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

@Alifemoreordinary123

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"

Exactly- because it is free at the point use demand will always outstrip supply - which is managed by queuing. Abit like how in communist countries where say bread was heavily subsidised in price - this meant the demand was way higher than supply which was managed by queuing and only those that had the time to queue got bread. Whereas in capitalist countries the price would rise until supply meets demand and only those that can afford it get bread.

If you made the entire A&E process more pleasant then even more people with available time would go along to A&E making the queues even worse.

The trouble is that our local A&E is so awful that I would definitely put off going unless I was I really bad pain, it just puts people off going that really should be going!
Last time I went to pick up my father in law from there, the corridor in A&E was rammed with mostly old people in various states of undress, looking really sad 😔 I got a lady some water who was thirsty and helped another lady put her jumper on (she was cold, with no blanket)
honestly, if you would think it was a war hospital, staff running around completely frazzled.
I can’t ever remember things this bad

The most obvious solution is to staff and have information for everyone about a) GP services 24/7 and not closed on weekends and unable to issue basic prescriptions b) Minor Injuries with scanning machines to siphon off a good proportion of the next level up of sprains, possible fractures, cuts and so and then c) leave A and E for more serious cases. You cannot blame people who can't get care within the system for going to the only place in the system they can get care- in fact, 111 tell you to go to A and E all the time because there's nowhere else to send you. It is not the fault of the patients that they need to seek medical care, there are some time-wasters but these are vastly outstripped by the people who do need medical attention and can't get it within the current system except there.

I remember going with a relative who was having a serious medical emergency and it was awful. My relative was very ill and taken straight into treatment where there was not a single chair to sit on or drink of water to be had. I'd been on my feet at work all day and having to spend the entire night in hospital in such physical discomfort made a horrible situation even more stressful and decision-making even harder.

I later accompanied a friend who'd had an accident to a different hospital. She waited for hours, bleeding and in terrible pain, before being seen but what really shocked me was a woman who was in agony and obviously in a very bad way (I reckon she had sepsis or peritonitis from things I overheard) being left to lie across several uncomfortable hard plastic chairs for hours. The staff just seemed so indifferent to her suffering.

I actually dont think it is that deliberate. The people who build hospitals are not the same people who actually work in them. IME there is not a lot of communication between the two groups.

The pressure on the system is unsustainable. However, there are ways to relieve that pressure. Over 20 yrs ago in our area we had a walk in centre, if you couldn't get an appointment at your GP, you could go to the walk in and wait in line. Our walk in was brilliant, it could glue small wounds, butterfly stitch, it had an x-ray machine so could check ankles/ wrists/ arms/legs, it could prescribe most medicines. It went a long way to taking the pressure off a+e, it was shut in 2014 and now all those people are at A+E.

Again, about 20 years ago the nurses at our GP surgery could also glue or stitch minor cuts. Now you have to go to a+e for that.

My childhood town growing up, my husband's childhood town and my current town all had small hospitals. They had maternity wards, had X-ray machines, performed some minor surgeries, had a minor injuries section. All 3 have disappeared and we are all funneled to the big hospital in the bigger town.

We really really need to get these smaller but significant pressure relievers back up and running. With the govt wishing to build on every inch of land it's time that most medium sized towns had their own hospitals again.

We also really need to look at social care and elderly care. It's going to be incredibly expensive to sort out or need vast reform and therefore need the political will to do so.

Maybe Wes Streeting should have a read of this thread in case he's not aware of just how bad things are. Or maybe we just accept that it's chance, not need, that gets you the correct diagnosis and treatment.

My DH, DS and I have all had first hand experience of sub-standard A&E 'care' in the past few years. I even diagnosed my son's appendicitis from 150 miles away after he'd been sent home with a 'urinary infection' having waited hours and being given a cursory examination. He had so many text book symptoms the cleaner could have probably made a good guess. Of course, his situation was made much worse by the delay and his stay in hospital was longer. I'm just glad I insisted he went back as he was naively believing their tosh. This was at leading teaching hospital.

Oh no that must have been horrid trying to deal with from so far away as well

I went to the Mayo Clinic in Minnesota once with a friend who was having some minor surgery.

It was like an upmarket hotel!

Squashy chairs, rugs, a little museum and a bookstore/post office. Artwork.

This was back in the 1990s when NHS hospitals were even mankier than some of them are now. I thought I was dreaming!

A & E may not have changed, but certain things have which makes everything much worse. I have been fortunate enough to have not had anything much wrong in years.
When, about 25 years ago, I had horrendous stomach pain, I got an emergency appointment with my GP. She suspected appendicitis, so she called the hospital, informing them of my case. Phoned an ambulance for me which picked me up from my home. I didn't have to go through A&E as doctor had called ahead, they were expecting me and knew what they were looking at. I was assessed in a ward and operated on that night.
Now, the GP is effectively out of the equation. Emergency GPs don't seem to really exist out of hours. You have to ring 111 and mostly they will direct you to A&E. Even if it's in hours and you get an appointment, if hospital is an immediate necessity, it seems to be A&E. No contact between the doctor and the hospital.
The occasions I have heard when people ring 111 and they suggest a doctor, but it's on a weekend, they say a doctor will telephone you. You wait hours for it, then the doctor invariably advised ambulance/A&E.
At one time, unless it was a serious accident, or something that had the appearance of a stroke/heart attack, you couldn't breathe or were unconscious,your first point of contact was your GP. And it would BE your GP or at least someone from the practice you were registered with because they used to take it in turns doing out of hours. Your GP would effectively be triaging you, then call the ambulance. Because your GP was in charge, they spoke to the hospital, gave them the information so you could go straight to the necessary department.
My mum thought I might have meningitis once when I was a child. This was in the night. Severe temperature, very stiff neck. Today, she would be driving me to A&E. Then, her first call was to the doctor, who came to our home, told my mum it was more likely a virus, but call again if I got certain other symptoms.
A&E is overloaded because the patients are having to make the decision to go because there isn't any other option more often than not. Mums with babies with temperatures are sitting in A&E because it's Saturday and they can't speak to a doctor and 111 sent them there. And you really aren't going to wait with a sick baby until Monday.
Countless people who could have been assessed by their GP are in A&E because they can't get to see their GP in a timely way. People are treating paramedics like they once treated their emergency GP, because there doesn't seem to be any such thing as an emergency GP.
No wonder A&E is so terrible. Too many people end up there who could have been seen by a GP, but there isn't a GP available to see.

Psst don’t tell anyone, but the Mayo Clinic accepts Medicare and Medicaid so that means a pensioner or a poor person will get treated right along side of a prince or celebrity.

honestly, if you would think it was a war hospital
This is the absolute truth. I was in A&E recently when my mum fell down and broke her knee. It was full of very unwell people who were just being ignored. People were passing out from waiting so long, and the staff were just picking them up and putting them back in the chair. One elderly lady keeled over and hit her head, and the staff attitude was just “oh aren’t you silly” and they sat her down to wait another few hours. There was no food or drink available (not even a water tap). No blankets. Nowhere to charge a phone. No wifi. People were picking up other people and trying to help them because the staff weren’t doing anything.

I know it seems mad with staff not seeming to do anything, but if they did then flow stops - everything is running over capacity so if any staff member stops in the waiting room to assess anyone there then they're not seeing the patients that have already waited x hours in the room and it was finally their turn to be assessed. Also it's not set up to assess someone in the waiting room, you'd need to bring the equipment through to 'check them out' and to do it properly you need to take a whole history etc - so effectively you now need to move them to be seen next - but now if you do that then the only people who'll get seen are the ones who collapse, be it genuine exhaustion/illness, or genuinely reasonable complete frustration with how long it is to be seen.

Also, and this will sound really cruel/heartless. But you just become accustomed to seeing people who are really quite unwell. Really the only people who should be there are the ones who are quite unwell. When you work in that environment seeing quite unwell people is just normal. For most patients going to A&E will be a persons absolute low point of their year/life. For staff it's just Thursday.

You have to detach yourself a bit as well from it all otherwise you just end up angry (because you're struggling to get to those that really need help/are really sick/yet not sick enough to bring into resus). It's really really hard not to get absolutely rageful at the overwhelming number of people who are there who for one reason or another shouldn't be there/you know they will garner no benefit from their attendance at A&E - because going through the process you have to go through is part of the reason why there's such a long queue in the first place.

The perfect example is back pain - the amount of people who come in "i've had lower back pain for x months/years now and my GP isn't doing anything about it, just keeps telling me to goto physio and take paracetamol. I need a scan" - Essentially I already know they're going to be in the department for 12-18hours taking up a seat for best part of the day, they wont get any scan, they will be told to go back to their GP/physio, maybe given a short script for naproxen or codeine (commonly available from GP for short term use), if the clinician is keen they'll go through so weight loss/exercise/lifestyle advice with you. But that's a seat they're sat in the whole day. That's clinical time revisiting the same symptoms and history that they've already told their GP, answering the same red flag questions the GP will have already screened for, even if the A&E staff think hmmm this could actually be cancer - there's still no scan done on the day, just the same referral a GP makes.

When there's a consultant on the front door it can be more efficient - a decent % of patients just get turned away/refused assessment in the first place, but that's pretty rare these days as it takes away that senior cover for the rest of the department. It comes in every now and again because a consultant has the knowledge and clout to make those decisions quickly as opposed to the rest of the staff who need to go through the motions (i.e most of the Drs working in A&E won't be anywhere near as experienced as your GP is, rotating in and out every few months and could well be newly qualified fresh from med school

In 2009 I had a fall at my caravan & broke my leg, exh rang 999 as he was scared he would do more damage moving me. The ambulance turned up within 5 minutes, I was taken straight to Xray when I arrived at the hospital, then seen by a doctor & sent to have a backslab pot put on. I was sent home with my Xrays on a disk to take to the hospital when I went home & a letter saying my diagnosis & treatment, given painkillers to take away, no waiting all done one after the other. I fell at 7.25pm, Ambulance was there by 7.37pm, at the hospital by 7.45pm & tucked up in bed back at the caravan before 10.00pm. The very efficient A & E was closed down in 2011, leaving ambulances having to travel 25 miles to Mansfield, this is supposed to be progress. Every time we had to use Newark hospital, it was well run, efficient, clean & patients got treated with kindness & respect. We had been before for exh having a heart attack & me having a miscarriage, exh as an inpatient couldn't praise the hospital enough, they had their own allotments to grow fruit & veg to feed patients, the meals wouldn't have looked out of place in a restaurant.

I totally agree. My dd was at a club when I got a call saying she needed hospital for hurting her arm. My first instinct is to wait for the morning. She had dislocated her elbow. The same when my son broke his leg. The first dread isn't " oh god its broken" it's "oh god I have sit my kid in a&e for 8 plus hours" with drunks and people puking everywhere.

We fid go straight to A&E both times but I really didn't want to. We also now go further out to a better A&E as that's the local nhs advice.

I would definitely take DD to MIU in my parents' or PILs' towns rather than subject her to our one or our A&Es. MIUs can send you through for Xrays etc if needed. The experience is hugely variable by area/facility.

I’m not talking about the Consultants, their offices are in the ward areas, which is their convenient space, near to their patients. I’m talking about the senior managers, senior administrative staff, Chief Executive Officer etc., those people who just stay in their offices near the entrance to the hospital, people who would most likely not even be recognised by many of the ward staff, if they ever deigned to actually go into the ward areas.

I wouldn’t grudge a hard working Consultant a private parking space, but I do grudge these senior officials (many of whom have no hospital background, prior to becoming hospital managers) their private parking spaces and offices, as far away as possible from actual sick people.

Regarding the shorter internal routes, the lowly nurses/healthcare assistants aren’t allowed to use them. Their badges aren’t activated to allow access to these areas, they aren’t allowed to take shortcuts, they have to take the long way round.

”As you say we can get you a wheelchair and a volunteer to solve your problem.” Where all all these volunteers that can solve my problem? As I said in my post, there is often a queue waiting to be wheelchaired to where they need to be. There is normally a maximum of 3 volunteers to help everyone who needs it. They are a godsend, but there are not enough of them to anywhere near solve the problems. They don’t just wheelchair people to their clinic / X-ray, but also take visitors to the wards, so they can visit family / friends. They help outpatients use the self check-in computers and try to solve registration problems, trying to find out where someone is meant to go to. As for visiting in the evening, there are no volunteers to help after 5pm.

I have actually had to miss an appointment as I couldn’t get parked. I actually allowed myself 40 minutes to get parked, but there were no spaces apart from round the other side of the hospital, which is too far for me to walk from. I phoned reception they couldn’t help, I entered A&E and asked if it was possible to let me through the door which separated it from X-ray, but was told they couldn’t allow it, so I got to within 10 meters of where I had to be, but couldn’t get any further. I had to finally give up and leave, without being able to attend my appointment.

So, all in all, NO, you cannot solve my problem, but at least the senior executives can have their private parking spots and offices just inside the entrance, well away from the sick people.

Yep, sometimes one isn't enough, especially when people are really vulnerable and struggling. Which of course is going to be a disproportionate number of people who are in A and E in the first place.

My grandad's got dementia, and managing him for many hours in an unfamiliar and stressful setting simply cannot be done by only one person. Regardless of whether any passing fuckwit understands and approves of this.

The most obvious solution is to staff and have information for everyone about a) GP services 24/7 and not closed on weekends and unable to issue basic prescriptions

There are already not enough GPs for the limited Monday to Friday service. It would solve a lot of issues if we could have 24/7 GPs, but it's not an obvious solution because it isn't a possibility.

@Peakpeakpeak Absolutely! It's wild that people keep trotting this out, "just make it a 24/7 service.... "

There's not the staff to really make it a fully 8/5 service, but sure let's just magic up a lot more GPs (+aux staff) to provide a 24/7 service. There's just not enough Drs coming into the job and this is why they're drafting in nurses/acps/pa's/paramedics to provide shortfall cover to maintain an 8hr 5 days service in most areas (ignoring the fact that clinicians in these roles will never have to knowledge and acumen of a GP) so when you pop in on the sunday morning to check out the random hand tingling that's been bothering you, you absolutely might have a nice reassuring consultation from the paramedic telling you the most common cause/that it's probably just a bit of carpal tunnel and give you some exercises, but likely they've not even considered causes like MS/Guillain-Barré Syndrome which a GP would.

Basically, it’s designed with a ‘perfect flow’ in A&E in mind.

It doesn’t matter that it takes longer than 10 minutes to be seen by a triage nurse, or that you spend longer than 4 hours to be discharged. That’s not how it should be, so they aren’t going to design A&E around ‘bad practice’.

You can bring it up a million times, A&Es don’t operate like they ‘should’. It doesn’t matter, it wasn’t taken in to account with the funding granted. So they say the hospital staff do have isn’t taken in to account.

I shit you not. It’s fucking ridiculous.

I had a gallbladder attack a few months ago and spent 11 hours waiting in A&E in agony and vomiting constantly. I couldn't stand or sit so I had to kneel. They finally gave me 2 paracetamol, even though I told them I couldn't even keep water down. I immediately threw them up, but was then told I couldn't have any more pain relief for 4 hours!! Despite having thrown up 2 intact tablets. Eventually I was given IV painkillers and antisickness and was fine within 15 mins! After 15 hours of torture. I've since had it removed (privately as the waiting list in the NHS for an urgent referral was 2-3 years. And I am traumatised. I'm terrified of getting ill again and having to go to a&e again.

Tbh it doesn’t sound like any design will help your problems.

Regarding why you weren’t allowed through a back route to X-ray. You don’t know why that area is controlled. It might be below, above or adjacent and MRI for example.

These places aren’t designed to piss you off. It’s hard enough to design one that works in the first place. Believe it or not that is usually the main objective.

Just revisiting this thread because I'm back in a and e again with mum. It's been a long wait (currently at 11 hours) but in that time she was triaged after 20 minutes, has been given painkillers, was offered a baked potato with a choice of filling at about 6 pm along with every other patient waiting that wasn't nil by mouth, has been given advice about taking her normal medication and then we were all (not just patients) offered tea, coffee biscuits and sandwiches at 9pm. Bottled water from the fridge is freely available, the staff do their very best to find trolleys or comfy chairs for patients and stacking chairs for everyone else. And this was on a night when staff admitted it was the worst it had been for a while. Yes we still had to wait, but they had done what they could to make the wait more bearable.

@nonevernotever glad to hear they are treating you well and hope your mum recovers soon.