How does this work ? (A&E question)

[JadeJewellery]

Just want to start off by saying I’m NOT criticising the treatment I had nor am I criticising the staff. I’m just curious of how it works thats all!

It happened 2 months ago but just sort of wondering now since I’m feeling better and reflecting on it all. I’m in England if that makes a difference.

i was in a&e recently with what was potentially quite serious. I have multiple conditions, knew it was my heart and told them at reception. I was violently vomiting, could barely stand up, and I just had this feeling that I was going to die in the waiting area. My heart felt completely wrong and I knew something was very bad. It turned out I was correct- I was in 3rd degree block and my heart was barely in the 20s.

The treatment I had was brilliant, but it took so long to be seen for triage. I was in the waiting area for around an hour and a half and they were taking people in order of who arrived first rather than severity. There were multiple people going in for things which were definitely not life threatening eg a sore finger from 3 weeks ago (and it wasn’t that they were going in for minor injuries, it was all A&e) and even they themselves were saying to reception that I should be seen quicker because I was visibly so unwell in the waiting area but the staff kept saying I’ll be seen when I’m seen and i basically had to wait my turn

maybe im completely wrong, but i thought people were seen in order of severity rather than order they arrived? Or is that only the case after triage?

i know I sound a bit melodramatic about it all but I was just so frightened because I seriously thought I was about to die in the waiting area. I felt dreadful- they said the vomitting was because my blood pressure was falling so low and my body was struggling to keep going because I’d been in the block for so long. It was just frightening realising how many people were in front of me and I assumed (probably wrongly) that you’d be taken immediately if something was wrong with your heart?

but yeah not criticising staff they were brilliant! Just wondering about if that wait is normal that’s all

Not sure about everywhere but I know ours has a sign that says they aim to triage within 15mins of arrival. I doubt they always manage that but seeing everyone in order of arrival if they are going to leave you an hour and a half seems risky.

That does feel like something that maybe someone does need to complain about.

Did they agree with you that it was your heart?

My experience with my son was that once they decided what it was, that was that and it took far too long for them to acknowledge that it wasn't what they initially thought and by that time, he had rapidly declined.

It was the same when my partner went into A&E last year. He had sepsis, and as soon as he was triaged he was taken straight through to resus and received amazing treatment. But we had to wait almost two hours to be triaged to get to that point.

Did you go back to reception and say that you felt you were going to die?

They usually have a nurse on reception, my guess would be that the initial receptionist had you down as vomiting and didn't take seriously your statement about your heart condition.

Yes agree. Once a single doctor (who could be wrong) gets it into their head that it is xyz they refuse to consider anything else. Even when their first line of inquiry scans etc throws up nothing to suggest that it could be xyz.

It's a bloody nightmare - doctors who wont accept they barked up the wrong tree.

In some hospitals you can get an alert put on to explain the complexity of your medical conditions, so that triage staff are aware, but you can also tell reception staff of it happens again that last time you had third degree heart block and get them to tell the triage nurse as they can prioritise patients for triage if the waiting time to triage is longer than ideal standard of 15 minutes. If you are really bad then calling an ambulance to bring you in might be best.

How long were you there before you were triaged?

You do realise though although you all sit in one waiting room there are several clinics that run from A&E and some of those will have been called through to those?

around an hour and a half

yeah I understand but that wasn’t the case- the nurse told us later that everyone was queuing for a&e. The same triage nurse who took the other people in took me in. Maybe people were streamlined afterwards (like for minor injuries, resus etc) but initially everyone was in the one big triage queue

Yeah I should have called an ambulance- in my head I just kept thinking it would probably be faster to make our own way there, I don’t think I was really thinking straight tbh I was just feeling so crap. Oh I didn’t realise about the alert thing but that’s really helpful to know x

Yes that's right, you're all triaged then filtered off.

People do come to A&E with the most ridiculous of things.

Yeah I think that’s what happened (unless it actually is the case that everyone is taken in order of arrival to be triaged) but I was sure it was done by severity which would suggest they thought it was just sickness initially. Ah well, just curious when I was thinking back to it all x

Oh yeah I don’t doubt it for a minute! I overheard a few reasons why people were there and I know it’s terrible to be judgemental because you never know the full story, but it was just so scary being left basically and in my head I kept thinking am I going to die in this waiting room?! Scary stuff. X

My partner did (and multiple people in the waiting area) I couldn’t go because I couldn’t even stand up properly. It was like the most intense nausea and a feeling like I was going to die, I think they call it a feeling of doom and that honestly describes it perfectly!

So you’re saying even though you were there and clearly unwell, they were taking people who came in AFTER you with a sore finger before you?

Many A&E departments are incredibly busy- seeing 2 or 3 times the number of attendances that they were built for.

The issue with seeing people in order of severity is the point of triage. If triage was being delayed (and it sounds like it) it was incredibly busy. You won't have seen the rest of the A&E from the waiting room with patients in corridors, sitting in chairs who should be in beds (and that is after triage). When it gets that busy, everything slows down even more because there is no space to see anyone. I am not a A&E dr, but attend patients there as part of my job and there have been times where it has taken me 3 hours to find a space to see a patient, and that space is often the phlebotomy (blood taking) room, which of course shouldn't be used to see patients in, but if I don't see them there it may be another 2 hours before there is a free space. Then the phlebotomists can't get in there to take blood so have to do it in bedside location. I'm not telling you this as an excuse but as the reality of the front door of the hospital. My team often has 60 patients - that's 2 whole wards worth of patients - stuck in ED (A&E) waiting for a bed on a ward.

Unfortunately you can't rely on people telling you that they feel terrible as a marker of severity, there are lots of conditions that make people feel dreadful/faint/ that they can't stand up that aren't lifethreatening (conversely some people have lifethreatening/very serious things wrong and look reasonably OK).

I don't think you were being melodramatic, and in your case there was something seriously wrong, but yes, you shouldn't have waited that long for triage.

I used to suggest that patients complained, as sometimes patient complaints are a leverage to get things changed, but I think that the NHS (at least the front door bit is past that point), and it's really soul-destroying answering complaints about factors outside our control as the doctors and nurses on the front line.("why wasn't my mum moved to a ward/why did my grandad spend 2 days in a corridor"?).

I think they will do the initial triage based on arrival but the next stage will then be based on severity - that's certainly what happened when I went in with a suspected bleed on the brain when once I'd had the scan my number went from the bottom (roughly in numerical order reflecting the order of arrival) to the top and off as they were admitting me!

No, they were there before. I think everyone was taken in order of when they came plus there seemed to be a backlog and it must have been really busy in the hospital because everyone was waiting a while (again not complaining! These things happen)

As PPs have said, people are triaged in order of arrival - the triage is what determines the severity of your condition and the urgency of being assessed. National target is to be triaged within 15 mins of arrival. Very hard to keep up with that though when new patients arriving in a consistent stream.

If you are really bad then calling an ambulance to bring you in might be best.

Calling an ambulance doesn’t mean you skip the triage queue though. Unless you get taken straight into resus, in which case OP that might have been better. Although you can wait hours for an ambulance now.

Oh gosh I completely agree! Please do not think I’m complaining about the staff- they were great. And to be honest it’s not the end of the world I had to wait- I obviously could wait or else I wouldn’t be here.

I think it was just frightening because I knew something was really wrong, and it was upsetting for everyone (even the person with a sore finger who actually questioned why I had been left and wasn’t being seen by quicker) but I completely agree with you that some people might look bad and actually might be fine so fair enough if the staff thought this. Not the end of the world tbh and I was fine in the end, I just wasn’t sure if that was normal when waiting for triage or not x

If you call an ambulance and they do an ECG that shows third degree heart block the ambulance crew will pre-alert A&E prior to arrival and OP will be prioritised in Resus.

Makes sense! I think I’ve just watched too much greys anatomy where someone who looks unwell is seen immediately but of course that’s a tv programme and not real life haha! I mean, I obviously could wait, because I did, and although it wasn’t pleasant I survived to tell the tale so maybe actually I was safer to wait than I initially thought!

I’m a nurse and have worked in ED so I know how it works thanks.

My point is people think calling an ambulance means you skip triage and get seen first.

After triage ir may be that the treatment you need requires a specialist from somewhere else in the hospital so they have to be called and waited for. Someone else's treatment could be really straightforward. Thats what i think anyway.