A&E Peads never want to root cause creating viscous cycle

[jamesc25]

Hello all, long term viewer but first time post. My 2 year old DS has ended up in A&E a few times due to illness/viruses that worsen and won’t clear. On one of the occasions he had to stay in for nearly a week with IV antibiotics. On every visit we have a battle trying to get anyone to actually help root cause anything. They are so on their knees that they send everyone home after the 5 hour wait as long as they are not “clinically unwell”.

This time our DS has has diarrhoea for 11 days and then started being sick late last night for the first time but to the point where his body was shutting down and started passing out. We were told by the doctor (Not a peads doctor as they had a shortage) that they are happy for this to go on for longer until they do something and would need major signs before investigating. Most of the NHS advice says not to leave it, yet the doctors are happy for it to drag.

Does anyone else feel like our little ones are being made to get to the point of being very unwell and back in hospital due to no prevention? It seems to be counter intuitive to let people get seriously unwell.

Outside of the A&E visits we are paying privately to try and work out why he can’t shake illnesses off without it always ending up in a hospital visit but struggling to find a cause, so we end up with this vicious circle of hospital battles and 5 hours of our DS being ill laying on the waiting room floor.

I am a very strong willed person and I will fight to ensure we are not fobbed off, however, it’s like talking to a brick wall. My biggest fear is if he then does get to the point of needing urgent attention unless you aren’t breathing the ambulance wait time is 20 hours, if you then choose to drive directly like we did last night, there is no one to even see you at the reception desk.

Interested to know if anyone else feels like they have this battle? I spoke to a lot of parents last night that seemed to feel like they were waiting for 5 hours to just be sent away again.

I have nurses in the family so am very aware of the NHS stretch but every-time I come away they are horrified at the outcome.

Many thanks in advance!

A and E ate there to treat the immediate issue and stabilise the patient for discharge or admission. If you need investigations you need to go via gp and access outpatient/consultant care.

I agree with LIZS. It is not the role of A and E to find that cause. That is for the GP.
Have you seen the GP?

Sorry I have to disagree, the GP sends us there! I would agree with you both if there were tests that could be done outside of this but they would be long term tests not immediate to find the issue.

For example checking bloods to see if infection markers are raised would need to be done via the hospital. Bloods via the GP are a week wait for peads bloods.

As an example last time I had to fight at the hospital for them to test. They then did bloods and his CA125 was majorly raised. They would have sent us home and completely missed him needing the IV.

Sorry CRP*

In the immediate situation the GP may advise A and E attendance but that’s not the same as expecting a referral to arise from A and E because it won’t.
I have a child that ends up in hospital with chest infections so I feel for you.
My advice would be to arrange a GP appointment when your DC is well (if bloods etc are to be taken it’s good to have a “baseline”) and ask their views on making a consultant referral.
Obviously I don’t know your DC but could it be food allergies/intolerances, dehydration will lead to becoming very unwell (do they get a lot of fluid especially if they have diahorrea)?
Id suggest creating a diary - of what eaten/drunk/ bowel movements etc and see if you recognise any patterns.
And sorry to be a nuisance- was the IV antibiotics for a chest infection or stomach/digestive system… something else?

GP should not be sending you to A and E though. They can refer direct to Paed outpatients for blood tests etc.

Has your DC had Covid-19?

A and E are there to firefight, fix you up, send you home, refer you to your GP.... not diagnose long term conditions.

If the gp thinks there is an actual problem, they would be referring to a paediatrician.

Do you have health anxiety either for yourself or your child?

Your GP manages chronic illnesses . A and E manages acute/ emergency flare ups and essentially are there to determine whether or not you are safe to go home. . Both can refer to Paeds for specialist input either as an inpatient or outpatient.
it would be the Paeds team who would advise on root cause investigations which might be done by them or requested by your GP.
Some toddlers just get run down by a run of infections a cause will often not be found.

It would never be A and E who do root cause analysis though. It is not their job. ( hospital consultant)

A&e will never do route cause analysis. The don't refer to paeds, that would be your gps job

Sorry have i confused things by using the term root cause? I don’t mean the reoccurring issue, I mean this current issue. He has had diarrhoea for nearly 12 days and they say just keep going until he basically is floppy.

if you then choose to drive directly [to A&E] like we did last night, there is no one to even see you at the reception desk

Just flagging this up as it's important. This also happens at the A&E Department at my city's major hospital. Casualty it ain't.

People being advised by GPs and 111 to get themselves to A&E by car or taxi are being faced with tumbleweed.

Thank you for your compassion, sorry you have also been through it.

Last time it was a fever, he often has fevers over 40c that won’t go for weeks.

The doctor outside of this episode is doing base line bloods and also checking for Coeliac but they always use A&E for the intimidate issue.

Yes he had covid a month or so ago. Oddly it was one he actually recovered quickly from, but I know thats more normal with children. It didn’t hang like the others have.

Couldn’t agree more. It’s scary to see and all the parents there said the same.

In my dc's case, GP actually contacted paed directly and sent to be seen in paed dept, not A&E.
So maybe next time if they tell you to go to A&E, ask them to refer you to paed directly instead?

Thank you thats great advice. I think there is a gap between GP’s and A&E and maybe this is what we needed.

No I just have a poorly child and we know that we are struggling to get the help for him during flare ups of illness like this that then quickly escalate.

Seems a very insensitive odd comment.

If the person (adult or child) is stable then you get sent home, if not they admit you. A&e don't investigate. You need to see your gp

I am not sure if this is an area based thing but where is this gp support everyone speaks of here. Of course they can refer but when my DS has diarrhoea that won’t clear we fall down a hole between the two.

Agree with others. You need to approach this from a different angle / view it differently. Phone GP and ask for referral to proper dept - be that Paed's or bowel section. Only that way will you get a referral to the right dept, for them to look at underlying issue.

You don't seem to be reading, or understanding the advice being given. You need to approach it differently. Ring GP tomorrow. Ask for referral. Do you get it now?

Rude. I enjoy how you think its that easy.

How is it rude? I'm trying to help you! Have you talked to your GP about being referred to the appropriate consultant, re trying to find the route cause? Has GP refused to do so? If so, that your starting point. Ask GP again. If they refuse, speak to Practice Manager.
A referral to the right consultant is the best route. Do you dispute this?How is that rude?