At least these ED’s aren’t randomly closing due to strikes caused by serious underfunding and running out if resuscitation beds
For those who don’t know…. ED = ERECTILE DYSFUNCTION /s
If they’re managing to wait 90 hours for a bed then it probably wasn’t an emergency in the first place…
I wonder how many of these people could have been treated by their GP or at an injury clinic?
First time I read the headline I was wondering why patients with Erectile Dysfunction waited 80-90 hours
Think it’s bad now, just wait until the post-holiday Covid wave is in full swing…
Queue the “Well if they were waiting that long were they really that ill…” comments.
Weird hill to die on for alot of people, not everyone who goes to A&E goes for the craic.
People get recommended by GPs incase there’s an emergency.
Was only in Beaumount A&E the other week and a man in his 70s who fell and hit his head was left sitting in a chair all day & night, the man could barely hold himself up and was vomiting. Doctor wouldn’t even get him a wheelchair for walking down to get a scan, tell me how that’s not deplorable behaviour.
I would say that that is actually very uncommon.
I thought I might offer a little perspective of the issues facing the ED staff. Also, I’m not casting blame when I say issue, it’s an inconvenience that has arisen due to the system. I’ve worked in different hospital departments, ranging from busy urban to more rural ones, across 3 counties. Lets say you have a cough and you’re getting worse, so you decide to head to the ED on a Saturday night.
1. **Reception. Hour 0**. All patients register with reception, who confirm your personal details (Name, age, phone number, etc). This is your first stop, whether you have self presented or been referred by your GP. These people have the patience of saints, they encounter a shocking amount of abuse but remain unbelievably professional. You can skip triage and go into the emergency department directly if:
You’re brought in by an ambulance or if you look like sick (serious injury, difficulty breathing, unconscious, etc).
* Issues:
* A small proportion of people call the ambulance for non-medical reasons (usually due to transportation issues) and a very very small proportion (there have been 1-2 patients in each of the places I’ve worked in) do so for convenience (An elderly gentleman is a small town would call an ambulance fairly regularly after a few pints on a Friday night, sleep in the ED for a few hours then catch the morning bus home. On second thought, I suppose he had a transportation issue as well.)
2.**Triage. Hour 1** The triage team calls you in to record your complaint, check your vitals and order any tests (bloods, imaging, urine sample, etc). They are usually excellent and very experienced nurses, and occasionally doctors. Depending on where you are in the country a consultant or senior emergency registrar will see you in triage, take your history, treat you and discharge you before you even get inside! After your assessment they give you a triage score ranging from 1-5. If your triage score is 1, you need immediate, treatment for a time sensitive illnesses, like a stroke or a seizure. This is what the staff have trained for, they will move you to the resuscitation area (resus), pull staff from other patients and treat you asap.
5 is non-urgent, aka, you don’t need to be here.
Patient charts are then placed in the central station and a doctor will pick up the next chart in order of score and time spent in ED.
* ISSUES:
* Your score essentially determines the order in which you will be seen. 1’s will be seen first, then 2’s then 3’s, etc. For the sake of this example lets say you’re a 3 (You’re coughing but your heart rate, oxygen levels and blood pressure are normal) and you’re next in the stack but a 2 shows up, then tough luck.
* If a member of the triage team wants to bring a patient into the department, they need to bring them to the relevant area (sprains/strains/fractures go to injuries unit, chest pains to chest pain units, so on and so forth). Now they can only do so if there’s a place to put the patient, be it a trolley or a chair near/inside the unit). They hand you over to a nurse that is responsible for you.
This can be absolute pain in the ass for everyone. So who is taking up beds? Patients waiting to be seen, patients waiting for results, patients waiting for a decision and those waiting for a bed on the ward (we call these admitted patients). They are often the ones who are waiting for an obscene amount of time.
3 . **Your nurse. Hour 3**. I have never been as grateful to work with a group of healthcare professionals as ED nurses. They genuinely care about every single patient that is under them, it’s astounding. They work 12 hours shifts, 3-4 days in a row, switching between days and nights and in some places, run the department. They are your biggest advocates while you’re under their care and they will do literally anything to help you, from making you a cup of tea, to finding you a phone charger. They go above and beyond what can be reasonably expected from any healthcare professional and some people have the gall to abuse them.
* ISSUES:
* Nurses can end up with 10, or more patients, under their care at once. These are patients that they have to monitor constantly by checking their vitals, doing bloods, catheters, ECGs (heart tracing), dress wounds and god knows what else. If you start declining, they’re the ones that usually notice and alert the doctor. The ratio is just not sustainable. Both the patients and the nurses deserve better conditions.
4 .**Your ED doctor. Hour 5** . You’ll usually meet an emergency doctor first, they can be either specialising in the field or on a rotation as part of a different specialty or as a stand alone job (that’s someone who is not specialising). The person you meet will vary in experience, confidence and ability. Junior doctors are told to discuss EVERY patient that they see with a senior doctor and are told NOT to discharge you until they do. If they feel that you need to be seen by a doctor of a different speciality (medicine, surgery, gynaecology, etc) then they’ll assess you and refer you to them. In this scenario, lets your cough is a pneumonia and you need IV antibiotics after they’ve looked at your xray and bloods, so the medical team will see you.
* ISSUES:
* Most doctors in the ED see multiple patients at the same time and they’re expected to make a decision within 6 hours to either admit or discharge you. (it’s a national mandate whose name I’ve forgotten and the HSE audits the waiting times and informs the hospital, some emergency departments can hit 90% which is impressive!). If everything is running smoothly it’s easy enough, but if there’s an emergency they might be pulled away for an hour. Your blood sample clotted, so it has to be repeated. They did not select the correct type of xray and had to re-book it. A good day to turn to absolute hell with a series of small setbacks.
* They make mistakes. Usually small ones, but there are safety nets in place to prevent that, namely senior doctors and nurses. Still, I’ve seen patients who have been treated inappropriately, misdiagnosed, or discharged prematurely. The more pressure there is on them, the more mistakes they make, it’s human nature and they’re only human. But they work relentlessly despite unsociable shifts (18:00 to 6:00 anyone?), difficult patients and the constant fear of killing a patient (for the first few years at least).
5 . **Your medical doctor. Hour 10** The ED doctor refers you to the on-call team. Medical teams are usually the biggest amongst the on-call teams, varying from 1-2 senior doctors to 2-6 junior doctors for the entire hospital on a Saturday.
They’ll take a detailed history, order more tests if needed and decide the management plan for the night, until your consultant sees you the next morning. They tell the nurse in charge in ED that they want to admit you. The nurse then contacts the bed manager or nursing manager, who will find you a bed in the appropriate ward.
* ISSUES:
* The medical on call team are responsible for every since patient in a medical ward in the hospital and for admitting new patients. Depending on the set up, you can have 2 doctors to admit patients and 1 to manage ALL the other medical patients. They do help each other out of course but it’s madness. You can start a shift and find that there are 12 patients who might need admission in the ED and they’re waiting for your assessment. If your patient is stable and straightforward then you thank your lucky stars, write a note and move on. If not, then they’re now YOUR responsibility, even if they’re still in ED. The ED doctors still help out if they can of course. What if there’s a stroke? whoops, there goes your senior doctor. Someone fell in the ward and hit their head? The other junior doctor won’t be coming to help you anytime soon. You might be wondering why you’ve been waiting 12 hours to see your doctor? Because they graduated medical school 1 year ago and are now responsible for an absurd amount of patients.
6 . **We need to admit you. Hour ??**. You’ve finally made it to the end, they want to keep you, you want to stay and all’s well. They are going to find you a bed on the ward any second now. Well, probably not at night because there might not be free beds depending on how many people were admitted yesterday and how many were discharged but definitely in the morning! And it is a Saturday so not all the services are available. You might need to wait until Monday for your CT scan because your xray looks unusual and they want to make sure a tumour is not hiding behind among the infected lung, or you might need an ECHO because your heart tracing is a little unusual.
It’s important to note that most people get discharged from the Department, something like 80-90% of people will go home with treatment and GP follow up or outpatient appointment.
But we’ll get you a comfy bed. Hang on, your cough could be due to covid so you need to be in a cubicle until your swab comes back so you won’t infect any other patients, so you can’t be on a open ward with 6 people to a room. And don’t forget the relevant ward.
There’s no single solution to the problem but more staff members, purpose built emergency departments and staff retention will make a difference.
It’s not fair to blame the patients for presenting unnecessarily (except maybe Mr. Friday Pints), people come because they’re scared. How could you possibly expect someone to know if their chest pain is because of indigestion or a heart attack? We have a range of tests and even we can’t tell sometimes.
Also food, if you ever want to show your appreciation to anyone in the emergency department send them food. Seriously.
**Special mention to the Healthcare assistant who do their utmost to preserve your dignity in the chaos of the department and porters who somehow manage to make you laugh as they wheel you and your broken leg around the place**.
8 comments
At least these ED’s aren’t randomly closing due to strikes caused by serious underfunding and running out if resuscitation beds
For those who don’t know…. ED = ERECTILE DYSFUNCTION /s
If they’re managing to wait 90 hours for a bed then it probably wasn’t an emergency in the first place…
I wonder how many of these people could have been treated by their GP or at an injury clinic?
First time I read the headline I was wondering why patients with Erectile Dysfunction waited 80-90 hours
Think it’s bad now, just wait until the post-holiday Covid wave is in full swing…
Queue the “Well if they were waiting that long were they really that ill…” comments.
Weird hill to die on for alot of people, not everyone who goes to A&E goes for the craic.
People get recommended by GPs incase there’s an emergency.
Was only in Beaumount A&E the other week and a man in his 70s who fell and hit his head was left sitting in a chair all day & night, the man could barely hold himself up and was vomiting. Doctor wouldn’t even get him a wheelchair for walking down to get a scan, tell me how that’s not deplorable behaviour.
I would say that that is actually very uncommon.
I thought I might offer a little perspective of the issues facing the ED staff. Also, I’m not casting blame when I say issue, it’s an inconvenience that has arisen due to the system. I’ve worked in different hospital departments, ranging from busy urban to more rural ones, across 3 counties. Lets say you have a cough and you’re getting worse, so you decide to head to the ED on a Saturday night.
1. **Reception. Hour 0**. All patients register with reception, who confirm your personal details (Name, age, phone number, etc). This is your first stop, whether you have self presented or been referred by your GP. These people have the patience of saints, they encounter a shocking amount of abuse but remain unbelievably professional. You can skip triage and go into the emergency department directly if:
You’re brought in by an ambulance or if you look like sick (serious injury, difficulty breathing, unconscious, etc).
* Issues:
* A small proportion of people call the ambulance for non-medical reasons (usually due to transportation issues) and a very very small proportion (there have been 1-2 patients in each of the places I’ve worked in) do so for convenience (An elderly gentleman is a small town would call an ambulance fairly regularly after a few pints on a Friday night, sleep in the ED for a few hours then catch the morning bus home. On second thought, I suppose he had a transportation issue as well.)
2.**Triage. Hour 1** The triage team calls you in to record your complaint, check your vitals and order any tests (bloods, imaging, urine sample, etc). They are usually excellent and very experienced nurses, and occasionally doctors. Depending on where you are in the country a consultant or senior emergency registrar will see you in triage, take your history, treat you and discharge you before you even get inside! After your assessment they give you a triage score ranging from 1-5. If your triage score is 1, you need immediate, treatment for a time sensitive illnesses, like a stroke or a seizure. This is what the staff have trained for, they will move you to the resuscitation area (resus), pull staff from other patients and treat you asap.
5 is non-urgent, aka, you don’t need to be here.
Patient charts are then placed in the central station and a doctor will pick up the next chart in order of score and time spent in ED.
* ISSUES:
* Your score essentially determines the order in which you will be seen. 1’s will be seen first, then 2’s then 3’s, etc. For the sake of this example lets say you’re a 3 (You’re coughing but your heart rate, oxygen levels and blood pressure are normal) and you’re next in the stack but a 2 shows up, then tough luck.
* If a member of the triage team wants to bring a patient into the department, they need to bring them to the relevant area (sprains/strains/fractures go to injuries unit, chest pains to chest pain units, so on and so forth). Now they can only do so if there’s a place to put the patient, be it a trolley or a chair near/inside the unit). They hand you over to a nurse that is responsible for you.
This can be absolute pain in the ass for everyone. So who is taking up beds? Patients waiting to be seen, patients waiting for results, patients waiting for a decision and those waiting for a bed on the ward (we call these admitted patients). They are often the ones who are waiting for an obscene amount of time.
3 . **Your nurse. Hour 3**. I have never been as grateful to work with a group of healthcare professionals as ED nurses. They genuinely care about every single patient that is under them, it’s astounding. They work 12 hours shifts, 3-4 days in a row, switching between days and nights and in some places, run the department. They are your biggest advocates while you’re under their care and they will do literally anything to help you, from making you a cup of tea, to finding you a phone charger. They go above and beyond what can be reasonably expected from any healthcare professional and some people have the gall to abuse them.
* ISSUES:
* Nurses can end up with 10, or more patients, under their care at once. These are patients that they have to monitor constantly by checking their vitals, doing bloods, catheters, ECGs (heart tracing), dress wounds and god knows what else. If you start declining, they’re the ones that usually notice and alert the doctor. The ratio is just not sustainable. Both the patients and the nurses deserve better conditions.
4 .**Your ED doctor. Hour 5** . You’ll usually meet an emergency doctor first, they can be either specialising in the field or on a rotation as part of a different specialty or as a stand alone job (that’s someone who is not specialising). The person you meet will vary in experience, confidence and ability. Junior doctors are told to discuss EVERY patient that they see with a senior doctor and are told NOT to discharge you until they do. If they feel that you need to be seen by a doctor of a different speciality (medicine, surgery, gynaecology, etc) then they’ll assess you and refer you to them. In this scenario, lets your cough is a pneumonia and you need IV antibiotics after they’ve looked at your xray and bloods, so the medical team will see you.
* ISSUES:
* Most doctors in the ED see multiple patients at the same time and they’re expected to make a decision within 6 hours to either admit or discharge you. (it’s a national mandate whose name I’ve forgotten and the HSE audits the waiting times and informs the hospital, some emergency departments can hit 90% which is impressive!). If everything is running smoothly it’s easy enough, but if there’s an emergency they might be pulled away for an hour. Your blood sample clotted, so it has to be repeated. They did not select the correct type of xray and had to re-book it. A good day to turn to absolute hell with a series of small setbacks.
* They make mistakes. Usually small ones, but there are safety nets in place to prevent that, namely senior doctors and nurses. Still, I’ve seen patients who have been treated inappropriately, misdiagnosed, or discharged prematurely. The more pressure there is on them, the more mistakes they make, it’s human nature and they’re only human. But they work relentlessly despite unsociable shifts (18:00 to 6:00 anyone?), difficult patients and the constant fear of killing a patient (for the first few years at least).
5 . **Your medical doctor. Hour 10** The ED doctor refers you to the on-call team. Medical teams are usually the biggest amongst the on-call teams, varying from 1-2 senior doctors to 2-6 junior doctors for the entire hospital on a Saturday.
They’ll take a detailed history, order more tests if needed and decide the management plan for the night, until your consultant sees you the next morning. They tell the nurse in charge in ED that they want to admit you. The nurse then contacts the bed manager or nursing manager, who will find you a bed in the appropriate ward.
* ISSUES:
* The medical on call team are responsible for every since patient in a medical ward in the hospital and for admitting new patients. Depending on the set up, you can have 2 doctors to admit patients and 1 to manage ALL the other medical patients. They do help each other out of course but it’s madness. You can start a shift and find that there are 12 patients who might need admission in the ED and they’re waiting for your assessment. If your patient is stable and straightforward then you thank your lucky stars, write a note and move on. If not, then they’re now YOUR responsibility, even if they’re still in ED. The ED doctors still help out if they can of course. What if there’s a stroke? whoops, there goes your senior doctor. Someone fell in the ward and hit their head? The other junior doctor won’t be coming to help you anytime soon. You might be wondering why you’ve been waiting 12 hours to see your doctor? Because they graduated medical school 1 year ago and are now responsible for an absurd amount of patients.
6 . **We need to admit you. Hour ??**. You’ve finally made it to the end, they want to keep you, you want to stay and all’s well. They are going to find you a bed on the ward any second now. Well, probably not at night because there might not be free beds depending on how many people were admitted yesterday and how many were discharged but definitely in the morning! And it is a Saturday so not all the services are available. You might need to wait until Monday for your CT scan because your xray looks unusual and they want to make sure a tumour is not hiding behind among the infected lung, or you might need an ECHO because your heart tracing is a little unusual.
It’s important to note that most people get discharged from the Department, something like 80-90% of people will go home with treatment and GP follow up or outpatient appointment.
But we’ll get you a comfy bed. Hang on, your cough could be due to covid so you need to be in a cubicle until your swab comes back so you won’t infect any other patients, so you can’t be on a open ward with 6 people to a room. And don’t forget the relevant ward.
There’s no single solution to the problem but more staff members, purpose built emergency departments and staff retention will make a difference.
It’s not fair to blame the patients for presenting unnecessarily (except maybe Mr. Friday Pints), people come because they’re scared. How could you possibly expect someone to know if their chest pain is because of indigestion or a heart attack? We have a range of tests and even we can’t tell sometimes.
Also food, if you ever want to show your appreciation to anyone in the emergency department send them food. Seriously.
**Special mention to the Healthcare assistant who do their utmost to preserve your dignity in the chaos of the department and porters who somehow manage to make you laugh as they wheel you and your broken leg around the place**.
Sorry, that got a bit ramble-y…