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

If you think logically about it the only order they can triage people in is the order they arrived. If they saw people based on how sick they thought they were then that would cause chaos, plus they would miss serious illnesses where the person was misrepresenting their symptoms. And imagine what would happen once people worked out that they would be seen quicker if they said they were very ill!
The problem was not in the triage order but in the amount of time you had to wait to be seen. And that is a systemic problem.

I think the only sure way to avoid triage is to come in on a blue light so if it happens again don't feel bad about calling an ambulance

Yeah good point tbh. I hadn’t thought of that. The little quiet older lady not wanting to make a fuss would be seen last and might actually be having a stroke. But would be last because she seemed ok. That sort of thing

That sounds awful. I’ve been to A&E a couple of times with acute pancreatitis and I was seen almost immediately and never left the triage, they took me straight through to majors both times. Pretty sure all A&Es will triage on severity.

My husband was blue-lighted to hospital, he was taken straight in and dealt with straight away. NHS 111 called the ambulance. The ambulance took about 15 minutes to arrive. It was quite busy as well. I was (pleasantly) surprised.
OP, I think ambulance is the way to go, paramedics are brilliant.

When I called 111 for my son, they asked if it was possible for me to take him to A&E myself because the wait for an ambulance was 6 hours.

Triage from what I’ve experienced is based on order in which you come in (the first point of contact doesn’t know what’s wrong with you) so that’s why triage. Then people get filtered in to different departments so some may not be seen by a doctor but advanced nurse practitioner etc and so more severe cases will be referred to particular departments etc

A&Es vary on how they stream or triage on arrival but your hospital had a near miss in your case and I think you are being very reasonable under the circumstances

NHS is struggling so I mean this as a learning point for your A&E, please think about giving feedback of your experience to PALs so they can consider reviewing their triage system in busier periods - it will save lives.

If it happens again I would say “I’ve previously had heart block and I have a feeling of impending doom” which (previous ambulance dispatcher) would make me go “uh oh”

I’m a doctor (medical not A&E so see patients like you once referred to medicine) and I think this is shocking. It is a ridiculous wait for triage and means those who are the sickest can’t be seen quickly enough. Plenty of people use A&E inappropriately but I think that’s partly a symptom of underfunded GP surgeries and a lack of investment in the nhs. And partly people not realising that the emergency department is for emergency’s like the OP had.

It works differently in different hospitals.

Our hospital has HCAs in A&E who do obs on arrival (temperature, blood pressure, heart rate etc) before triage and every hour while patients are waiting so anyone who needs to be seen urgently or is deteriorating can be prioritised. Another local hospital has a registrar (doctor) doing triage during busy periods.

Sorry you had such a bad experience.

Where I work, everyone is triaged first and then seen based on the severity of their condition. However, not everyone in the A&E waiting area is on the same “pathway.” Patients with minor injuries are often waiting for different staff, so someone with something like a sore finger may be taken in before you as they are in a completely separate “queue.” We also have patients who are referred in for specific things, such as an X-ray and they are again seen through a different “queue.”

Waited in A&E with my 89 year old Mum for nearly 15 hours...
Suspected fractured coccyx and hip but she still had to sit on a hard chair for hours...
Triage was up to 3 hours and then 6 on top of that to see a doctor.

I must have been lucky, or maybe our hospital do things differently. I reported to reception that I had tonsillitis but I was worried I had sepsis. I was triaged within 15 minutes, within another 20 minutes I’d had blood tests and was in a room on a drip.

I can’t fault the treatment I had. Several bags of fluid, IV steroids, IV paracetamol and several lots of IV antibiotics. I was really impressed.

I think staff do have some discretion in their decision making. When I took my daughter to A and E with breathing difficulties, they took one look at her and brought her straight in, bypassing triage. She was having her first asthma attack, with low oxygen saturations.

An hour and a half to triage sounds too long.

Yeah similar. Sat waiting ages for triage with palpitations, and when I finally got seen I was in fast AF and rushed through to resus.

One hospital I worked in had a senior nurse on the door and would decide how quickly you needed triaging. That worked well.

I went my local A&E about 2 weeks ago. Triage took an hour. It used to be done within about 10 minutes. I was shocked to be honest, if uou're very seriously unwell you could deteriorate a lot in that time. A friend of mine recently had a massive DVT. He was 3 minutes drive away from a major London trauma centre. He got in a cab and went to A&E. If he had waited an hour for triage, he might have died.

At my local hospital, we have urgent care next to A&E, Anyone with a sore finger goes there.

I was recently taken by ambulance to A&E for serious agonising stomach ache after calling 111. They told me to sit in a chair where I had to wait for an hour to be triaged and they checked my heart and then left me alone for 10 hours. The issue was completely unconnected to my heart and by the time I ended up in resus with sepsis. It was a complete nightmare as I was given the wrong drugs (despite me telling everyone what I was allergic to) and had a reaction so needed even more attention. It was chaos and I now dread ever needed to go there again. The A&E waiting room in our hospital doesn't even have sufficient chairs for the patients waiting to be seen (and the plastic chairs they do have are really uncomfortable).

OP you should have been prioritised! I would be putting in a complaint. You rights feared you were going to die- and you could have!

When I went to A&E with a known insect venom bite allergy I was triaged very quickly, sent into a bay for immediate life saving treatment and then waited for a couple of hours for further treatment. In another A&E when I had life threatening asthma I had to wait to be triaged. Different hospital, different systems. I know where I would go in future.

Agree with this, it highly depends. We live 10 mins walk from A&E and once they have suggested we go under our own steam (I thought I'd dislocated my knee so DH drove me!) and obviously I could wait in the waiting room, and an ambulance would not be tied up for hours but was miles away. Same thing happened when DS had a fit as a baby - we walked him down in his buggy because he was too rigid to get in the car seat
But when he had a lengthy fit more recently and when he was knocked over by a car they took him in an ambulance, the ambulance could come quickly both times thankfully. The car accident was about as minor as you can get and he could have walked but they didn't want us to wait.

My next door neighbour has heart failure, she was sent in by her GP with a heart beat of 160 per min. She sat in A&E for 11 hours before being admitted on a bed and given medication to try get her heart to slow down.

She was told next time go by ambulance, no messing around because going through the normal A&E route with heart failure is risky.

Glad doing better OP, hope getting all the help you need. x

I had a health scare recently and was given a tip by my gp, assuming out of hours (in hours ring gp) to call 111 because if they triage you are needing hospital care triage are expecting you and it’s quicker, she also said 111 can advise which a&e to use, we have 3 equidistant time wise

No, read it again.