A&E Crisis made worse by people who shouldn't be there?

NIMAN

http://www.independent.ie/irish-news/health/50000-walk-out-of-ae-as-waitingtime-crisis-deepens-34737633.html

So 50,000 people walk out of A&Es because they are fed up waiting?

If you are able to walk out and head off home, maybe you shouldn't have been there in the first place?

sullivlo

It's a tough one and depends on why you're in A&E in the first place.

I've, unfortunately, had to play the waiting game lots of times in A&E. The people in the waiting room vary from the genuinely sick, the accidents, the ones who have been sent up by their GP, the time wasters, the drunks, the druggies, the people who have nowhere else to go...

I've been in A&E late at night when a GP would be able to fix the problem that people present with, but as the GP isn't open, they end up in hospital.

There are also cases of people hurting themselves in sports or wherever, and heading up to A&E for it to be checked out, and then leaving because of the queue.

Then there are people who do need to be there, but leave because of the queue. I had a friend a few years ago who presented to A&E with suicidal intentions and lethal means (she had gone to her GP and was sent up to A&E for a psych evaluation), but was told that the wait was a few hours. She waited, and waited, and waited. She wasn't being seen and she was really distressed, so she just left.

When she was brought back in later that evening after taking an overdose and cutting herself, she was seen almost immediately.

sullivlo

Also, there is a high number of patients brought in by ambulance that just need to sleep off their drugs or booze - they tend to walk out without being seen.

kneemos

Got fed up after waiting seven or eight hours with no end in sight probably.
If they didn't need to be there they should be triaged and sent home.

stimpson

We need drunk tanks. A big padded room with blankets and a doctor to check on them now and again and a couple of burly guards. Double the price of A and E visit for pissheads and halve it for everyone else.

NIMAN

kneemos wrote: »

Got fed up after waiting seven or eight hours with no end in sight probably.
If they didn't need to be there they should be triaged and sent home.

If they didn't need to be there, they shouldn't have been.

Too many people walk into A&E when its not an emergency. To be checked and assessed takes up man hours.

If you are genuinely ill and in need of emergency treatment, you'll not walk out.

lawlolawl

Been there with both of my parents a few times in the past couple of years and i also know a couple of A&E nurses.

Full of pissheads and junkies wasting time and space.

gctest50

NIMAN wrote: »

A&E Crisis made worse by people who shouldn't be there?

The HSE ?


with staff half dead on their feet ?

Wibbs

sullivlo wrote: »

I've, unfortunately, had to play the waiting game lots of times in A&E. The people in the waiting room vary from the genuinely sick, the accidents, the ones who have been sent up by their GP, the time wasters, the drunks, the druggies, the people who have nowhere else to go...

I've had to attend A&E myself pretty regularly(with elderly relatives) and the ones I underlined in your post numbered at least half of the other attendants. Maybe I was unlucky on those days? Certainly it's a minuscule sample size, but it did make a strong impression on me. And in all but one case this wasn't a weekend night(or a Monday morning after the weekend before). Where it might be expected that the drunks would be out in force. I've also noted - and again small sample size - that over the last decade GP's seem to be much more a case of "oh it's not a sniffle or an owie, so get to A&E with you". The younger the GP the more likely this seems to be. I've also too many times been behind somebody with something a GP could easily attend to, but the person went straight to A&E.

NIMAN

I wonder are GPs ever taken up if they have an exceptionally higher number of people referred to A&E?

Is it even recorded and analysed?

Widdershins

I've been to A&E a few times when someone needed an investigation like a scan and their GP felt they couldn't wait for weeks for an appointment.
People have suggested they should've called an ambulance to be seen faster but to me, an ambulance is for even more urgent situations. Ten hours waiting and no sign of a doctor, though. (Once,when they eventually admitted, sat on a trolley for a night and a day, then moved to a bed and ignored for 36 hours while they were under a nil by mouth order, with no real idea what was happening. Told different things and nothing was actually done) People have jobs and families waiting. Even sick or in pain, life has to go on. That's one reason why people get up and leave.

While we waited we heard two men chatting. One said to the other, your doctor could have fixed you up. ''But the doctor here is better and gives you better pills''!

Widdershins

I've been to A&E a few times when someone needed an investigation like a scan and their GP felt they couldn't wait for weeks for an appointment.
People have suggested they should've called an ambulance to be seen faster but to me, an ambulance is for even more urgent situations. Ten hours waiting and no sign of a doctor, though. (Once,when they eventually admitted, sat on a trolley for a night and a day, then moved to a bed and ignored for 36 hours while they were under a nil by mouth order, with no real idea what was happening. Told different things at the start and nothing was actually done) People have jobs and families waiting. Even sick or in pain, life has to go on. That's one reason why people get up and leave.
I think it then goes down on your medical history as ''this patient declined medical treatment'' or something like that.
While we waited we heard two men chatting. One said to the other, your doctor could have fixed you up. ''But the doctor here is better and gives you better pills''!

JustShon

My experience of A&E is that it's nearly always filled with drunks and druggies.

That said I have been one of the people who didn't need to be there. I was very very sick, throbbing headache and felt too weak to move around much. Sounds like I needed a doctor right? That's the thing, got a doctor out to the apartment and he sent me on to A&E via ambulance. Doctors in the hospital gave me a handful of tablets, let me rest for a few hours and sent me on my way. They were baffled as to why the doctor didn't just give me the tablets and tell me stay in bed for a while.

Borderfox

Ended up in a&e about three times with broken bones surrounded by drunks and drug addicts (Mater, daytime) so anytime now I head to the switches clinic and pays my money or the d-doc up in Navan (which is a great service)

NIMAN

Maybe if RTE Investigates did a proper documentary on the crisis, they could show us the kind of people and type of emergencies that are actually causing the crisis, instead of just talking about it.

If A&Es are half full of drunks and druggies, or people with a headache or a flu, it needs to be highlighted.

JustShon

NIMAN wrote: »

Maybe if RTE Investigates did a proper documentary on the crisis, they could show us the kind of people and type of emergencies that are actually causing the crisis, instead of just talking about it.

If A&Es are half full of drunks and druggies, or people with a headache or a flu, it needs to be highlighted.

The last time I was in A&E my mam got talking to one of the... I don't know what to call them, "people" there.

One member of the family was in for alcohol poisoning, another of them was in with his arms all cut up from some kind of fight or other and the rest of the family just decided they go along for the trip.

They made a family outing of it, brought in kebabs and chips and a few bags of crisps. They looked very used to sitting around A&E for hours. I'd wager one or more of them winds up drunk and injured in the A&E at least once a week.

sullivlo

Wibbs wrote: »

I've had to attend A&E myself pretty regularly(with elderly relatives) and the ones I underlined in your post numbered at least half of the other attendants. Maybe I was unlucky on those days? Certainly it's a minuscule sample size, but it did make a strong impression on me. And in all but one case this wasn't a weekend night(or a Monday morning after the weekend before). Where it might be expected that the drunks would be out in force. I've also noted - and again small sample size - that over the last decade GP's seem to be much more a case of "oh it's not a sniffle or an owie, so get to A&E with you". The younger the GP the more likely this seems to be. I've also too many times been behind somebody with something a GP could easily attend to, but the person went straight to A&E.

Yes. There is most definitely an issue with the number of GP referrals.

Taking myself as an example.

1) I have a chronic tummy issue. When it flares up, I know what I need. When I lived in Cork, my GP was very happy to give me what I needed to avoid a trip to A&E. Any time I DO go to A&E with the issue, I do get admitted, but ultimately for what they do, I can do it at home and not take up a bed. When I moved back up to Dublin, the first time I had this issue, my new GP sent me to A&E, even though I tried explaining what the issue was. When I linked in with a new GI doc up here, and he was happy with my progress / happy with my understanding of what has to happen during a flare, he wrote a letter to my GP outlining what meds were / were not okay to prescribe and now my GP is happy enough to just give me a script if I get a flare.

If I wasn't being proactive in looking after my tummy, I could justifiably end up in A&E frequently and being admitted frequently. My GP was initially eager to send me to A&E. Even though it wasn't strictly necessary. (I now have instruction from my GI of what to do if I think myself I do need A&E.)

2) Last year I developed a really bad pain in my lung. I felt like I wasn't getting enough air. My breathing was erratic. I had a really bad pain when I was breathing. My pulse was ridiculously fast. GP sent me for a chest xray. Nothing she gave me was helping. So she ended up sending me to A&E for an ECG and bloods to make sure I didn't have a clot in my lung. She could have done this in the surgery and waited a few days for the bloods to come back, but had it been a clot, that would have sucked. But I was in and out of A&E within a few hours having been seen promptly.

It's important for GPs to refer if they need to, but I do think that some are too eager to refer.

NIMAN

Are GPs now afraid of their arses of getting sued for something critical they might miss?
Is that why they send so many to A&E?

"Dr, my heads very sore"
"Better send you to A&E, just in case its a brain tumour".

JustShon

sullivlo wrote: »

It's important for GPs to refer if they need to, but I do think that some are too eager to refer.

I think it's an arse-covering method. It's 99% this harmless thing that can be fixed with a dose of painkillers and a day in bed but it's very faintly possible it could be something lethal. So rather than take the 1% chance of getting sued out of existence by your family after you die they send you on to A&E.

Edward Hopper

It isn't helped by people who've been discussed so far, but it's trivial compared to the delay A and E's have to trying to place the genuinely Ill that come through their doors due to general overcrowding and bed blockers. The drunks and drug addicts and idiots are nothing new to emergency departments.

Countless beds in hospital and long stay community care have been closed and remain so, private providers are either full or no longer taking new residents due to onerous regulation put on them. Funding of private nursing home takes reams of paperwork and weeks on end, Private homes look at elderly patients with dementia and high falls risk and decide it isn't worth their while and the state provision is no longer there for those patients.

Also, not that regulation isn't necessary but it leads to homes sending the very old, and very sick, who in years gone would have died in their nursing home, a peaceful and natural death into hospital to die, taking up a bed as they don't want the death registered as happening in their home. Or carers who've had their care hours slashed or respite bed time reduced can no longer cope and send their loved one into hospital. Acopia is as common a diagnosis these days as respiratory tract infections. (slight exaggeration but not far off it)

So in summary the cluster f*ck that is A and E and the Irish Health Service has many rich, colourful and varied causes.

Akrasia

It's the fault of the hospital admission system, A&E is basically the only way into a hospital for treatment. Your illness might not be an emergency, but you still need to be assessed by the A&E dept before you can get the treatment you need, even if your GP has already diagnosed your illness and told you you need to be in hospital.

I got quincy this year and the gp eventually identified it correctly and sent me to the hospital, I would need to see an ENT specialist and IV antibiotics, but instead of going straight to the ENT dept to get the treatment I needed, I had to go through the A&E and spent the most part of a day without any treatment while my condition got worse waiting for a A&E doctor to confirm the GP diagnosis.

P. Breathnach

I don't enjoy the company of drunks or druggies, and I don't think that A&E staff should have to suffer the kind of abuse that some of them hand out.

But if they have a real medical emergency, even if self-induced, then A&E is the place for them. Are they any less entitled to help than the middle-class person who has had a heart attack as the result of bad lifestyle choices?

JustShon

P. Breathnach wrote: »

I don't enjoy the company of drunks or druggies, and I don't think that A&E staff should have to suffer the kind of abuse that some of them hand out.

But if they have a real medical emergency, even if self-induced, then A&E is the place for them. Are they any less entitled to help than the middle-class person who has had a heart attack as the result of bad lifestyle choices?

The difference is the middle-class person who has had a heart attack as a result of bad lifestyle choices doesn't go up to the triage station and bang on the door every 15 minutes yelling and screaming about why they haven't been seen yet.

The middle-class heart attack sufferer isn't so high that they don't hear the nurse call their name five times in a row then half an hour later go trying to kick in the door to the triage station because they "should've been seen by now"

Lastly, any time I've been stuck in the A&E for hours there's ALWAYS a few, not just one or two, drunks and druggies in there but I haven't met many middle-class heart attack victims.

Yes they're entitled to medical attention the same as the rest of us but most of them don't actually need it. Most of them wind up walking out after 2 or 3 hours of screaming abuse at nurses doesn't magically get them seen sooner.

Macy0161

I'd like to see a proper investigation too, on the real causes, rather than simplistic trolley counts/ time spent stuff. I suspect like most of our health system, it stems from primary care. GP's appear resistant to change though, without more "resources".

My experience of A&E is that it was full of "normal" people, not drunks and druggies.

corner of hells

JustShon wrote: »

The difference is the middle-class person who has had a heart attack as a result of bad lifestyle choices doesn't go up to the triage station and bang on the door every 15 minutes yelling and screaming about why they haven't been seen yet.

The middle-class heart attack sufferer isn't so high that they don't hear the nurse call their name five times in a row then half an hour later go trying to kick in the door to the triage station because they "should've been seen by now"

Lastly, any time I've been stuck in the A&E for hours there's ALWAYS a few, not just one or two, drunks and druggies in there but I haven't met many middle-class heart attack victims.

Yes they're entitled to medical attention the same as the rest of us but most of them don't actually need it. Most of them wind up walking out after 2 or 3 hours of screaming abuse at nurses doesn't magically get them seen sooner.

It sounds like you spend a significant amount of time in A and E .You also seem to be well enough to observe and give accounts of what goes on there.
Your own health is of course your business yet the only thing you mention being in hospital was severe headaches.

Ohbethehokey

The news just reported there that people are walking out of a&e in Drogheda.


They mustn't have needed a&e in the first place if they stroll out without been seen to.

MilesMorales1

There should be something in-between A&E and the GP, to stop it getting so clogged. Its entirely possible there already is and I'm just unaware of it, but whatever. Drunk tanks aren't a bad idea.

Widdershins

You don't have to be unable to walk for it to be an emergency.

Macy0161

Widdershins wrote: »

You don't have to be unable to walk for it to be an emergency.

However, if you can't be bothered to stay it probably wasn't?

Widdershins

Macy0161 wrote: »

However, if you can't be bothered to stay it probably wasn't?

yes, for some people, others might have been there upwards of 8 hours already with no prospect of being seen despite the potential seriousness of their complaint. Some might have been afraid of being physically sick or passing out either on a chair in the waiting room or standing against a wall, if there's no free chairs. Maybe they have to get back to their lives.

jam_mac_jam

There should be more out of hours GPs and clinics that can deal with low level injuries. It can be very uncomfortable to sit on a hard chair if you are sick so maybe people feel they are better off going rather then sitting there in pain or sick.


I love how everyone is blaming the sick people and not the sham of a system, oh they must not have been that sick then. Maybe we should have a system where you don't have to sit around for a day before being seen.

jam_mac_jam

Macy0161 wrote: »

However, if you can't be bothered to stay it probably wasn't?

Or you have kids, or a job, or you are in pain and have been sitting on a chair for hours.

Widdershins

I'm sure a lot of people don't know what to do or what they'll do when they walk out but they just know they're not going to get any care so they have to.

gctest50

JustShon wrote: »

The last time I was in A&E my mam got talking to one of the... I don't know what to call them, "people" there.

People, that's what you call them.

Shouldn't jump to conclusions that suit you either really :

JustShon wrote: »

One member of the family was in for alcohol poisoning, another of them was in with his arms all cut up from some kind of fight or other and the rest of the family just decided they go along for the trip.

Maybe he cut his arms as some people do ( suicide attempt etc )

wtf esoteric thing were you there for ? f***king Fields Disease like ?

JustShon

corner of hells wrote: »

It sounds like you spend a significant amount of time in A and E .You also seem to be well enough to observe and give accounts of what goes on there.
Your own health is of course your business yet the only thing you mention being in hospital was severe headaches.

By all means ignore the fact that I also agreed that unnecessary GP referrals are part of the problem and that was how I last ended up in A&E.

The rest of my A&E experiences come from when I was younger and had a gang of lads in secondary school decide they didn't like me so I was in and out of A&E with broken bones from the ages of 14 through to 18.

Quite how having a broken arm, broken rib or needing my lip extracted from between my own teeth because they hit me that hard in the face should prevent me from observing those around me is something I can't figure out.

In summary, I hope you don't wind up in A&E when you fall down off that high horse of yours.

Widdershins

jam_mac_jam wrote: »

Or you have kids, or a job, or you are in pain and have been sitting on a chair for hours.

Or you care for elderly relative with alzheimers..as many do

gazzer

jam_mac_jam wrote: »

There should be more out of hours GPs and clinics that can deal with low level injuries. It can be very uncomfortable to sit on a hard chair if you are sick so maybe people feel they are better off going rather then sitting there in pain or sick.


I love how everyone is blaming the sick people and not the sham of a system, oh they must not have been that sick then. Maybe we should have a system where you don't have to sit around for a day before being seen.

Definately. My local GP only sees people from 9.30 to 12 and from 2.30 to 4pm. Its rediculous. The D Doc is a joke. My friends mother had to wait 12 hours to see the GP one day last month.

Ohbethehokey

jam_mac_jam wrote: »

Or you have kids, or a job, or you are in pain and have been sitting on a chair for hours.

Or there's a miracle cure in the water...

JustShon

gctest50 wrote: »

People, that's what you call them.

Shouldn't jump to conclusions that suit you either really :



Maybe he cut his arms as some people do ( suicide attempt etc )

wtf esoteric thing were you there for ? f***king Fields Disease like ?

You shouldn't jump to conclusions either. Have you ever been in an A&E room? You wind up talking to people. It was a fight, unless he meant he was going to attempt suicide again when he said he was going to kill the guy who cut him up.

inocybe

Macy0161 wrote: »

However, if you can't be bothered to stay it probably wasn't?

Not true. I'm one of those who left a&e, went there after a weird collapse, was feeling like death when I went in, but after a few hours on a plastic chair I was recovered a bit but desperate to lie down. Triage told me it would be about 12 hours wait in that chair, I couldn't take it and went home.

andrea1983

isn't it strange that GPs train for at least 10 years and yet, a whole load of unqualified keyboard warriors are able to tell that they're actually crap and are referring too much to emergency departments.

The hse should just come in hear and sign up a few of the geniuses. problem solved.

Wibbs

Widdershins wrote:

Or you care for elderly relative with alzheimers..as many do

+1 Many such people simply can't be left alone for more than a few minutes.

Edward Hopper wrote: »

Countless beds in hospital and long stay community care have been closed and remain so, private providers are either full or no longer taking new residents due to onerous regulation put on them. Funding of private nursing home takes reams of paperwork and weeks on end, Private homes look at elderly patients with dementia and high falls risk and decide it isn't worth their while and the state provision is no longer there for those patients.

Also, not that regulation isn't necessary but it leads to homes sending the very old, and very sick, who in years gone would have died in their nursing home, a peaceful and natural death into hospital to die, taking up a bed as they don't want the death registered as happening in their home. Or carers who've had their care hours slashed or respite bed time reduced can no longer cope and send their loved one into hospital. Acopia is as common a diagnosis these days as respiratory tract infections. (slight exaggeration but not far off it).

+1000. At this stage, going back near a decade I've a fair bit of personal experience of what you describe and what you describe is quite evident alright EH. Elderly patients, particularly those who need more hands on care like dementia sufferers are taking quite the number of beds and hospital resources.

A few years back I was visiting an elderly relative in hospital over the Christmas period. They most certainly needed to be there with an acute and life threatening illness(which they sadly died from a fortnight later), but what struck me was how many of the other beds in the general ward were occupied by elderly folks who seemed healthy enough.

I ended up chatting with one of the nurses and mentioned this and she told me that a goodly proportion were indeed stable and could have gone home days, even weeks ago. If they had a home to go to. Some had crossed that line of frailty so couldn't go back to their own home alone and were in limbo waiting to see how to proceed. Others had come from care homes, that were "reluctant" to take them back yet. Some that were living with and being cared ofr by their adult children/families were apparently left in for the Christmas period to "give the family a break" and would be collected in the New Year. I remember chatting to one lovely old dude and was saddened to hear that his family hadn't even been in to see him. He got a phone call on Christmas day. Maybe he was a street angel and house devil, but if he wasn't then what level of wanker would you have to be to not give a crap about him. At effin Christmas.

This issue can manifest in another way. Namely that if you're caring for such a "difficult" person and are seen as coping and able to bring them home, the staff tend to be all to quick to discharge in case you might change your mind and want a longer break and take up another bed for longer. That has happened to me more than once. In one case discharging early was sailing bloody close to medical malpractice and internal enquiries were made. I was not a happy camper, but I can understand the pressures the staff are under. The ward in question had a least a third of the elderly folks who required constant hands on supervision. This is going to get worse too as the various dementias are on the rise and few enough families these days are free of it.

Dyr

need to sort the Junkie problem out, legalised and government distributed heroin is the way forward.

No more cycling them through useless methadone clinic over and over again.

corner of hells

JustShon wrote: »

By all means ignore the fact that I also agreed that unnecessary GP referrals are part of the problem and that was how I last ended up in A&E.

The rest of my A&E experiences come from when I was younger and had a gang of lads in secondary school decide they didn't like me so I was in and out of A&E with broken bones from the ages of 14 through to 18.

Quite how having a broken arm, broken rib or needing my lip extracted from between my own teeth because they hit me that hard in the face should prevent me from observing those around me is something I can't figure out.

In summary, I hope you don't wind up in A&E when you fall down off that high horse of yours.

Relax , I'm not doubting anything you say.You seem to get very defensive suddenly there.I'm making an observation , I'm not on any high horse.

Where I work a policy we have is do not return to me unless you have a discharge letter saying you have been seen by a doctor .

Stay calm big boy.

JustShon

andrea1983 wrote: »

isn't it strange that GPs train for at least 10 years and yet, a whole load of unqualified keyboard warriors are able to tell that they're actually crap and are referring too much to emergency departments.

The hse should just come in hear and sign up a few of the geniuses. problem solved.

To be fair, in my case the A&E doctors actually questioned why I was sent in at all. So it's not a case of me thinking the GP sent me in unnecessarily but of other doctors thinking that.

P. Breathnach

JustShon wrote: »

The difference is the middle-class person who has had a heart attack as a result of bad lifestyle choices doesn't go up to the triage station and bang on the door every 15 minutes yelling and screaming about why they haven't been seen yet.

The middle-class heart attack sufferer isn't so high that they don't hear the nurse call their name five times in a row then half an hour later go trying to kick in the door to the triage station because they "should've been seen by now"

Lastly, any time I've been stuck in the A&E for hours there's ALWAYS a few, not just one or two, drunks and druggies in there but I haven't met many middle-class heart attack victims.

Yes they're entitled to medical attention the same as the rest of us but most of them don't actually need it. Most of them wind up walking out after 2 or 3 hours of screaming abuse at nurses doesn't magically get them seen sooner.

Which bit of "I don't think that A&E staff should have to suffer the kind of abuse that some of them hand out" did you miss?

I was careful to qualify my position with the words "if they have a real medical emergency", and you are describing people who, in your judgement, don't have one. I wonder if you have the expertise to diagnose medical condition from an observation of the individual's behaviour.

Life in general is not simple. Life in an A&E department is particularly messy. The staff cannot determine if a person has a real medical emergency without applying clinical skills and perhaps using diagnostic tests. They can't take the risk of ejecting people who behave obnoxiously and run the risk of their being found dead in the car park outside.

Wibbs

andrea1983 wrote: »

isn't it strange that GPs train for at least 10 years and yet, a whole load of unqualified keyboard warriors are able to tell that they're actually crap and are referring too much to emergency departments.

Because many people with personal experiences of dealing with emergency and not so emergency health issues are finding that yes, more and more the local GP is sending them to A&E, even for existing conditions and illnesses that the GP could treat and often did previously. Especially with ten years training. This is not all GP's either. I have found it can vary quite a bit, but yes some could be replaced by triage nurses with little change in patient outcome or experience.

ebbsy

A & E is shagged because of all those u6 medical cards handed out.

corner of hells

gazzer wrote: »

Definately. My local GP only sees people from 9.30 to 12 and from 2.30 to 4pm. Its rediculous. The D Doc is a joke. My friends mother had to wait 12 hours to see the GP one day last month.

D Doc prioritise thier calls.

Wibbs

JustShon wrote: »

To be fair, in my case the A&E doctors actually questioned why I was sent in at all. So it's not a case of me thinking the GP sent me in unnecessarily but of other doctors thinking that.

Good point. More than once I've had a similar discussion with a hospital doctor. With some mutual head scratching and in one case an addition to that end in the report letter for the GP.

JustShon

P. Breathnach wrote: »

Which bit of "I don't think that A&E staff should have to suffer the kind of abuse that some of them hand out" did you miss?

I was careful to qualify my position with the words "if they have a real medical emergency", and you are describing people who, in your judgement, don't have one. I wonder if you have the expertise to diagnose medical condition from an observation of the individual's behaviour.

Life in general is not simple. Life in an A&E department is particularly messy. The staff cannot determine if a person has a real medical emergency without applying clinical skills and perhaps using diagnostic tests. They can't take the risk of ejecting people who behave obnoxiously and run the risk of their being found dead in the car park outside.

I wouldn't suggest kicking them out but belligerent patients are a big problem in my experience. The whole process of diagnosing patients is slowed down when you have to stop every so often to calm down someone who's trying to kick down the door to triage or who just walked in as soon as they opened the door to other patients.

I'm not suggesting this is the only issue either. As another poster said, there are myriad problems.

Even without unnecessary GP referrals and if all the drunks / high folk sat quietly waiting their turn we'd still likely be sitting there for hours on end due to understaffing and lack of available beds for those who need to have more extensive testing conducted.