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

Yeah I was. It was the long wait to be triaged and I was so unwell in the meantime that was the problem. Honestly ive never been so frightened in my life- i knew something was really wrong and it was scary just having to wait it out x

Agree that its not the staffs fault. They are fantastic.
The fault is that there are too many people in this country for a and e to be able to cope with the amount of people coming through the doors. Even a member of staff in my a and e said the same. Same reason for it being almost impossible to get a doctors appointment.

I think my local hospital works well for triage. They essentially have a 2-stage triage. First triage is within minutes of arriving. Sats probe on finger. 'Why are you here?' If HR or O2 sats are very bad, they whisk you through to the RAaT (Rapid assessment and triage) bay. If it isn't terrible, you sit back down.

Stage 2 is a more in-depth set of obs and brief history. That nurse decides what initial investigations are needed. Normally bloods +/- cannula. Then they escort you to either minors or majors.

From there the wait can be prolonged, but they'll start IV antibiotics/fluids in the waiting room if necessary..

We've still had some quite scary experiences. DH was triaged as being able to sit in majors when he actually had a CRP in the 600s and was on his way to sepsis. When they saw his results and his chest x-ray they whisked him around to a bay. The triage nurse actually remembered is a few weeks later when I had to attend with DD1 and said 'I'm sorry, I missed that one. I should have seen his lactate.'

Took DS to ED last week after much debate. Wob and high resp rate not responding to inhaler.

Of course we walked in and he looks bright as a button and he knows the place well so went straight to the play area. I could see his breathing was bad but I'm positive they looked at him and thought nah he's ok. Of course get triaged and his resps are 40+ and sats in mid 80's, so they start calling Drs and getting oxygen therapy etc.
He's fine now.

We've often seen thea particular nurse on previous visits and she just triages straight away on arrival, but she wasn't there on this occasion. Some people just don't look sick, in fact personally I had 2 lengthy hospital stays about 10 years ago when initially the Dr/ENP thought I was fine and were talking about sending me home until my bloods came back. I knew I was ill, but how do you get that across?

So I agree, it's not a perfect system. Glad you are OK now. I think mentioning you've been admitted previously must help.

Same. And my daughter has asthma and frequent hospital visits. Got her to a&e, oxygen in the 80s rushed right through for a nebulizer.

I had the same, I dislocated my shoulder in a horse fall, no ambulance available as I wasn’t classed as a priority - they advised DH to bring me to A&E which he did - checked in on a screen, said it was a dislocation, 2pm on a Monday afternoon - A&E was standing room only, I propped myself against a wall and sent my husband to the pharmacy to get any kind of painkillers. Ended up almost fainting after an hour and DH went to front desk to ask if anyone could get me somewhere to sit - to be fair once he explained my injury they got me seen quickly but had I been alone I have no clue what would have happened. I had amazing care once I was seen but the first bit doesn’t make any sense to me. I’m sorry you had such a frightening experience and hope you are recovering well.

Calling an ambulance isn’t always the answer either, my mum had a stroke and the ambulance took 8 hrs.
if I was in A&E in your condition and wanted to be seen earlier, I’d have just collapsed on the floor and started fitting. Kind of accelerate the triage.
mind you I went into A&E with a non serious head cut which just needed some stitches and despite bleeding onto the floor still didn’t get moved up the triage list. When I came out the large puddle of congealed blood was still there

Just curious as I've been taken into A + E a number of times by ambulance in Ireland. Straight away my BP and heart rate are checked. I always alarm them because I have usually a tachycardia of 130 bpm. And highish BP. I imagine the same thing happens in the UK and Northern Ireland? One of those times I had along with the high BP and tachycardia, a feeling of dread and it turned out my phosphate level was only 0.29 and my potassium was 3.1. I was in danger of having a heart attack. Another time I had had a minor surgery earlier that day but because they hadn't packed the wound correctly it started bleeding again and wouldn't stop despite all the first aid measures I knew of being applied. I was rushed straight into the second most serious case zone and had an adrenaline wick stuffed straight into the wound along with an adrenaline injection into it as well. Extremely painful but it stopped the bleeding straight away.

Oops. Should have said by etc is checked as soon as I land in the ambulance. Then they stick a heart monitor on me.

Sounds a very scary experience OP, hope you are ok now?

The last time I was in A+E, I was lucky in that my condition was so obvious (haemorrhage), I was seen immediately and straight through for treatment before they could complete triage.

Yes same for me. As soon as the reception saw me I was taken to resus. Luckily otherwise I wouldn’t be here now. I had called an ambulance but they said I wasn’t a priority.

I was lucky that the paramedics wheeled me straight into resus, but they had already done an ecg and got a line in, had radioed ahead so I was expected.
I don't think I would have survived trying to get there any other way.
What was terrifying for me was the 999 call handler's absolute refusal to send anyone. She decided a call back in 2 hours would be fine.
Luckily my dh managed to convince her superior after 15 minutes of begging.
It can be very hit and miss.

Please don’t pretend to have a seizure in the waiting room, it’s actually really obvious to staff and it distracts from the really sick people for the time it takes to check whether it’s real or not! Do you really want to be known as a time waster faking seizures as I can safely say it’ll be recorded in your notes and next time you attend staff will see that

I would never do that.

besides, I was feeling so unwell I could barely even properly hold my head up tbh, I don’t think I could even process things properly let alone consider the idea of pretending to have a seizure!

I have a heart condition and have to say the speed of triage in my local A&E has always been good.

The problem with OP's situation is that by default the unqualified receptionist is triaging and deciding that it is OK for someone to wait their turn. If she/he thought that someone was in dire need they could flag this up. Seeing someone throwing up could easily just be a tummy bug, but she/he is not in a position to make that call and decide whether to flag it up.

I did have one very bad experience in A&E while on holiday in Wales. They missed a heart attack - which is pretty basic - in spite of me telling them my previous cardiac history. They sent me out with a diagnosis of oesophageal spasm. I brought this up with their PALS team after my return home and proper diagnosis and treatment from my home hospital. To be fair to them they took it very seriously and I was shown the papers from their subsequent enquiry and the changes in protocols and staff training that ensued.

So - if I were you I would bring it up with PALs. Sometimes they come up trumps.

Problem is if you do this it's usually fairly obvious to any clinician what's going on, unless you're very well practised any pretend/functional seizure just looks farcical. Then when you end up with a report/coding on your records that establishes to other clinicians you fake illness/symptoms you'll never get taken seriously again.

In my a&e you are seen first by a nurse, they then flow you to a&e / urgent care / pharmacy / whatever. They take very scant details and it’s one minute. They also make a note on priority. Reception then complete the booking.

When I presented with a post operative infection that was progressing rapidly towards sepsis I was triaged within five minutes of sitting down and then was straight into majors.

When I’ve been in with a severe sprain or an eye injury I’ve been sat for far longer before full triage.

I would say what they are doing is dangerous potentially and report to PALS your experience for it to be reviewed.

When dh took ds2 to a and e, the man who was stood outside to make sure nobody was parking where they shouldn't rushed in and came out with a nurse and a wheelchair. They bundled ds2 into the wheelchair and ran with him to resus.