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?

@WitcheryDivine I didn’t know that 😱

I have gone to A&E twice in the last couple of years as advised by 111.
The first was a cat bite that I needed a tetanus and antibiotics for, my GP surgery said they could not deal with animal bites.
The second was a bad scold that needed dressing etc.
So yes I will have looked well and drove there on both occasions but there was no alternative.

That is the ooo gp, we have one based next to a&e and also have one at our minor injuries

I was sent to A&E last week by my GP. I had seen him early morning for a whole list of issues but he was seriously worried about some swelling I’d got on the same side as my recent craniotomy surgery scar. He sent me for a CT scan. Should I have not gone and spent 8 hours waiting just because I ‘looked fine’ and was talking to a chap also waiting for treatment as he was brought in by ambulance because he was unable to walk??

It’s tricky because sometimes you get sent to A&E from elsewhere in the hospital because they can get it done faster than whatever department.

I have cancer and every time I spike a fever, I get sent to A&E for them to run bloods, mainly sepsis cultures (I’m apparently at high risk of sepsis, plus 40c fever). It’s because it’s after 5pm and the cancer day assessment nurses have gone home or there isn’t a bed on the ward.

Even when I refuse to go in (which I’ve started to because I can’t be asked with sitting in A&E all bloody night shaking and feverish), my GP won’t do them. They don’t do the cultures anyway, but even normal bloods requested by my consultant, they refuse to do. So I have to drive an hour to the hospital and sit in A&E until someone will do them, if they can’t take me on the ward. It’s annoying. I’ve stopped going now because the bloods are always fine and I hate sitting in A&E.

That said, one of the issues with A&E is that people seem to bring their whole bloody family with them. One parent with a child, yes, of course. Or one carer with someone who needs a carer or advocate, perfectly fine. Both parents and a 5 year old in attendance with a 20 year old. Or you and your 6 mates from rugby. Too much.

I don’t honestly know why people want to come en masse to A&E. I’ve spent enough time in A&E though (alone, I’ve never brought anyone with me because Dh needs to be home parenting our dc) to know that there definitely doesn’t seem to be a good reason in most cases for one unwell person to attend with 4 other people. I’ve sat next to them all night, seen them diagnosed and sent off with some antibiotics. Their herds didn’t seem to do much other than take selfies and watch films loudly and eat, and take up seats, so people who are actually ill are standing or on the floor. 🤷🏻‍♀️

Be very, very careful when it comes to sepsis. It only takes one time and if it doesn't kill you, it can be life changing.

Do you have a central line for your chemo? If so, you are very susceptible to sepsis because the central line goes directly to your blood stream. My son developed sepsis twice, the first time was before we even knew he had cancer and the second time was during his treatment but it was caught incredibly early thankfully.

It's been 15 months since he had septic shock and he still can't walk, he was in intensive care for 7 weeks and his heart, kidneys and bowel all stopped working properly. His bowel was permanently damaged and it was lucky he didn't lose his right leg.

Please, please take care with sepsis. I hope your treatment is going well and you have a speedy recovery xx

I attended a and E in the summer with a threatened miscarriage.
When I arrived there was a 5h wait in a and E but due to me experiencing very heavy bleeding, having bled through 3 night pads during the afternoon I was fast tracked straight through to urgent care section and was seen in 30 minutes.
I looked completely normal though as you couldn't see where I was bleeding from!

Our GP is 6wks wait for a telephone appointment to see if you actually need to see a GP in person, then thats another 6wk wait - its no wonder people take themselves to A and E if they're in pain!

I think there is also a culture of wanting to pass the responsibility of being sued onto someone else - very elderly FIL had a routine app with the nurse yesterday who said their heart beat was too fast, go to A and E, which they did, many hours sat there to be told no issue go home. But I suspect had they not gone and later dropped dead, the poor nurse would have been in trouble.

I think a lot could be solved by family GP’s who actually know their patients - I couldn’t even tell you my GP’s name anymore, just one of the 20 or so GPs at the practice, and good luck trying to see the same one twice, would probably be 6 months for an appointment if you were fussy who you saw!
It’s all pretty rubbish, for the amount of money the NHS swallows up I’m sure it could be better.

Have gone to a and e with clot symptoms, tho not particularly painful at all. Had multiple clots, both lungs. If i followed your idea that no one should be there unless in agony id quite likely be dead.

I was at A&E with my dad this weekend. Arrived in an ambulance. Suspected (and as it turned out, actual) stroke. He looked fine, apart from a stiff arm. Had we not had an ambulance, and I had driven him there and waited in the room, he'd have looked perfectly healthy to you, OP.

If a GP can't see you, you call 111. If there's the slightest chance that your problem can't wait a few days, they'll tell you to go to A&E. What are you then supposed to do - even if you don't think you need immediate attention? Stay home and find out they were right?

Yes, it is a fact that it all depends on your post code. Once you are on the unlucky lot, it is a proper nightmare!

Yes I agree with you. I visited A and E a few times a few years ago and saw a load of folk thinking it was jolly day out. Whole families taking about 6/7 seats up when two folk could have just waited. Genuine sick people couldn’t get a seat. Ridiculous

I disagree.

The only way I could get my son seen by a Dr was to take him to A&E despite my very polite protestations to the Drs receptionist that he had all the symptoms of type 1 diabetes, that I was an ex nurse etc etc

I was just told no doctors were available, not even for a quick phone call and to call back tomorrow morning.

I took matters into my own hands, took him up to A&E where the sister was horrified at our treatment and it was quickly discovered he had a blood sugar of 35mmols.

We've since left that particular surgery due to the impossibility of speaking to, let alone actually seeing in person a Dr.

As our old (excellent if you could get access to him) GP used to say 'The NHS is broken' and as a result we have a situation where people use A&E like a GP drop in service.

The problem is that it can be impossible to get help anywhere else. If i need a gp appointment i have to phone at 8 am. It can take 2 hours to get through on a good day and there are never any appointments left on the same day. They don't let you book a gp appointment for a few days time. Yet if i want a smeer it is easy to get in. 111 are no better. A few years ago i had raging toothache. There were no emergency appointments at the dentist. I phoned 111 as i wanted an emergency appointment with a dentist. I was on hold for over an hour. When i finally got through i was told that i would get a call back. The call back never came.

I honestly think the solution is GP services should be 24 hour everywhere.

Mondays as by far the busiest day in A&E, as, patients who have had bloods done in primary care on a wed night/thurs/fri, all get resulted over the weekend, something abnormal flags, GP's contact them and send to A&E. Patients who fall ill on the wekend wait till monday to call GP, receptionists redirect to A&E. People dont want to waste their weekend, but happy to take the monday morning off work, come to A&E. Now the latter wont change, but the first 2 could be solved if GPs were available 7 days a week, i think all surgerys should now be made to open 7 days a week, and some nights later into the eve.

Onsite GP clinics, without the faffing of 111 referrals like OOH clinics, should be at every A&E 24 hours. Ours is staffed by some locum GP's, then F1/F2s from A&E, advanced emergency practitioners. ED employed HCAs rotate going over there to do obs and bloods etc. The model works, and should be rolled out everywhere.

Absolutely right- a mixture of those who cant get a Dr's appt, some stupid, some attention seeking. But mainly people have no skills in managing minor illness.

I’m just astounded at the length of time waiting for a GPs appointment in the UK. Here (in Ireland) you can generally get a GP appointment within a few days though I’ve been lucky and gotten one on the day.

But to add to that it doesn’t fix the problems in A&E as people who just don’t need to be there still go. I recently went to A&E here (as an urgent referral from GP who’d I’d managed to get a same day appointment with). I couldn’t go to an urgent care center or a private hospital due to the nature of my symptoms. I was triaged (incorrectly but that’s another story) before I waiting 20+ hrs to see a doctor. I saw so many people who didn’t need to be there. I’m not talking about the people like me sitting there quietly not obviously ill who you can’t ascertain by looking what their complaint is. It’s the people with the sprained ankle or cut on their thumb who could have went to a GP or care center where they could have been treated/assessed first.

I still remain confused by the idea you can tell just by looking at someone whether they are ill or not.
Rightly or wrongly, in a stressful or unpleasant situation my default is to often to make light of it.
Before an exam I am the same, I seek out anyone who will chat about something random. I was never someone frantically running through flashcards.

It's just my coping mechanism. I am not dramatic when ill. I just tend to keep surface level chat going.

To the untrained eye, my symptom has no visible outward signs most of the time (although family and close friends and my neurologist would all be able to spot the signs I was flaring).

It's really ignorant and harmful to imply that illness is somehow visible (or audible).

It isn't everywhere. I'm in England and can get an appointment with my GP, sometimes it's online or by phone but I almost always get a same day appointment.

Yesterday I did an online enquiry about something. Five minutes later I had a text from the pharmacy to say they had my prescription, a few minutes later I got a call from the surgery to say prescription had gone to pharmacy and information about what I needed to do particularly if x y or z happened.

Some of this does sound ridiculously inefficient.

Some of these problems sound fairly easily fixed though. Some examples where I live.

• Xrays/Ultrasounds - Mobile units that come the patient in the ER. These are dedicated units for the department so it’s much quicker to get the procedure and results. My husband unfortunately had to use this when he thought he was passing a kidney stone. All in we were there for 4 hours and that included all wait times, testing, ultrasound, consult with the ER doc + the on call specialist
• Urgent Care - again has X-ray equipment and ability to splint/cast a break or sprain. They are generally staffed and equipped as a mini ER dept. Anything that turns out to be out of their scope has an ambulance called. My second hand knowledge indicates they are pretty good about only doing this in legit situations.
• A lot of hospitals have an A & B side to the emergency departments. One side treats emergency care (stroke, heart attack, trauma, etc.) and the other side treats the more minor situations (stitches, breaks/sprains, flu/cough, etc.)
• In general there is less gatekeeping where I live. If you think you need to see a specialist you just make an appointment with them. Your appointment may be a few weeks out but you’re not waiting for a GP appt and then have to wait for a specialist appt.
• Virtual appointments have exploded since Covid. All major health groups offer them and they are super quick and take care of those minor but need a doctor situations (sinus infections, bad cough, conjunctivitis, etc.)
• Rehab hospitals- not strictly an ER related thing but I often hear that it contributes to your long wait times. So people who are admitted and treated but fall into the category of not sick enough for a hospital but too sick or need additional treatment to go home are transferred to what is called Transitional Rehab Units. These are either dedicated facilities or housed within Nursing homes. It’s for people who need OT and PT after injuries or surgery or need maybe a little more time before going home. Generally the stays are measured in weeks. This keeps beds in hospitals open and available for admissions. It’s also good for the patients who go there because it’s generally a more relaxed atmosphere with less ‘hands on’ nursing like the vitals checks at all hours and beeping machines keeping you awake all night.

The one thing that I didn’t know about is the cancer center in my hospital has a separate 24/7 ‘clinic’ for their patients. Any cancer patient under their care is directed to call the nurse line first if there is something going on. Then they will be directed to attend their clinic first to keep them out of the general ER.

Of course the trade off to this is that you have to pay for this and I know that according to some it’s the devil’s system 😉 but honestly some of these things should be doable under your NHS.

It's impossible to know. Anyone who's ever ended up in A&E with a child with croup knows this.

Just seeing how they look does not mean you could tell how ill someone is or is not.
Some people ride pain better than others; I cry and moan with discomfort. OH is a stiff upper lip type!
the trouble these days there is so much trouble getting to see a GP; in desperation, some people go to A&E instead, right or wrong?

I was chatting to an actuary working in pensions and insurance at an event the other day and we were talking about the models insurers use to plan for longevity and what the impact of the fat drugs might be. He told me that the thing they watch extremely closely is the NHS - productivity or investment increases are the biggest single factor to move their longevity models ie those are what drive people living longer.

One thing I find odd is how little many GP surgeries are able/willing to do. Ours is really good so we can get blood tests there, and they'll usually contact us directly with results. ditto we can drop of urine samples and get results. But even in my area, I hear people complaining becuase their GP wants them to have a blood test so they have to go up to the hospital and sit for 2 hours.

Our surgery also now has a number of nurse practitioners/physicians assistants which seems to be great. They can prescribe antibiotics for minor issues etc and it frees up doctors' time for other things.

These are basic productivty things that CAN Be better everywhere, not just in isolated spots.

I remember cutting my head open as a child and my parents taking me to the regular GP who stitched it. Ditto as a teenager I had a very small mole removed by my GP because he was a bit concerned it might be becoming a problem. NOne of that seems to be possible anymore?

Just goes to show how the postcode lottery affects all kind of things I guess. Health care provision is clearly not equal all over the country. There is a GP practice in my county that has 16,373 patients to one GP - that is one Doctor not one GP surgery - that is simply insane. It is very much down to house building with no infrastructure of any kind. The population growth here is 10k-15k per year. It would require an additional 7 GPs per year (that's new additional GPs not replacements for those leaving) to have any reasonable chance of offering an adequate service. I can't see that happening in my lifetime (and I'm not that old).

I forgot to add blood tests to my examples above. (@magequeen reminded me) Yeah those are done at the GPs office here. It would be really odd to be referred to a hospital for this. It’s considered routine. They can also refer for more advanced tests like MRIs, but generally speaking it’s usually specialists so would do that.

I will also note that some insurance plans require a referral to a specialist to be covered but generally speaking you can get that referral without having to have an appt (or a quick virtual consultation) and some specialists you can self refer (gynecologist as an example).

That was one battle that health insurance companies lost. When the referral rules came out a lot of women just named their OB/Gyn as their Primary Care Physician/GP. So they could go to them for their annual exam, then if they needed a referral for another specialist it was just a phone call.