To say stop moaning about A&E

[Darkcarpark]

My son (21) dislocated his shoulder and I took him to A&E. They were absolutely fabulous with him, because it was an emergency! He had bloods taken, X-rays, two doctors and a nurse manipulate his shoulder back into place with morphine and a further X-ray, all in under 3 hours. So I just want to say to all the people moaning about A&E waiting times to think about whether you were a genuine accident or emergency and for anyone what has had good experiences of A&E to put a shout to the staff that are there for us in our time of need.

My experience of broken bones is that because you are the walking wounded and not (generally) likely to keel over and die in the chair, that despite it being in many cases very quick once you get seen (x-ray, temp cast, referral to fracture clinic) the wait is very very long to get to that point. Yet there is nowhere else in my town that can x-ray. 2 minor injury units can’t do it, so A&E is your only option.

There really needs to be a very simple place to go for uncomplicated muscularskeletal issues eg sporting injuries, trips and falls in the otherwise healthy young (kids falling off scooter at low speed but putting hand out and breaking wrist etc) that can x-ray, splint and out again.

In comparison to breaking a bone in a ski resort where this is presumably very common where we were seen in the local village doctor, x-ray, splint, transfer from clinic to hospital, deemed not to require surgery and put in a boot. Injured at lunchtime and home before dinner, including the 2x 45 minute transfers from the regional main hospital. In UK A&E we’d not even been triaged in that amount of time. I’d pay the ~£75 that cost us with EHIC to have the same here. On return to the UK it became even more of a joke, as we couldn’t self refer to fracture clinic with the foreign notes/report, and the GP couldn’t refer to fracture clinic either because they couldn’t x-ray to verify it was broken, so we still had to go to A&E and hang around for hours despite not needing treatment to get access to the right department for ongoing outpatient care. It’s a massive waste. That GP and A&E visit could have been replaced with a phone call to the fracture clinic saying ‘foreign hospital told me to make an appt within a week with my own clinic, when would you like to see me’ and then saying ‘Tuesday at 10 please’ but because the whole nation is treated like children who can’t possibly know what they need everything has to go via the gatekeepers and sadly for too many things that’s only A&E.

I would say my then seven year old son was a genuine emergency. Sent to A&E by the GP with suspected appendicitis. He sat on a hard chair for seven hours, in a lot of pain and given no pain relief despite me asking several times. He was finally admitted but by then his appendix had ruptured. His recovery was longer than it needed to be had he been seen promptly.

Most (not all) of my experience with actual, real emergencies in A&E for myself and family (unfortunately quite a few over recent years) have been diabolical.

I didn't have a problem so everyone obviously must have had the same experience.

You sound like those defending Ellen DeGeneres "she was always nice to me" - of course she was, you're famous.

You had. fabulous A&E visit! congratulations! Amazing, happy for you.

I'll remind my 83 yr old mother, who now won't consider going to A&E because last time she went (turns out she had broken her back in 4 places), sat waiting on a chair for 7 hours (before leaving at 4am to go home) in tremendous pain in a packed waiting room. Dr finally rang to see where she was a mere 18 hours after she had booked in. 18 hours... she could have waited 18 hours to be seen by a Dr.

But its OK, because you was in and out in 3 hrs. Problems all solved obviously.

My dad sat on a trolley for 16 hours in Rotherham hospital A&E with chest pain, back pain and vomiting. He had a further few days on a ward with very little intervention and was sent home. Another hospital was able to diagnose that he had had a heart attack! Rotherham hadn't done the scan that would have confirmed this so he had to waste the resources of another hospital. I would say your experience is probably a mix of luck and postcode lottery.

My experiences have been similar, and honestly if I compare A&E in the last 5 years to A&E when I was a kid 30+ years ago I would say that we spent a lot longer waiting in A&E when I was a kid.

My experience is definitely the reverse. 30 years ago, when we turned up there would always be seats available and we thought we were hard done by if the wait went over two hours. I was really quite shocked last time I went (fall resulting in wrist injury and broken nose) by the fact that it was just so crowded - I couldn't sit till someone kindly offered me a seat, and it was hard for people to hear their names being called. Ultimately I was out around 4.5 hours later, and I think I did a lot better than many who were there with more serious conditions.

My friend died after being sent away from a and e.

he had severe sepsis.

the hospital paid out a lot of money in compensation but his widow and kids were devastated.

Sorry I voted YABU because I think you’re taking your one good experience and ignoring all the evidence that there is a real issue with A&E in the UK right now. But I do agree with you that A&E can be fantastic in genuine emergencies, and it’s also not the staff at fault when the waiting times are insane.
I had to take my DD for an x ray last year because she broke her arm, we were there about 4h including x rays and plastering, all the staff were lovely and no issues with the care we had.
However my elderly grandmother with dementia had 2 several hour waits in an ambulance queue outside, to then be on a trolley in a corridor for another several hours. Another person I know had to be taken in a car to A&E with a suspected stroke (which is an emergency) because they said there would be an hour wait for an ambulance. These issues are real and can’t just be brushed under the carpet because you had one good experience.
It does annoy me too when people go to A&E for non emergencies but also with the state of GP availability I can’t blame people for doing it if they feel there’s no other option.
People are allowed to complain about the state of the NHS because it’s not working and something needs to be done about it. But I agree that moaning and being abusive to hard working A&E staff isn’t the way

Im an A&E nurse. for clarity.

A&E does not work for a lot of people now, because resources are so stretched. Teh corridors are now listed beds on computer systems for a lot of hospitals. However, there is no set national guidance on who is allowed to go on the corridor. In our case, its those waiting for pysio/OT/social care referrals and they are unsafe to send home but not eligible for a ward bed, patient being admitted but have been seen by that speciality and the treatments required are simple, such as 8 hourly IV antibiotics, any requiring close monitoring, continous treatments, oxygen, or are confused are not eligible to be placed there. Its awful for the patients, i promise you staff hate the corridors as much as patients, but if the wards are full, and theres a 30+ hour wait for a bed, what else are we supposed to do with patients we cant send home?

I will also add that not everyone is seen by the same professional. Not everyone can be seen by the same professional. And wait times vary because of this. So say its a suspected stroke. We could have 3 different patients come in with suspected stroke. Its night time. One is blue lighted straight to resus, they call the emergency phone on route, tell us suspected stroke, that then immediately called through as an emergency to the stroke team, who come to ED, generally a dr and a stroke nurse. They are immediately taken to CT and reviewed by them. Another comes in an ambulance, but its not blue lighted and flagged for on arrival, at ED they go to ambulance triage that is then flagged urgent to the stroke team - but they are with the one called through as emergency. A third patient comes in the front with family as they didnt want to bother 999 and understand the wats for the ambulance, so thought it best to take them themselves, where there is a wait for triage,after triage, even if triaged at possible stroke, and at a high triage level, there is a wait to be seen as a Dr then flags to stroke, who by this point are thromoblising the emergency patient, and have the ambulance triage one waiting. Then when seeing the ambulance triage patient, the emergency call goes again so the third in the front is still waiting, and deteriorating, and is now past the time limit for thrombolising. Also bare in mind - the ED resus dr is 1 reg/consultant dr - 8 patients with 2 or 3 juniors and the on call staff plus different specialities on call to attend resus immediately when paged. Ambulance triage 1 reg/consultant dr to 14 patients and 2 or 3 juniors. ambulatory, or the front is 1 reg/consultant dr and 3 or 4 juniors to however many are queuing on a given night.

Who is at fault there? Who gets the blame for the third patient waiting hours to be seen? Thrombolising isnt something ED staff can do, it is done by the stroke team, but the night stroke team is one reg and one specialist nurse. The specialist nurse can go and review by themselves, however, if they are needed to thrombolise, they cant.

Its the system thats broken, the staffing levels that are broken, the limited bed spaces available, the amount of people needing to use services, yes there are some bad eggs, but most staff are doing their best the keep theirs and their patients heads above water in a system that is causing them all to drown. its impossible. Some thing, such as a dislocation thats easy to diagnose treat and send home are done well and correctly, but so, so many other cases arent, because there arent enough resouces, be that staffing or bed spaces, to go round.

This is what worries me. And I know it'll happen at my local (otherwise really good) hospital at some point. They are SO dismissive of anyone that doesn't have an immediate and obvious injury. There will be a death in the waiting room at some point. It's just a matter of when, not if.

You were lucky. My mil languished in an and e on a trolley in a corridor for 48 hours after being blue lighted. She died before they got her to a ward for antibiotics. It was no better than third world.

Does complaining (like PALS for example) help at all in the grand scheme of things? Can it actually bring change?

There seem to be two school of thoughts on MN, never complain or moan or bring anything up and complain as it’s the only thing that will help.

Hats off to you though, I couldn’t do what you do in a million years , even in great conditions, nevermind being understaffed, overworked, overwhelmed and frustrated at the state of it all.

The quick handling of simple stuff is very important here.

DH went into A&E with a suspected eye injury after a smack in the face last year and was in, xrayed and out in an hour and a half with a small fracture to his cheekbone.

He has a history of heart lining infections (pericarditis) and we've had huge variation in experiences of that being handled both badly and brilliantly.

One where the receptionist was hitting the panic button as we booked in and he was straight into the unit, bloods, ultrasound and seen by a cardiac specialist and diagnosed and provided with medication in an hour and out the door.

Another where they nodded, told him to take a seat and I had to chase them every hour for the next five hours pointing out we don't know if he's having a heart attack (symptoms are the same) before someone bothered to see him then another 8hrs for the blood results. We were there for 13hrs that day with no ultrasound, no specialist and no meds.

Meanwhile my young neighbour who has had a kidney transplant was sent to the same A&E with sepsis last month and sat for five days in a chair in A&E awaiting a bed before spending a week in HDU.

Complaining to pals does get back to us, in that we have "huddles" where senior staff are brought in to discuss what went wrong, why, and how we could attempt to stop that in the future. That discussion is then opened to all staff for suggestions for improvement. However if the complaint comes down to waiting times, there isnt a solution that can be found by staff in the department. We recently "won" funding to have additional staff on shift, we were able to argue and prove that staffing levels were causing direct harm to patients using pals complaints to assist us, and helped us go from 1 nurse to 6 patients in majors to 1 nurse to 5 patients, it was only 1 additional nurse on shift, but everything counts right? We also have system such as named professionals, so at the start of our shift we have to write on boards our names so families and patients know who is responsible for their care. That again came in through pals. If it is a bigger complaint, internal invesitgations and action plans are completed, thankfully i have only been involved in one and the responsibility wasnt on ED staffing, but it was awful, traumatic for everyone involved, and still on going.

So in a nutshell, pals are flagged to us, we do what we can to answer them and make changes, but all to often our hands are tied and theres nothing we can do to improve outcomes as cant change how many beds there are, and how long people are waiting.

I then saw a doctor who told me my toe needed relocating but she was a vegetarian and too squeamish to do it.

I'm sorry WHAT

@TheCurious0range

I know!! If they'd actually given me any pain relief I would've thought I was hallucinating!

Having spent many months visiting someone in hospital over many different periods, I've actually noticed the quiet in the main hospital, fewer people arround, visitors, patients, quiet corridors with nurses doctors, porters just moving to and from departments, it seems quieter than previous years.

Turn the corner and go to A and E and it's like a war zone, it seems like the only part of the hospital with noise and busyness.
I would hate to work in that department, front line facing every trauma imaginable, the drunks, the drug addicts, the minor patients who have been signposted there because there is no way of seeing a GP.

The lack of accesibility with Gp's it seems to all have been dumped on the A and E departments.

Frontline, first port of call, A and E staff should be paid more, from the receptionists, the nurses, health assistants and doctors, they need more staff and an incentive to work there. Most people will not be admitted to the main hospital but there needs to be more staff to ease the situation and better pay.

A and E deserve danger money.

DH waited 12 hours in severe abdominal pain. It wasn't the staff's fault, they were snowed under. It's not always possible to be treated in 3 hours, even if it was an emergency.

The whole A and E department needs a complete over haul.

No beds for patients who need them suggests there needs to be another department that bridges A and E and the rest of the hospital.

Something needs to be done as employees and patients of A and E are equally hopeless about the situation.

I mean what is actually happening with the Gp's ? are they being phased out because no one I know can get near them, I suppose once they have gone and their pensions sorted they still won't plough the cash back into the A and E departments.

Fortunately for your son he got seen and dealt with quickly and efficiently. For many, many people they are left for hours, often in vulnerable and extremely poorly circumstances with inadequate care, attention or even basic dignity. Maybe instead of preaching here about how we should all be grateful, think about how bad other people have it compared to your son's one off experience. Very small minded approach to life you have.

There are other places. There are loads of assessment places, medical, surgical, early pregnancy, cancer, speciality, frail and elderly, same day emergency treatment, loads. The vast majority (in my hospital) once a decision to admit is made, go to these units before going to a specialised ward, the exceptions being cardiology, neuro, stroke, and nofs (hips fractures) tend to go direct to those wards, but the overwhelming majority to to an assessment unit first, designed to bridge the gaps. But these are full also, because wards are full, because they cant discharge patients, because cottage hospitals, nurse led units, and rehab wards, have all but closed down. The issue is A&E gets fuller, forced to use corridors, forces patients to wait hours upon hours to be seen whether outside on an ambulance meaning that team cant get out to others in need, or in a waiting room on uncomfortable chairs feeling like they are forgotte about. Wards and assessment units arent forced to find the space.

We also have an onsite GP, open 8am-10pm, where we can refer elegible patients, overnight we can send people home for a referral the next day to them, or to the same day treatment unit and surgical assessment units. Sometimes, if they return at 8am, this is infact the faster option than waiting to be seen by ED dr's - but that is seen as fobbing patients off in some cases.

But these inbetween departments do exist, and have for a long time. What needs to happen is cottage hospitals be phased back in to manage the care of elderly patients, not well enough to return home unsupported, and waiting for packages of care, or need longer physio input, or adaptions made to homes. The hold up in A&E is because cubicles are used to house patients needing bedspaces on wards, but ward beds are being used to house patients who could be cared for in cottage hospitals. Some patients are in because they failled the physio stair assessment, they could fail it 5 days in a row, theres no alternative but to keep the on the ward anymore. This directly impacts A&E. Which affects ambulances. Its all connected. The impact from the difficulty to see a GP is much lesser than the impact of "bed blocking" from elderly patients as theres no longer other care options for them.

I agree. In the waiting room they were coming to do my obs every 30 minutes - they did not do that for any other patient, so clearly I was sicker than everyone else there that day. It didn't mean I waited less time. There was another patient who ended up on the same ward as me who waited a similar amount of time. I've unfortunately been through A&E a lot over the last couple of years, always referred by my GP or 111, and always at least a week stay, so definitely needed to be there, and time and time again the complex patients wait longer. There are targets for A&E to treat, admit, or discharge within 4 hours which means that they see as many patients as they can within 4 hours of arrival. That means straightforward injuries and minor illnesses are seen quickly, whereas those of us who need a bed (of which there are none) wait even longer. I also think being younger, early 20s, means you wait even longer for beds as you are deemed 'fit to sit' in a way that elderly people aren't. I've sat in a chair for 3 days before, 4 drips running at once, blood transfusions, 24 hour heart monitoring... where noone else in the room was even on medication. Just there for straightforward injuries.

I'm still unwell and dreading needing to go back through A&E again. The hospital are amazing once you get to a ward, but getting there when so unwell is an awful experience. Lack of staff and beds mean that long waits are a reality for lots of people who need emergency treatment.

I agree that far too many people go to A&E that would be better off using an alternative service but when GP appointments are impossible to get and people are being incorrectly directed to A&E it's hardly surprising.

I was taken to A&E in an ambulance last October after collapsing in my GPs office with pneumonia (I'm usually an extremely fit and healthy 30 something who runs half marathons and triathlons for fun). I was out on oxygen and despite being taken in by ambulance I was still expected to wait over 10hours and was left to soil myself as I couldn't take myself to the bathroom and no one would help me despite me asking several times. That is unacceptable treatment and no one would deny I needed to be there. When I was eventually seen I was admitted for 4 nights for IV antibiotics so was clearly extremely ill.

Obviously depends on the hospital and how busy A and E is, but I’d say my two visits in the last month have been very different to yours OP.
I attended in severe pain from a gallbladder attack. I have had attacks before but nothing like this. Triage were terrible, I was rocking backwards and forwards on the floor on all fours and offered paracetamol. I was left like this for 6 hours. I was sent away and told it was a stomach ulcer. 3 weeks later, with pain after eating or drinking, even water, I attended again as my eyes were going yellow and my urine was brown. I was in agony, and well aware this suggested I had a blockage in a bile duct.
Again I was left for 7 hours and my husband had to chase pain relief. This time, 3 hours later I was given OTC strength cocodamol (did nothing).
I’d have No problem with sitting and waiting - if they’d given me effective pain relief rather than leaving me in agony for hours.
A gentleman was in clear distress howling in the corner in pain for a similar length of time.
This time, I was admitted and stayed in hospital for 11 days whilst they gave antibiotics for a very infected gallbladder and removed a stone blocking my common bile duct.
I am terrified of needing to attend A and E again, a real possibility as I will not have my gallbladder removed for another few months. I would add though, once I was seen by the doctors, the second time at least, my care was brilliant. But at triage there seems to be a real inability to accept that unless your obs are a concern, you could possibly need medical attention sooner than 6 or 7 hours. I would also add there is clear compassion fatigue from many of the staff.
Just to add I’ve worked in hospital and had to see patients in A and E in my speciality - and I know they’re run ragged. But the care I’ve received this last month at A and E was abhorrent.

I’m delighted that you had such a great experience.
My elderly mother had a very apparent, massive stroke and was taken in by ambulance. She was left, distressed and naked from the waist down, on a trolley in a corridor for almost 5 hours. A&E staff had been informed that she’d most likely been laying on her cold kitchen floor for 20 hours after collapsing while making her dinner, and had been asked to consider that her agitation may be partly due to dehydration…yet she received no fluids and no medications for 5 hours. I reported several times that she was so distressed that she was throwing the blanket off repeatedly, and was showing her private parts to every man and his dog - but they did literally nothing.
So, to repeat - I’m super happy that your relatively fit and healthy young son received great treatment, but my gravely ill elderly mother was treated like shit, and I’d suggest you start to realise that you were in the very fortunate minority. I don’t mind waiting, and I would never complain about it. But the service is so overwhelmed that in places they’re losing control entirely.