A and E waiting times

Trampas

rant so sorry.

My gf has been down in A and E since 2 today and still hasn't seen a doctor. It is shocking. I know the staff are doing there best but all the drunks and people strung out is shocking. They should be left outside till they sober or come down.

Some old lady went home after a fall as they told her she will be atleast another 6 hours.

Why do hospital departments close down at weekends.

Medical is not a mon - fri company it is a 24/7 company.

I cant wait for the knocks on my door as I will be needed to be held back.

Of back to the hospital I go.

Its great to see my taxes been well spent

And she is down as an urgent case

rant over

I've never had long waiting times in the A&E department, thankfully. Think the longest I've ever had to wait is.. uhm .. 5-6 hours?

But wouldn't you be better off waiting for your girlfriend in the hospital rather than being here complaining bout it?

InFront

Now now op, there have been "vast improvements" in the health service, and there will be many more improvements "going forward".

Sorry to hear that by the way, which hospital was it in?

seamus

It's been like this a long time. I went into A & E in Crumlin 14 years ago at 7pm on a Friday, and didn't get seen until 12.30am. I had a broken kneecap, but had to stay overnight and couldn't get an Xray as the radiologist had gone home at 12.

I gave myself some fairly serious facial lacerations one morning back in January. I rang all the A & Es in Dublin, all except James's said they were out the door. So I went to the VHI clinic in Dundrum. For about an extra E50 (I had no insurance) I was in & out in under 90 minutes. And MRSA free. Money well spent IMO.

Blondie86Star

Ive only been to a&e once and had to wait only 2 hours, that was on a tuesday morning, not busy. But my brother went a few weeks ago and was there for 11 hours. The docs n nurses cant do much, they have to take in the drunks, waste of taxpayers money imo

Nala

So basically if i was to break my leg in the morning I'd be sitting there in horrendous pain for like 12 hours???

mikemac

Only been in A&E once, and was seen on the spot, no waiting time as I was the only person there.
In fairness, it was a Tuesday night so no drunks and it was Nenagh, so not exactly the busiest hospital around.

Never been near a hospital since and hoping to keep it that way

Rhyme

Only been in A&E a few times and have only experience the waiting times people talk about once... twas Hell.

Two of the my other visits involved serious chest pain (turned out to be a spontaneous pneumothorax [collapsed lung]) so i was seen instantly even though i'm only 21.

But as seamus said, for some cases it might be best to head to a clinic. A fair amount of people in A&E probably don't need to be there.

seamus

Nala wrote:

So basically if i was to break my leg in the morning I'd be sitting there in horrendous pain for like 12 hours???

Actually, breaking a limb doesn't hurt all that much unless you try to move it

You could easily be sitting there for 12 hours.

Basically they prioritise patients based on the following three criteria (in order):

1, Who is the most serious?
2. Who is likely to cause trouble to patients and staff?
3. Who is making the most noise?

If you sit there quiet as a mouse with your broken leg, then these people will get seen before you, regardless of what time they arrive at.

ronbyrne2005

The system is a mess despite the vast amount of money thrown at it(We spend more per capita than countries with world class health systems despite having a young population which is a lot less sicker as a whole). The likes of radiologists and other specialists/technicians not being available 24hrs a day on demand is a joke. Drunks and druggies dont actually cause much delay and there are security officers available to throw them out if they become violent, they are noisy and highly visable but they dont take up much time of the medical staff. Theres numerous reasons for the bottle neck in a&e which need to be fixed rapidly but unions are holding up reform in the sector. The government have thrown money at the problem with little reform and accountability. Do you think the government wants the health system to be the way it is? No, obviously not, and we can only conclude that the billions they are spending each year with good intentions is not being used effectively. But taking on the 100,000 unionised workers in the health system is long drawn out process.

sam34

seamus wrote:

Basically they prioritise patients based on the following three criteria (in order):

1, Who is the most serious?
2. Who is likely to cause trouble to patients and staff?
3. Who is making the most noise?

If you sit there quiet as a mouse with your broken leg, then these people will get seen before you, regardless of what time they arrive at.

thats just blatantly untrue. people are prioritised based on clinical need, and then the most urgent are seen first. furthermore, people are categorised into "major" (eg potential heart attack) and "minor" (eg piece of glass in finger). there are different medical teams assigned to majors and minors, so at any time one queue may be moving faster than the other. Most minors can be seen and sorted quickly enough, which is why a minor case can come in after a major case like a broken leg and yet be seen first.

also, suppose someone cant be sorted out in casualty and needs to be admitted or at least seen by either a surgeon or physician. well, the patients will be waiting until that doc is free. but the surgeon might be in theatre, or the physician might be in intensive care with someone, hence the delay and uneven waiting times.

but shouting and "making noise" will not help and may even end up with you being escorted out by security!

Schlemm

That Swiftcare clinic is the way to go if you need to be seen urgently, unfortunatley it's just another reminder of how those who can afford healthcare will get better treatment in this country. I suppose in reality there will always be a difference of some sorts between private and public healthcare, but it shouldn't be that big.

What I don't understand is why GP's can't do more of the A&E type work for some of the minor problems in their own clinics, eg, stitches, X-rays for minor fractures, IV treatment for minor burns, or whatever. An X-ray doesn't take that long to take, develop, and analyse, especially if it's not too serious! I guess a lot of it is due to legal issues with medical negligence cases and insurance premia....

luckat

They say you can judge a society by its jails and schools (and we certainly fall down there).

You can certainly also judge it by its healthcare, and Ireland is failing its citizens and inhabitants badly in this.

Yes, GPs should do A&E. GPs should also have practice nurses, as they do in England, where every GP practice has a nurse who deals with things like taking blood pressure, blood tests and weights, renewing prescriptions, etc.

As for the drunks, yes, it's horrible to go in and find a lot of drunk and stoned people waiting for treatment - but to be realistic, if one gets drunk, one's more likely to cut off one's thumb with a carving knife or drop the barbecue on one's foot.

We just need a proper national health service, paid for out of the taxes, with preventative medicine part of the mix, and basic efficiency central. And an attitude of idealism.

If you want good treatment, go to France. Or Cuba.

zuutroy

I dislocated a finger last night and was seen, x-rayed and strapped up within 2.5 hours and they were apologetic about the wait. How can other countries manage it. Do Iirish people just hurt themselves more?

gazzer

My friend collapsed at home last Tuesday night. He is only 25 and when he woke up his heart was racing. His girlfriend brought him straight to Tallaght Hospital (Tuesday 11pm). He was on a trolley in the corrider in A and E from 5am on Wednesday morning till 6pm on Thursday evening and then he eventually got a bed in a ward... Disgraceful

The Muppet

My daughter broke her wrist last Sunday . She went into Beaumont at 9.30 pm she got out at 10.45 on Monday morning. She was seen soon after she went in but was then left sitting the waiting area for an xray to be taken.
It's scandelous.

Traumadoc

I have worked in both private and public hospitals the main difference is that the public system is trying to improve the situation by increasing effiency.

This seems to be done by increasing the number of managers.

It does not work.

The private system when there is more demand builds more capacity – there have been plenty of new private beds created but no public beds.
(The public system is like a bussing company with one mini-bus that responds to increased demand by making the drivers go faster, instead of buying a bigger bus)

When you are waiting in the emergency department the reason is often because there is no space to see you. There is often an elderly patient in the cubicle that you should be seen in, with nowhere to go.


You also have to remember that there is not one queue in the emergency department but 5 separate queues. If you have a condition that is unlikely to kill you, it’s the slow queue.

The Swiftcare clinic generally do not see you if you have a condition that is likely to kill you , so that they do not have elderly patients blocking the cubicles so they can see you in a planned timed way- It works very well.

tallus

seamus wrote:

Actually, breaking a limb doesn't hurt all that much unless you try to move it

Ok, I broke my femur and distal radius a number of years back and I can tell you it was extremly sore on both breaks, my femur was shattered which didn't help pain wise but I certainly disagree that it doesn't hurt unless you move I was in total agony . I was left on a trolley for a number of hours in the mater hosp after a road traffic accident, no laughing matter I have to ad.

sam34

Schlemm wrote:

.
What I don't understand is why GP's can't do more of the A&E type work for some of the minor problems in their own clinics, eg, stitches, X-rays for minor fractures, IV treatment for minor burns, or whatever. An X-ray doesn't take that long to take, develop, and analyse, especially if it's not too serious! I guess a lot of it is due to legal issues with medical negligence cases and insurance premia....

firstly, a lot of patients bypass their gp and head straightto casualty with even minor problems. i really dont know why people do this, as the a&e waiting time is well known and most a&e depts charge if you walk in off the street with no gp referral.
gp's can certainly suture and im sure would be happy to do a lot more suturing, except the patients dont present to the gp. as for xrays, im not sure. if the gp does the xray, he/she will have to read it, and most gps do not have any qualification in radiology. some minor or hairline fractures can be very difficult to see. then, if the gp finds a fracture, well they'll have to deal with it, ie have a plaster cast facility on their premisis, an be able to cast, or else have a nurse or technician who can. its a lot of equipment, expense, risk and time to invest, considering that they prob wouldnt see too many people with fractures anyway.

re IV for minor burns- its impractical to send patients home with an iv line set up and a bag running in. what happens when the line tissues or falls out or gets blocked? who decides if a second bag of fluid is needed? who hangs that bag? not practical.

things like fractures, burns etc will need to be seen in a&e - they're the "accident" part of a&e. a lot of the people presenting to the "emergency" part are not in fact emergencies and can & should be treated by GPs. they are the cause of a lot of the backlog.

Wisheress

Trampas wrote:

rant so sorry.

My gf has been down in A and E since 2 today and still hasn't seen a doctor. It is shocking. I know the staff are doing there best but all the drunks and people strung out is shocking. They should be left outside till they sober or come down.

Some old lady went home after a fall as they told her she will be atleast another 6 hours.

Why do hospital departments close down at weekends.

Medical is not a mon - fri company it is a 24/7 company.

I cant wait for the knocks on my door as I will be needed to be held back.

Of back to the hospital I go.

Its great to see my taxes been well spent

And she is down as an urgent case

rant over

Hi Trampas,

I'm a doctor who has just finished a 36 hour shift in A+E. Several people I saw waited 11 hours or more. I am sleep deprived now and had 2 digestive biscuits all day so excuse me if I rant now or am not as articulate as I should be.

I am ashamed of the system I work in. I work in one of the busiest A+ E departments in the country. The waiting times are ridiculous. We just do not have the staff not the facilities to cope (not just at weekends). Every week when I finish a long shift, I question my ability to continue to work in this field. It is heartbreaking to see unwell patients who have waited such a long time and then must spend time on a trolley or even a chair for the night. Most of us would find it impossible to spend a night on a hard trolley/chair even when entirely well. Imagine having to do so when you’ve an awful pneumonia or multiple seizures. The people in this country deserve better. I am gutted that this happens every day. I can only apologise to my patients that they should have to bear such an experience. I ask them to write to Harney, to ask her to funnel her money into basic A+E facilities instead of paying people who walk around with clipboards. I ask them to ask for more community services. We need more clinics and operating theatre time. There are always doctors and nurses working at the weekend, we just need more. It not just about not having certain staff members in at weekends, the backlogs are equally bad during the week. Mondays tend to be horrendously busy. The crisis is due to all the factors I've mentioned before and until the HSE start asking hospital staff how to address issues, we'll never get anywhere.

Please don’t tell me Minister ,that you have added hundreds more beds since your election. Hundreds of such beds lie empty because we do not have the staff to manage them. For the record, I have no issue with taking a big pay cut in the future as a consultant. I have no problem with coming in at weekends, as I do now, for the rest of my working life. I have no issue with working evenings and nights. That’s what I signed up to. I do however oppose the new consultants contract proposed by Harney which states that new consultants will not have team (i.e. no registrar/house officer/intern) and no guaranteed access for their patients to nurse specialists, physiotherapists etc. The new contract also states that non-medics (the people with clipboards) can overrule a doctor who feels that a patient really needs a medication. We will also not be allowed to criticise the hospital system ‘if it brings down the name of the hospital’. I would not allow my own parents to be treated by anyone with this new contract. But that’s another argument.

OP, to address your issue with the patients who are drunk/take drugs. The thing is that we cannot just leave them out in the waiting room. Unsurprisingly, some of them fall over whilst drunk, hit their heads and thus end up with brain haemorrhages and the like that need urgent neurosurgical input. Some go into life threatening fulminant liver failure. I have seen three people in their 20s who took cocaine and then developed strokes in the last 4 months. One of these female patients has been left with debilitating left sided paralysis and is now in a wheelchair. The point I’m trying to make is that until these patients are assessed by a doctor we don’t know if they are simply drunk/off their heads or else if they’ve developed life threatening complications of alcohol/substance misuse. I don’t know if that explanation makes it any easier to understand why we can’t neglect any subset of patients. I hope it does.

By the way, I don’t think private hospitals for in-patients are the answer. In general private hospitals don’t provide urgent care which makes up most of the cases treated in public hospitals. Private hospitals are limited in provision of intensive care and rehabilitation too. And why should we have a two-tier system? And why of why did I see and elderly patient in hospital last night who had spent 600 days in hospital even thought her initial pneumonia only lasted 10 days?!! Why has funding for care packages for these elderly patients rapidly declined recently…they have even been discontinued in some areas. We need more long term nursing home beds now.

Let me tell you a quick story. Last year the Minister for Health came to visit our department. The ‘people with clipboards’ were everywhere. I was ready to tell her (calmly!) about the shortcomings of the system. I acknowledge that by and large, the political parties may have the health interests of the nation at heart, but I wanted to highlight the real situation as it is on the ground, the resources we need, how we can save money and still achieve better patient care. Anyhow I started my shift that day and was shocked as soon as I walked into the department. The place was almost empty. All the trolleys normally taking up every inch of floor space had been moved. The cubicles were largely empty too. It turned out the administration of the hospital (who are non-medical) had opened up a ward that normally remains closed, moved A+E patients up to the empty beds, and low and behold when the Minister arrived, the place was stunningly empty. The visiting party were whisked through the department in seconds, they did not stop to speak to any doctors or nurses. We were not given a chance to even approach them. I tried. They left with the impression that the fuss about A+E was imagined. The next day things were back to normal.

I said earlier that I am ashamed of the system. I am however immensely proud of the doctors, nurses, physiotherapists, social workers, porters and all the other staff who work in our hospitals. It is my confidence in the ability of all these staff that keeps me going as a doctor. I know that when you do eventually get seen in A+E, we will do our very best to make you better. I know that some of you have had negative experiences too, it would be silly to deny that, but overall I feel that the staff in Irish hospitals are second to none. We are trained brilliantly in this country (just google your own consultant and see how well they’re known worldwide!) and for that I am grateful.

OP, I agree that medicine is “not a Monday-Friday company”. The sad thing is that even during the week, when ancillary services are in full swing, the waiting times are still ridiculous. The system needs to be overhauled.

I’m going to stop now. Sorry if I went on and on. There is so much I want to say and so much that we are trying to change.

I really hope that your girlfriend feels better now.

All the best

W

maxi-twist

Nala wrote:

So basically if i was to break my leg in the morning I'd be sitting there in horrendous pain for like 12 hours???

If you come in in an ambulance and your properly injured u get priority,when i broke my leg i was waiting for around 7/8 hours but that wasnt the doctors fault as i was actually waiting for a bed in the hospital rather than doctors.

timmywex

maxi-twist wrote:

If you come in in an ambulance and your properly injured u get priority.

thats wrong, if you are serious and come in an ambualnce, you get priority, but a lot of the time, the paramedics will just put you in the waiting room, they know that some people just called them to try skip the wait

mike65

Wisheress, we could with more of this kind of first-hand insider reportage on boards. Its easy to have a moan when on the outside. As for the Minsterial visit clean-up, thats no suprise at all. Is like the Queen and fresh paint, she smells it all the time. Government ministers get the same distorted vision, it would have been a good idea to photograph the wards before hand and then
send the snaps to her e-mail.

Mike.

RoundyMooney

Wisheress, thank you for an excellent and thought provoking contribution.

Attempting to shore up a failing system from within is probably the most frustrating thing that someone can experience in their working life.

I for one would never blame the people in the front-line, but I can only imagine the aggravation that unthinking, vulnerable and justifiably frustrated patients can inflict on doctors and nurses who are trying to make the best of a bad lot.

All I'll say is, there's an election on, people. Make this an issue, because it isn't funny any more.

Necronomicon

I'm just back from the A&E. Probably not the most accurate reflection because it's sunday morning, but it was pretty quiet. After being seen to pretty quickly, had to wait about an hour to be seen to again, then another twenty minutes or so for the X-ray. I was in and out in about 2 hours or so, maybe a tad more.

crazy_dude6662

i have experiance of hospitals in NY and in Dublin.
my sister is an asthmatic, she went to the hospital a few years ago fpr a severe allergic reaction/asthma attack, in A & E she was set up on a drip and what not and just left. fair enough doctors have other things to do, a nurse came in and gave her pain medication, my sister asked what it was, it turned out she had been handed nurofen which asthmatics arnt supposed to have. my sister had to tell the nurse this.
the nurse had looked at her chart before giving her the medicine.
my sister had to point out her error. she was twelve at the time. it took them 5 days to get her a bed that wasnt in A & E.
my sister was told to call the a nurse when the IV was empty. it took 5 hours for them to switch it even though she had called the nurse numourous times.

in NY on a class trip to NY 18 people in total got sick. we were brought into the hospital in ambulances. they checked us in and got us into beds and we were given drips. we were then moved into wards. this took less then half an hour. there were nurses every hour or so to make sure everything was okay. they got us a DVD player and TV to watch DVDs. there was also a gamecube attached to play video games.
when we left we were given teddies. not once did we have to wait if we pressed the intercom thingy.

skyhighflyer

Wisheress, it would be great if some or all of your post could be used as an open letter to Mary Harney and the rest of the people charged with the administration of our health service because I think that in about a thousand words or so you've summed up exactly what's wrong with our health service, but also given me some optimism that with some serious changes there is hope. Thanks for posting.

Schlemm

then, if the gp finds a fracture, well they'll have to deal with it, ie have a plaster cast facility on their premisis, an be able to cast, or else have a nurse or technician who can. its a lot of equipment, expense, risk and time to invest, considering that they prob wouldnt see too many people with fractures anyway.

Perhaps they could give GP's extra training in reading X-rays, and if they found a complicated fracture, then they could refer to a hospital/A&E. Casting isn't that hard to do, yes there would be more risks involved for GP's if they were to fix minor fracutres, but at least they wouldn't be taking up A&E. Or else there could be special clinics that deal with minor-ish fractures only,eg, where the fracture isn't posing a huge risk to the patient, just to take the pressure off the A&E people. Just for comparison, if your dog breaks its leg, you take it to your regular vet, not to a big vet hospital unless it's a major emergency. Why can't they do the same for people? Is it all about risks and insurance premia?

I wonder as well that for minor elective surgery, such as tonsilectomy or wisdom teeth extraction, etc. would there ever be special clinics available for this sort of work rather than having these patients taking up space and beds in hospitals? If you go in to have your tonsils out, you'll prob get a bed, but if you present with an emergency situation, you might find yourself on a trolley, in need of a lot more attention than the tonsil patient! I know that there's a clinic in Dublin that do GP stuff but they also do minor surgery eg, cyst removal and biopsy.

Attol

crazy_dude6662 wrote:

.

in NY on a class trip to NY 18 people in total got sick. we were brought into the hospital in ambulances. they checked us in and got us into beds and we were given drips. we were then moved into wards. this took less then half an hour. there were nurses every hour or so to make sure everything was okay. they got us a DVD player and TV to watch DVDs. there was also a gamecube attached to play video games.
when we left we were given teddies. not once did we have to wait if we pressed the intercom thingy.

Bear in mind that the hospitals there are run as a business. Had you not had all the relevant medical insurance you wouldn't have been seen at all without paying thousands of dollars. I think it's silly to compare something so different. People in America can't always afford medical care as it is shockingly expensive. Despite the failings of the Irish system I'd rather be injured here than in the States if I wasn't insured. Saying that there could definately be many improvements made.

Wertz

sam34 wrote:

firstly, a lot of patients bypass their gp and head straightto casualty with even minor problems. i really dont know why people do this, as the a&e waiting time is well known and most a&e depts charge if you walk in off the street with no gp referral.

The problem with people not going to their doctor/GP is again down to the 9-5 Mon-Fri work regeime of the entire health service.
There is either a very limited or totally non-existant out of hours service or doctor on call service in the country especially outside major urban centres.
Even when doctor's surgerys are open for business, you then usually need an appointment, and your 50 quid fee and whatever....the perception with a lot of people is that the GP wil simply tell them to go to A&E or will refer them where they ned up paying another fee whilst joinging the growing queue that's full of everyone else who couldn't avail of a GP's services.

The HSE can put on as many ad campaigns as they like asking people to go to GPs instead of A&E but until we gte with the times in thsi country and realise that people get sick and injured on a round-the-clock basis, not just during office hours, those ad caompaigns are (another) waste of resources by the HSE.

sam34

Wertz wrote:

The problem with people not going to their doctor/GP is again down to the 9-5 Mon-Fri work regeime of the entire health service.
QUOTE]

I've worked for many years as a doctor in the health service and i can assure you it is not a 9 to 5 mon-fri regime. nowim not looking for sympathy, all i want to do is correct the above misconception. the demands of various teams and services that ive been on mean that i have often routinely worked from 7am to 6pm as a "regular" day, and on top of that have worked on call, whereby you come in on monday morn and go home tuesday evening, or worse, come in saturday morning and go home monday evening, having been on duty for 57 hours or so, more than most people work in a regular week. you may get sleep, but you may not, or you may only get 30 mins here and there. so wertz, excuse me if i snigger with derision when u state that the entire health service works 9 to 5 mon to fri.