Sunday, 20 March 2016

Beware the Ides of March

This is not the post that I had intended to write on return from our trip Down Under, but as John lennon once said 'life is what happens while you are busy making other plans.' However, I really did not plan to spend last Tuesday evening in the A&E department of our local hospital. Ironically it just happened to be 15 March which is the Ides of March!

I had never experienced an A&E department from the patient's point of view before and I hope that I never have to again. My husband had collided with the wall while playing squash early on Tuesday evening, hitting his head and badly cutting it in two places. At the squash club someone managed to staunch the bleeding and put a temporary bandage on his head, then take him down to A&E at the local hospital. By the time that I got there just before 8 pm he had been waiting for 30 to 40 minutes and he had to wait until about 10.15 pm before being moved into the treatment area. Then there was a wait of another hour before he was seen by a doctor. So that was a wait of four hours for a head injury to be treated. If my interpretation of the NICE guidelines on head injuries is correct he should have been seen no later than one hour after arriving in A&E.

As the evening unfolded I had watched in horrified amazement at the running of the A&E department. As the patients arrive they take a ticket from a machine, then wait for the number to flash up outside the cubicle of the streaming nurse, who they are then able to see. She takes their temperature and blood pressure and asks a few basic questions so that she can prioritise the patient's place in the queue of patients waiting to be seen. The patient returns to the waiting area until called by the booking clerk who takes their name and address etc.There was a steady stream of patients coming into A&E, but not many moving out into the treatment area, with the result that by about 10 pm there must have been about 40 patients waiting to be seen. From the manner in which some of them sauntered in, they had obviously been there before and knew the form. For some it seemed to be social occasion. The couple sitting behind us were discussing the royal family and speculating on Prince Harry's paternity, while another couple sat in the corner reading the newspaper as if it were a convenient and warm place to spend a Winter's evening. Some patients came in alone. Others seemed to bring the whole family. On the wall was a large television screen - everywhere has them now. I was amused to see the hospital soap Holby City was on - nothing like the real thing! I do not watch the soaps. I had to look at a TV schedule to work out what it was, but just fancy going to A&E and seeing that on the TV there!

It was obvious to me that not more than half a dozen of the 40 or so patients were real accidents or emergencies. When husband was waiting to be treated I overheard the doctors discussing some of the patients and saying that they should have been referred to the out of hours GP service. Others I suspect should have gone to see their own GP. This should have been identified by the streaming nurse, who was hopelessly out of her depth. I was all eyes and ears. That evening they apparently had treated several constipated children. Then there was a young child who had helped himself to some paracetamol suspension, whose father was convinced that he had taken an overdose, but the doctor worked out from the amount that was in the bottle before and after the child had taken a swig, that he had not imbibed very much at all. The father was sent home with a lecture about keeping the paracetamol suspension out of the child's reach. Some people should not have children.

Shortly after husband was moved into the treatment cubicle the patient in the adjacent cubicle jumped off the treatment couch and walked off, fed up with waiting. The doctor in charge said that he was not going to pursue him, as he turned up every week with some problem or other. Next into the adjacent cubicle was a young man with a plaster cast on his arm, who had missed a fracture clinic appointment. The cast had become uncomfortable, so where else would you go with this problem than A&E? He had arrived at A&E a good hour and a half after husband and got seen before him! They removed the plaster cast and sent him for an x-ray, but they could not do much for him as he really needed to go to the fracture clinic. Meanwhile husband, with a bloody bandage on his head, and I patiently waited to be seen, feeling as we had become invisible.

Around 11.15 pm a young doctor came to assess husband and removed the bloody bandage from his head at last. During the evening I had thought about doing this myself to see if the cuts could be held together with steristrips, but had not done so partly because husband winced when I touched his head and partly because I had nothing with me that I could swab the cuts with. As it happened steristrips would not have done the job. The smaller cut in his hair was glued together, while the larger and deeper cut on his forehead required six stitches. By now it was after midnight and at last time to go home.


Maggie May said...

I'm not the least bet surprised to read this.
Our A&E departments are in crisis.
I recently heard of one person going to a Small Injury Clinic, only to be told to go to A&E so they wasted several hours doing this in order not to clog up the system. She was then admitted to hospital from A&E after a six hour wait, only to be discharged again in the night. The next morning she was rushed to A&E by ambulance and had an emergency operation that day.
Lets hope we all remain healthy and accident free! It's our only hope!
Maggie x

the fly in the web said...

I'm so sorry that you had this worry about your husband.
It does sound as if the triage nurse was out of her depth...

We experienced the 'emergencias' here recently: it was a Cecil B. de Mille scene, but there was a very efficient senior doctor doing the weeding out and keeping things moving while junior doctors circulated keeping an eye on patients awaiting tests.

I don't think anyone who should have been seeing their GP would have lasted half an hour before being turfed out.

cheshire wife said...

Maggie - you are right, but it should not be like this.

Fly - more like Carry on Nurse here. The doctors need to be more involved in the initial screening.