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 do agree with you (and often they take the whole family too!) but I also know some things aren’t visible- my DD (17 so had to attend adult a&e) was told to go straight to a&e when she recently had some heart issues. Anyone looking at her though would have thought she didn’t need to be there.

@Horserider5678 I wonder if the two nurses who saw my DP for 'constipation ' include him in their anecdotes. It was bowel cancer and then we got to A&E he was less than 24 hours away from death. He now has a stoma. He'd had inhalers thrown at him previously, he'd been having hear attacks, that's why his breathing was bad. Had one while driving as a taxi driver, it's lucky he didn't kill anyone. I'm on the FB stoma group and people's experiences of being fobbed off are disgusting. My first husband wasn't diagnosed with cancer until seven weeks before his death, again I often wonder if he features in anecdotes. As an ED Nurse, I would have thought that you'd highlight the silent, serious conditions that people can still chat, while needing A&E.

IMO you did absolutely right in going to A & E, a ‘lost’ tampon can lead to toxic shock which can be fatal, hence your GP sent you there. Hope you got sorted.

I guess because you could have someone who is really quite ill waiting forever while doctor advises on someones corn. Triage is to weed out the important cases and make the rest wait.

At our A&E in Norwich, on the reception desk a senior doctor does stand there and triage people. It's exactly as you said it should be, and it works brilliantly.

Still, when I went a couple of weeks ago, there was loads of people who were still in the corridor.

my gp sent me to a&e yesterday after a very abnormal ecg- I looked (and felt!) fine but have since been admitted so obviously am not… can’t always tell by looking!

Do you know how impossible it is to get an appointment in some areas?

To be fair, many emergencies will not present outwards. I had a pulmonary embolism last year and was sat quite normally in a and e, had chest pain but outwardly you wouldn't know anything.
I agree that a percentage could be treated at a walkin provision, investment is needed for these to divert numbers away from a and e. Also limiting numbers of people attending with patients to one if needed for care reasons would help the general business of the department.

I don’t know. I had an emphysema in my chest, almost died, but while I was waiting in A&E, I was sitting up chatting to my mum like everything was fine, not moaning in pain or anything, so you might have looked at me and wondered why I was there, but if I’d left it any longer, I would most likely have died!

The problem is the A&E is now a doctors surgery.
We used to be able to turn up at the doctors and wait to be seen, now you have to wait to even get your call answered so there is no where else to go. Plus all the cottage hospitals are gone, so instead of going to somewhere small near by and being treated everyone within a 30min travel radius are all crammed into one waiting room.
So it isn’t getting busier it is that the hospital has a bigger collection catchment.
Stupid isn’t it that if a supermarket gets busier they build more, however hospitals just get bigger.

Our waiting room is for a&e and urgent care which is ran by a GP service. You get triaged and you either get sent to a separate waiting room for the GP or you stay in A&E.

So not everyone is waiting for A&E.

Echo other comments - it is a mix between people taking the piss and people simply having no other choice because they can’t get a GP appointment for weeks.

There are also some things that may look okay but are not. I know someone went in with a head injury. Had been sick a few times but was otherwise sat up well and fine but turned out he had a bleed.

A&E isn't just for life threatening things though.
Last I went for was a suspected broken rib and needed an x-ray.
GP won't give an x-ray, if I'd have gone they'd have told me to go to A&E.
People aren't going to A&E with colds.
It's accident as well as emergency.

Quite often 111 will refer people to A&E who might look ok but need to be seen quick and that’s the only option.

To offer another perspective

When my daughter was 18 months she banged her head on a toy. She vomitted and was pretty out of it. Took her to A&E and the first hour we waited there she was grinning at everyone, running around and seemed totally fine. Anyone who had seen her would have thought she didn’t need to be there. After an hour the vomiting came back full force and she had to be monitored overnight.

You walking past people is a small glimpse of that persons trip to A&E

I always take food, chargers, entertainment etc to a&e, you'd probably think me a time waster too, though I'm always at paediatric a&e. I hate it there.

My son is a frequent flier, mostly due to zero other out of hours services here. Our out of hours gp services are triaged at a&e! Madness! He had recurrent tonsillitis, would go from fine to refusing all fluids and floppy within 24 hours - there was nowhere else to go over weekends and holidays. After the first few times of trying to wait it out for a Monday gp I just started taking him to a&e as soon as I spotted it, or he ended up being admitted for iv meds and fluids.

As well as his tonsillectomy this year (which went badly and resulted in 2 further a&e trips, 1 ambulance and a 2 night stay..) he's also had hand surgery he waited on for 2 years. When we first went to a&e for that, he was fine, running around, playing. But he needed surgery after a freak accident and now can finally use his hand properly after 2 years. That trip we'd be viewed as time wasters too. It goes to show that you can't always judge it right by appearances - especially for children in my experience.

I've never noticed proper time wasters there. I've seen young kids with orbital cellulitis running around just fine using their single working eye, the obvious bone brakes, no poop for 10 days and so on. These all need urgent care.

She has a point though, doesn't she.

That would be one way to cut wait times: if you aren't screaming in pain or bleeding from your eyeballs go home.

I doubt 70% of a&e patients would put themselves through it if they didn't need it.

Certainly at my a&e it's full of miserable ill looking people.

Reasons I’ve been in A&E where it probably looked like we were there for no reason

Toddler with a crayon up her nose, I mean, I suppose she was fine as in it wasn’t bothering her, but it still needed removed.

DS with a fairly small but deep cut in his elbow - needed it stuck together because it wouldn’t close as it was right on his elbow.

DD electrocuted herself at work, passed out, was seemingly fine, but they wanted to check her over.

DD - concussion, she ended up off work and uni for 3 weeks, but she was mobile and talking.

I’ve a back issue that has a list of, if this happens go straight to A & E - one of them happened so I did, but I’d have looked fine.

We were sent there every time by 111

Im an ED nurse.

If you are just talking about walk in patients, we have GP attached to our ED. Of our ambulatory aptients, at triage we send over on average 30% of patients to the GP. Much higher if you include childrens ED, it is closer to 70% in childrens. But adults only its 30%. However some could see a GP but by our triage its not appropriate, id guess another 20% are in ED when there would be better alternatives. Minor injuries we redirect before they book in to the walk in centre, unless there is a legitimate reason why they cant attend, so i dont have even estimated stats there. Then theres patients who come in because they literally have no place else to go, regular attenders who are in because they want and sandwich a hot drink and few hours out of the rain. Do they need to be there, no, but whats the alternative for them? Im more than happy to give them a sandwich and a cup of tea, try to move them on when the department is full and we are running out of seats, but if we have plenty of spaces, they can sit for a couple of hours.

However, most patients in the dept are brought in by ambulance, and waiting for ward beds. So looking at the whole department, id estmate its along the lines 30% total could utilise other services.

However! Some brought in by ambulance probably could have avoided admission if they had access to primary care when needed, if an infection had been seen to quicker, it wouldnt have escalated till they needed IV antibiotics. If waiting lists for surgerys werent so long, etc etc.

Its a complex situation. A&E isnt viewed how it once was, its now viewed as an alternative to GP's, because people cant see GP's. But people attend with a "GP" problem, knowing the pressure on departments, and still get angry at the 8, 9, 10 hour wait to be seen. Its frustrating as staff, but i get it, i understand theres no alternatives.

My A and E does a version of this.
My OH has leukaemia and back in March had a really nasty chest infection that turned out to be flu (we didn’t know this at the time.) GP saw him a few times and when he didn’t respond to antibiotics and seemed to be getting worse he advised straight to A&E for blood tests and chest X-ray.
He was triaged quite quickly and prioritised due to his condition so he was seen within about 2 hours by their on-site GP/ doctor. She wanted to send him home but after a fight with her (by me) he got the chest X-ray and bloods. This part took a further 7+ hours in total but he was found to have Flu and was finally admitted to a ward for 5 days. The 7 hour wait was grim but my point is that they had implemented exactly this process. For the most part it worked.

But if you have been to A&E you know they take your name and address on arrival, they ask what the issue is. They send you to the waiting room. Then they call you for triage. And if you do not present with issues that grant A&E, then they tell you to go to the GP. If they think you should see a professional, have X-rays, bloods..., then the put you on the corresponding waiting list and send you to the waiting area in the meantime.
The waiting time for the first triage is not that long. So most people who are in there are there for a reason.
The real problem is that there are not enough resources to deal with patients. GPs do not provide appointments, have long waiting lists and impossible to get through phone systems, then things get worst and patients that do not look all that bad are in A&E. But.... there have been people dying and all in those waiting rooms. If they had obviously looked like they had a stroke, then I can imagine that they would have been taken in.
Also, there are always lots of relatives/ companions in A&E.
Me, on the other side, I have witnessed casualties presenting with blood, obviously broken bones, vomiting sickness, massive pain. Yet, they were in that waiting room for a while, which I think is unacceptable.

My son was seemingly fine and chatting away in A&E too when I took him there early that morning as advised via 111. Later that evening he had a cardiac arrest as he had septic shock and a week later, after barely surviving, he was diagnosed with cancer.

If only it was that simple and the sick people always looked sick.

I broke a bone in my foot whilst on holiday. I had a cast put on. I was told there was no way I could self refer to my home hospital fracture clinic to have the cast removed. The only way to access the fracture clinic was to go to A&E at the hospital near home and explain. I had to wait to be accessed by them and then I was referred to the fracture clinic. I had to wait over 4 hours for basically a tiny bit of admin. The system is broken.

i would agree that a vast majority of people who sit for hours and hours in a&e do not really need to be there, but in all likely hood, they have called 111 and been told to go, because the standard response from 111 is to go to a&e.

the GP's do the same, if a patient rings and asks for an appointment today, and there are none they are told, if its an emergency, go to a&e.. and off they trott!

At one point pre COVID I was in A&E at least once a week due to gallstones. I needed strong pain relief, iv antibiotics, a load of other meds and full panel blood work every single time as my liver wasn't coping with the stress and my blood work was showing levels 12x higher than they should be.
On the outside I looked a little uncomfortable and tired but a liver specialist had no idea how I was walking around and not in complete liver failure at 25. I needed A&e but didn't look like it, they eventually moved me over to a department where I needed to be seen every day by the specialist which wouldn't have happened soon enough through the gp

I’ve been to A&E many times with SVT (on their advice), heart rate of 180+….you probably wouldn’t think I was ill to look at but I then am taken into resus and given meds to reset my heart.