I've posted this in chat

[underneaththeash]

So my DS(14) fell out of a tree yesterday evening and broke his arm - it was obviously broken and he was in a lot of pain. I put it in a sling and rung 111 and we were 30mins late for minor injuries, so A&E it was.

So, I wasn't expecting Saturday evening to be great, but when we got there at 9pm, there were 5 patients in the first waiting room, all with someone with them.

He was triaged within an hour and x-rayed within the next 20 minutes. Then sent to the next waiting area which had 10 patients in it including him. Some people also had a helper with them, including a. After a couple of hours, most of us had started chatting and I looked at the eye of px (f) and been to reception to say that was the likely diagnosis and they'd asked an ophthalmologist to come down to have a look.

2 (a&b) were having obvious mental health crises, one poor guy had a towel covering his head as he clearly couldn't manage seeing anyone/anything.
The other woman started banging her head on the wall and was actually taken though quickly - although they didn't clean the blood off the wall - I did after an hour.

2 (c&d) had back issues, the man had been waiting for a discectomy for 2 years and was disabled and the woman had been told to attend a&E by 111 - she had slight pins and needles in one of her hands consistent with a disc prolapse. She was perfectly mobile.

There was lady with a baby who had a suspect DVT. (e)

The man with uveitis (f)

Someone with a suspected broken toe. (g)

someone who had a chesty cough and couldn't get an appointment with their doctor (h)

A (very overweight) woman with swollen calves, who did actually leave after 2.5 hours (i)

DS was taken through to a cubicle at 3am, having arrived at 9pm. He was exhausted and in pain. We finally left at 5am. There was no transport to get us anywhere and no taxis available and we had to walk to the nearest hotel.

So what is the answer?
(a) and (b) shouldn't have been there in the first place, mental health services need to improve massively and there needs to be specialist support.
(c) should have had his op. (d) shouldn't have been told to go to A&E in the first place - (g) &(h) should have been turned away from A&E
(e) should have been seen preferentially.

The other major issue when we actually went through to a cubicle was the utter lack of urgency by any of the healthcare staff. No-one seemed that bothered about doing their job quickly. There was lots of chatting, wandering. Our cubicle was filthy. I did pop round to take sure there hadn't been a massive emergency, but everything was really quiet in the trauma part. I also know that August is rotation time for junior doctors and they need to learn.

I really think there needs to be a complete overhaul of the NHS - higher earners like me need to pay more, but something felt fundamentally wrong.

OP's posts:
See next
See all
Add message
Report

underneaththeash · Yesterday 22:07

Oh and I also forgot to mention that I'm an Optometrist and i did work for the NHS for 6 months - the bureaucracy drove me mad. But, I'm used to seeing a lot of patients in close succession.

I would like some ideas.

Stopped reading at 'higher earners like me'

I'm not sure this post is especially helpful. When you say staff were sat around doing nothing with no urgency you don't really understand how limited we are with the resources in ED. Eg to see the next patient we need a room. Most rooms were full overnight of bedded patients waiting for a ward bed. So we couldn't see anyone until a room was cleared and then cleaned. I would get new sheets and wipe things down myself but sometimes a deep clean is needed for ?covids. It made us look like we were sat around chilling. We waited for hours for some bloods to come back for some patients. We couldn't refer them onto the admitting team until they were back as understandably they don't accept half a referral. Same with patients awaiting x ray. As a junior in ED I'd wait a fair while often for the x rays to be done as the radiographers had a backlog. They also have to do all urgent chest x rays within the hospital overnight - and they have to take the portable chunky x ray machine with them so it can take an age. The same radiographer doing x rays might be covering CT scans too which was in a different end of the hospital so we would have a bottleneck of patients waiting for either. And then it takes >90 mins sometimes to get a report back anyway. We'd be one doctor down most of the night as anyone needing a CT with contrast overnight needed to have a doctor accompany them in case of anaphylaxis as we had no radiologists on site. Furthermore FY1s/SHOs need to wait until a Reg is done seeing his current patient to get them to check our patients' x rays/discuss cases and treatment plans as they all have to be double checked, so an even longer wait behind the scenes when again, it can look like we are doing nothing. A full rota in my ED last year was 2 registrars and 2 SHOs/FY1s. That was it. 4 of us all night. An arrest/peri arrest can take all 4 of you out instantly but actually many patients take 2; we do procedures such as nerve blocks, joint reductions under anaesthesia/sedation, difficult cannulas under ultrasound, ultrasound bedside scans for a huge number of patients that come in with abdo pain and more. They take a huge chunk of our time.

I know my post is long but emergnecy medicine is a hugely varied specialty that just doesn't permit for you to get through a decent number of complex patients in a short space of time. We're very limited in what we can offer in some circumstances and patients need so much more (eg the mental health patients). We are drowning and it's not just a case of us working more efficiently. The system is so broken, we can't. ED is not like a clinic of similar pathologies where all the equipment is in the room and there are quick solutions and a small number of common outcomes. The quick patients are usually streamed very well to minor injuries (less so at night but then very few minor injuries come in overnight anyway) and seen by acute care practitioners (who are fantastic) so the bulk of true ED patients are long and challenging cases to sort. Sometimes the easiest outcome it to admit but then we wait 24 hours for a bed to come up. What do we do in the meantime? We still provide care to these patients of course. So we have bedded wards within ED of sick patients awaiting a ward bed and of course the existing ED staff still have to care and treat them all too. This was a tiny district general and having 125 patients + in the department at night wasn't unusual. It didn't look busy but there was more to it than that

I used to love the odd broken arm / head injury at night as they were straightforward! I do not miss ED one bit. By the time I'd finished that job I was broken, it really was awful.

I think my email has