distraught to be on his own trying to deal with everything after having found her collapsed at home. Neither of us took up seats, we were both sat on the floor in the corridor outside resus and frankly if anyone had tried to enforce a "one companion" rule I'd have told them where to stick it.

I agree that in your situation you are definitely in a better place here than you would be in the US. But that's because you have a diagnosis. In my experience once you have a diagnosis the NHS is usually pretty good. It's the getting there that's the problem. So many people can't get seen or do get seen and get dismissed. I personally know a few young or youngish people who have very sadly died because they couldn't get anyone wrong take them seriously until things were too far gone.

What’s the bank idea?

You find a chair and let’s see your idea.

The temperature?! No one’s ever going to be universally happy with the temperature.

I think some are missing the point - it’s designed to deter people from going! ED was intended to provided resus / emergency care for really sick people. Only around 20% of those attending ED fit that bill. Unfortunately, the rest of the system (general practice, pharmacies, community services, diagnostic services) haven’t got enough capacity, or were not designed, to meet these other needs hence we all tend to revert to ED.

Too right! Minutes really matter if there's any nerve or vascular compromise in a hand.

I attended a 19year old quite recently who amputated his thumb climbing over a fence to retrieve a ball - really cleanly done - looked like it had been surgically cut off (so a lot easier for surgeons to reattach). But he'd waited just over 2 hours in the heat for us (ambulance service in a city) to attend. Several of his friends there had cars.

All I did was walk him to my ambulance car and drove him to A&E, I had a quick conversation with one of the Doctors ?whether it could still be reattached - the answer was no not viable anymore - so he got put in the waiting room to wait for wound closure essentially.

If they hadn't waited, just done what I'm fairly certain anyone 10-20 years ago would have done (put the thumb in a bag/cinefilm then in something cold - then gone straight to A&E hand in tea towel likelihood is he might still have a thumb - now he's spending the rest of his life without it because he delayed getting care! Such a waste. His partner followed us in a car for goodness sake!

I did want point this out to him (which I'm sure would have been received as a telling off/shouting or something), purely out of frustration for how stupid the whole thing was, he could have avoided a lifelong disability (I know there's quite a lot worse, but missing a thumb will definitely have consequence). But just felt what's the point...

What I find bonkers about A&E is that absolutely everyone is channeled through it. When my dad was late stage cancer the consultant decided he needed to be admitted - but he had to go though A&E. just why? The consultant had made the decision, surely my dad could just have been sent to the cancer ward on his say so?

As it was my mum had to queue for half an hour outside the hospital in the rain to even put his name down. No wonder A&E is full to bursting since it appears massively inefficient.