The madness

tallaght01

I usually do neonatal medicine. BUT, as part of my general paediatrics commitment I've spent the last couple of months in paeds A+E. It's an interesting job, and very enjoyable, despite being the worst hours I've ever worked.

I'm fascinated by the rubish that people take their kids to A+E with, though. Today I sent home an ingrown toenail and a kid with an eyelash in his eye within an hour of each other!

I have to say I'm pretty leniant with regard to the rubbish. I just send them home with a pat on the head. Most of my colleagues bollock the parents, which is fair enough as they've been in the game for years and it gets pretty frustrating. PLus I enjoy the pace of A+E. It's busy enough, but it's not quite as high intensity as neonates, which is nice for a while.

I'm also fascinated about the timing of A+E visits. People sit around for weeks while their kid has a funny rash. Then on a sunday morning, the parents suddenly get bored of their kid being spotty, so they bring it to A+E to get it sorted. I do find that kind of annoying.

I've also developed an appreciation of the kind of stuff the GPs look after for weeks in their surgeries before referring them up. Fair play to them. A GP sent us up a kid the other day who'd he's been visting twice a day to monitor his hydration status during a severe bout of D+V. Eventually, he realised he was fighting a losing battle and the kid was going to have to be admitted to hospital. But, it's GPs like that who make you think that the GP stereotype mongst many hospital docs (ie they send anything that looks in any ways taxing to hospital) isn't actually true in a lot of cases.

Don't get me wrong. We get some god-awful referrals from GPs. But they mostly do a good job in difficult circumstances.

A+E is also a nice specialty insofar as you can fix a lot of stuff there and then. You clan click a pulled elbow back into place, as I did today. You can give ibuprofen and paracetamol to a pyrexial kiddy and come back an hour later to see them playing with the toys in the department. You can very easily glue a laceration nicely shut in 5 mins. There's a lot of satisfied customers out there, which surprised me. I only ever hear bad things about A+E. I guess it's just the unhappy people who make the most noise. But I'm glad to say I think most people walk away from our department satisfied.

I don't really know what I'm trying to achieve with this post, or what point I'm trying to make. Just thought I'd share my new experiences, and see what anyone else who has A+E experience thinks?

oneeyedsnake

My one gripe about A and E is that it always seems to be chronically understaffed.

eth0_

oneeyedsnake wrote:

My one gripe about A and E is that it always seems to be chronically understaffed.

How can you say that having read the original post? Any time i've had to go to A+E it's been a frustrating experience due to the long waits caused by exactly the cases tallaght01 just mentioned.

It's a pity these people can't be sent back to their GP after being triaged by a nurse on arrival...

King.Penguin

great post thanks!

Vorsprung

I'm doing a 6 week elective in the A&E dept of a big Dublin teaching hospital, and for the last week I've found myself down in the minors section where there is only 1 doctor and myself, yet at any one time there could be 6 people waiting to be seen by one of us. It's not too bad with 2 of us there, but since there's only 2 nurses, casts/dressings etc can take a while, and since there's no plaster nurses assigned to the dept, patient's can be waiting a while unfortunately.

Then we have admitted patients (who haven't got beds yet) taking up spaces in the minors area, so today we only had 2 of our 6 rooms available for us! I was doing phlebotomy on chairs in the corridor just to try to keep things moving. In the rest of the dept, admitted patients take up most of the space, there are plenty of cubicles for the patients still under the care of the A&E staff.

It's all about the beds!

Just on the timing of visits, our consultant has a saying - "11 by 11" ie from handover at 8am, 11 new medical patients will be in by 11am. It's strangely accurate.