To think 70% of people shouldn’t be in A&E

[PrettyPleaseXo]

Recently I was admitted in excruciating pain to A&E due to kidney stones. Over the time I was there it got progressively busier as expected and there was corridor care (I was stuck in a corridor without pain relief and crying in pain for two hours) and ambulances backed up out the door.

When I was discharged and went back out through the A&E reception/wait room I couldn’t help but notice
that 80% of the people sat there looked perfectly fine, chatting etc and didn’t appear to be in either an accident or emergency.

AIBU to think that unless you’re seriously unwell, in acute pain or have an injury that needs immediately addressing you should be turned away from A&E and told to go
to the GP instead?

I don’t disagree that many people at a&e dont “qualify” but for many people it’s the only way they can get seen by doctor. The problem is lack of GP and walk in provision

If you are able to triage people just through the power of your eyeballs maybe you should get a job there and help being the waiting times down!

I don't believe for a minute there are very many people putting themselves through the hell that is a&e for shits and giggles, no.

I didn’t think of it this way, a very fair point!

I got a tampon stuck once, when to GP, they didn't have the tool to remove it. Told me to go to A&E, told me not to go to work first, go now, don't leave it. I was absolutely 100% fine.
What should I have done?

I spent 13 hours with dh in A&E recently he had a suspected bloodclot in his leg. A&E was bursting. Some sitting on the floor as no chairs.
In truth I saw noone where I thought they didn't look sick. One guy was in so much pain he was crying out every time he moved. He was told they would get him a bed but when we finally left at 5 30 am he was laying across 3 chairs with a blanket still moaning in pain.

One eldery lady had clearly had a fall blood was running down her face and she had a lot of bruising she was there all night too.

Police was there with a dude whose head looked very sore. A young girl was there with her boyfriend in obvious pain.

Im not saying people dont go when a 111 call or gp visit could but that horrendous night worrying my husband was about to die. I didnt see one I thought should not be there.

Edited spelling

I read once some opinion that A&E have triage the wrong way around. Instead of a nurse on triage, they should have the most senior doctor on duty on triage. This doctor would then just send loads of people home, often after minor/advice treatment. This way loads of patients would only have to see one HCP not two, cutting workload and waiting times. There must be some reason why hospitals don't do this though.

I have a genetic blood condition and if I have symptoms of a DVT I have to go immediately to A+E for a scan. A+E is the only way to get the scan in my area.

While I’m in waiting for the scan, as my DVTs are not very painful, I will probably look perfectly well.

If I don’t get the scan, and do have a DVT, it could travel to my lung and I could die.

I’m not a medic but my impression is that so much diagnosis is based on sophisticated test, scans etc, and some of those waiting in A+E are there because it’s the only route to getting those things done.

It’s not the “only way they can be seen by a doctor”.

it’s the only way they can be seen by a doctor in a timescale they consider appropriate.

People are so entitled these days - everything has to be fixed NOW - many who are there, know they shouldn’t be, but if you hear the way they speak to receptionists and triage staff you just know why they think they’re special.

Twice in the past 18 months the GP or 111 have told me to take my child to A&E. I didn’t agree (and neither did A&E) but then again if I hadn’t and something had gone wrong, and my child had come to serious harm bevause I hadn’t listened, then what?

Things start as minor but the lack of go appointments cause problems to become major so A and E becomes the only option. No one is in an and e for fun, everyone knows it’s hell going there, they have no choice.

As pp said, many people can't even get registered with a gp and those that are registered can't get an appointment. Many walk in centres have closed.
My local council is planning a new housing development of over a thousand flats. I doubt there will be new gp practices springing up. God knows how the local hospital will cope.

I agree but it’s not all the patients fault. There was a post on here yesterday where the DC had a fungal infection and the GP said that if it didn’t clear up after treatment, to go to A&E as apparently they can do the swabs there. Is this really what A&E is for?

I’m sorry @PrettyPleaseXo i don’t think it’s a fair point.

I think people have taken it upon themselves to decide that whatever their complaint, no matter how minor, that their doctor’s surgery should see them TODAY - in one day - without fail.

anything which isn’t same day is then treated as “right, off to A&E” and some people even treat it as a bit of an adventure, it makes them feel important etc

Ive seen entire families waiting in A&E chatting away and sharing snacks , the patient themselves looking very happy and comfortable, no ostensible issues. Most of us have seen this. When will it end?

I could have been one of those people OP.

I have Crohn’s disease and was experiencing a flare up not long ago, the IBD nurses - after liaising with my consultant - told me to go via A&E in order to be admitted. Once I got there, the gastro team were contacted and I was seen very quickly and had bloods / imaging HOWEVER I was sat in A&E for 18 hours waiting for a bed to become available. I ended up spending 9 days in hospital and having surgery so obviously I had a very real need to be there however just from looking at me, you would never have known as I too was having a good old chat with other people who were also there for hours waiting for a bed.

Things aren’t always as they appear so I wouldn’t judge.

We have 3 new building estates going up, housing thousands, all will probably go to the local GP that is already struggling. No infrastructure is built to support the housing estates.

I do suspect a few of the standard patients just need a 1st aid kit at home, a bit of common sense/Google search of symptoms/remedies on the internet, and a sympathetic ear from a friend or neighbour.

I don’t doubt you’re right.

But there will be a chunk who:

1. Dont need A&E, but do need medical advice and it’s the only route whereby if you wait long enough you’ll see someone. GPs don’t have that provision.
2. Don’t need A&E, but need something beyond GP and reasonably swiftly. Eg. Certain checks for certain chronic conditions. There should be better routes for these things but there aren’t.
3. Do need A&E, even though they look ok. I’ve been there with husband, we were chatting away and probably looked fine. He was in hdu with sepsis 10 hours later. I knew he wasn’t fine. Same with friends child, playing with the toys looking fine, while staff discussed whether to admit her.

DP cut his hand last year at work, and we started off at minor injuries where they deliberated for a while then insisted it needed to be stitched at A&E instead because they wanted orthopaedics to look at it first due to possible nerve damage.

So off to A&E with a deep but clean cut we went. DP was fine in himself, just needed a few stitches! 7 hours later, a junior doctor who had never stitched a real person before did it. No orthopaedics input.

He didn't want to be there, he didn't need to be there, the experienced nurse in minor injuries could have done a better job 7 hours earlier! This is the sort of shite that clogs up A&E in my experience.

If you are registered at a GP surgery that only lets you ring on the day, has no online or econsult service and you can't ever get high enough in the queue to be answered but you have an issue that could be cancer like a lump or bleeding and it goes on for weeks getting worse?

If you can't find a dentist that will let you register but you have toothache that is getting worse and you now have an abscess and a temperature?

If you have a long term condition and need regular meds but no pharmacy in a 20 mile radius can get hold of them to fill your prescription and your condition needs management or it could become life threatening?

You have been bitten by a human and need PREP and it's out of hours.

There are so many reasons why people can look ok but still need what only a&e can provide.

Whole many patients may not be there for what a&E was originally set up to provide, we have also reduced our health service to such a poor shadow of itself where desperate people can't access the right service like pharmacy or go or dentist, and are left with no option but to go to the place that is actually open.

That is a massive issue, and people are at fault, but it's not the desperate patients to blame.

And I want to be part of a society where everyone is deemed worthy of help with their concerns, and that you shouldn't have to get to the point of screaming in pain and lying on the floor to qualify.

I was in a&e on Friday night
It was surprisingly quiet
But 4 people including me had been called by the OOH dr after having bloods done that day by the GP
All of us needed emergency infusions and to be kept in.
All of us had been trying to get GP appointments for weeks.
Cant be 100% sure if id been seen by a GP weeks ago that I wouldnt have ended up taking up a&e and hospital resources, plus 2 outpatient clinics since Friday....but im 95% sure I wouldn't

Not helpful to consider them all feckless.

fwiw, the official statistics are that about 40% of people in A&E 'could' have been treated in primary care. "Inappropriate presentations" etc. We find maybe 30% (of that 40%) didn't try to get care elsewhere. The reasons given by "inappropriate presentations" (I spend time researching this) are roughly in this order from most to least (plenty people have multiples of these reasons)

*Someone vulnerable is unwell like small baby or frail adult & the carer can't tell how bad it is (& maybe carer couldn't reach GP)
*Tried and tried to get GP appt for hours or maybe days and now gave up, especially if pain increase or severity has changed
*Told by GP / pharmacist / NHS111 to go to A&E
*Told by A&E to come back after previous treatment in A&E
*The patient never sought medical care before, they don't know about any NHS options; maybe they come from a country where all health care happens at hospitals where you just turn up (eg China)
*On holiday/far from home & problem is worrisome
*Perception that they have seen GP about this problem before but it never gets better, now desperate to try to progress treatment somehow, maybe A&E can offer something
*Perception that all the tests happen at A&E, things just happen, it's "better"
*Experience knowing that if they talk to GP about their problem, GP always sends them to A&E anyway
*Urgent need for medication that must be prescribed
*Friend told them about good walk in service & they don't even want to take hours trying to reach GP, or they can't get on phone at 8:29am.
*Anxiety driven yes: convinced they have severe problem & refuse to believe otherwise

Wow @PrettyPleaseXo ... You may be able to resolve the NHS single handedly if you can tell just by looking at someone that they are "fine" ..what a magical skill set

Recently, we attended a non emergency walk in centre for an urgent but comparatively minor health issue.
We were seen quickly and a prescription was sent to our local pharmacy for collection the next day.
The whole process was quicker and more efficient than A and E would have been, minus the guilt about possibly attending unnecessarily.
We live rurally and travelled about fifteen miles to the small market town where the centre was based.
We didn't know it was there until a friend told us about it; our usual action would have been to travel fifteen miles the other way, to the A and E in another town, waited hours and perhaps take up time needed for more urgent cases.
I read that more of these centres are planned, which seems like the way to go.

Just because a person looks fine, and can talk doesn't mean they're absolutely fine and shouldn't be there. I looked fine and could talk when I went to A&E with severe abdominal pain.
It came in waves and at times I felt no pain at all and felt like I was a fraud being there. Turned out I had acute pancreatitis and was admitted, spent 2.5 weeks in hospital, and had my gallbladder out.

I would never judge.

I looked incredibly well at hospital yesterday but I was there for something serious found by other doctors and I’m now looking at having heart surgery.

I was also fast tracked and didn’t wait more than 5 minutes so I probably got alot of what the hell comments but it’s nobody’s business.