LONG WAITS IN EMERGENCY DEPARTMENTS!

BHSFINALY · 27-02-2014 1:12am #1

A friend of mine was recently involved in a minor accident which involved him heading to the emergency department (or A+E) of a local hospital. He had injured himself which was in no way life threatening but was in need of medical attention nonetheless.

He had never been to an emergency department previous and had no idea in what to expect.

After an 8 hour wait in the emergency room he was finally seen to and was treated with 4 stiches in his upper arm which took about 10 minutes to complete.
During his time in the hospital he rang me around 4 hours through his stay and asked me could I drop him up a pair of comfortable tracksuit bottoms, something to eat and a warm jumper. The reason behind his request was he arrived into the hospital wearing jeans and a t-shirt and an empty stomach, he was subsequently feeling cold, uncomfortable and hungry.

As somebody who has been in the emergency department on many previous occasions with injuries through sport I knew exactly how he felt. I also knew exactly what to expect!

He had no idea what to assume (i.e long waits in an uncomfortable environment with a lack of food) and actually noted to me that he had searched the internet to seek information on what to bring and what to expect. He found no results.

Therefore I thought it would be a good idea for people to share their experiences of long waits in the emergency department and how they best dealt with it and if they had do it again, what they do differently.

I will then re-write a final piece of people’s recommendations and it will be freely available along with this post for people to search in case they are ever caught in a situation similar to that of my friend.

It also lays bare the fact had he been willing to depart with a substantial amount of money he would have been seen far quicker in a private practice. This outlining the current situation in the Irish healthcare system that those with more money are treated much quicker in a private clinic and are not subjected to the harrowing experiences of public emergency departments.

Biologic · 27-02-2014 1:23pm

I've been once as a patient. It was a relatively minor issue, but warranted an A&E visit. I was seen within an hour and out the door within 90 mins. Great service. I realise this isn't the same experience everyone has, but the readers of your pending magnus opus may like to know that it's not all bad.

etymon · 27-02-2014 1:43pm

Can I ask if he was really first seen after 8 hours? He must have seen a triage nurse pretty soon after arriving and on the basis of his symptoms was then in for a long wait i.e. probably didn't need to be there. I'm sure the accident was traumatic and the general public aren't always expected to know when they need to attend A/E but I suspect your friend would have been fine to go to his GP/Dubdoc the next day.

Nonoperational · 27-02-2014 2:50pm

In answer to your question, what can be done differently, he could have gone to his GP first and they may have been able to put in the stitches.

DipStick McSwindler · 27-02-2014 3:35pm

This post has been deleted.

BHSFINALY · 27-02-2014 7:42pm

Biologic wrote: »

I've been once as a patient. It was a relatively minor issue, but warranted an A&E visit. I was seen within an hour and out the door within 90 mins. Great service. I realise this isn't the same experience everyone has, but the readers of your pending magnus opus may like to know that it's not all bad.

Of course the service can at times be exceptional and in my own experiences the staff have always been great. I was just hoping people could share some light on how they best dealt with long waits when in that scenario!

RobFowl · 27-02-2014 10:09pm

I've been to AE 3 times in the past 10 years and was seen almost immediately after severe trauma. Waited about 30 mins on other 2 occasions but 1 was in a private AE and would have been longer in a public one I'm fairly sure.

BHSFINALY · 01-03-2014 12:44am

IrishFeeney92 wrote: »

I had a very similar experience in A+E, I was in for something fairly innocuous but at the same time I needed treatment. It was my first time and I had no idea what to expect but I presumed I wouldn't be there for long!

I was waiting a substantial amount of time, maybe 5-6 hours as I kept being pushed down the list due to more serious cases.

The only thing I could say is if I had to go again and had time to gather some things to bring with me I would most definitely bring an I-pod or a book or just something to keep myself occupied. the boredom was by far the worst part!

I most definitely believe the experience would have been much less uncomfortable had I had something to keep myself occupied.

That's great, exactly the kind of information I'm looking for.

AndrewJD · 01-03-2014 12:22pm

I had a 'category 3' presenting complaint (abdominal pain) and went to a certain Dublin 8 based A&E department with a GP referral letter at about 11am. Waited about 80 minutes before eventually being seen by an intern, waited another 3 hours with no clue as to how I was being managed in a plastic chair, got a CT scan, waited another 2 hours for an SHO to give me the results of that (or indeed mention the bloods were fine), waited another 20 minutes to speak to the specialty registrar (who I'll see at my '6 week appointment' I'm currently 3 months waiting for), and it took about an hour from there to get an X-ray KUB and to be discharged with a prescription. I left some time after 7pm. Having spent a month as a student in a medium sized ED in Scotland (with the infamous but now I see fantastic 4-hour rule) I was fairly appalled at how bad the experience was.

Since you can't leave, the ideal scenario is a friend who lives nearby who can come and go with entertainment devices, food and company. Definitely bring sandwiches, snacks, bottles of water. I brought some study material to take my mind off things and try to make the experience vaguely productive. There's unfortunately not much else you can do.

bumper234 · 01-03-2014 12:29pm

Years ago i got a cut under my eye that required stitches, Went to A&E at 2 in the morning and was told there would be an 8 hour wait. Went home got a wet cloth and lay on it and fell asleep. Got up the next morning had some breakfast, went to the shopping center, bought a book and headed to A&E again. Got seen to after 3 hours

Gatling · 01-03-2014 12:40pm

3 years ago now badly dislocated shoulder tallaght A&E
19½ wait to be seen and treated by a Dr.
Mean while people were turning up with the holiday baggage asking to be seen by doctors as they had flights to catch and needed sick notes for work,

How would I cope if I had to do it again ,
For one I wouldn't be so nice about it ,I'll be demanding I been seen till I am seen and treated ,

Don't know what was worse the boredom ,
The hunger didn't bring my wallet and and my phone died after a few hours ,
Or the stupid amount of searing pain I was in

lollsangel · 01-03-2014 12:47pm

Brought my 4 year old son into a and e at just before 5pm on a saturday last oct. He'd been jumping on the bed and subsquently couldnt walk on his foot. A and e was fairly empty. However my son and 2 other little girs ended up waiting until 8.30 (im assuming no pediatric doctor on tik then) adults were going through fairly fast, add to that the local drunk was in the a and e begging money til secruity finally removed him. Partner went up to mcdonalds as wasnt feeding kids from vending machine. Finally got out at 11, they said a cracked bone and tore ligaments in the ankle, follow up following weds with a specialist reveiled a small broken bone in his ankle. I reckon8n a book or a tablet is a must. The ogher time he went through a and e he was brought in at 3ish and allocated a bed upstairs by 7...

BHSFINALY · 01-03-2014 2:28pm

Gatling wrote: »

3 years ago now badly dislocated shoulder tallaght A&E
19½ wait to be seen and treated by a Dr.
Mean while people were turning up with the holiday baggage asking to be seen by doctors as they had flights to catch and needed sick notes for work,

How would I cope if I had to do it again ,
For one I wouldn't be so nice about it ,I'll be demanding I been seen till I am seen an treated ,

Don't know what was worse the boredom ,
The hunger didn't bring my wallet and and my phone died after a few hours ,
Or the stupid amount of searing pain I was in

Thanks a million for sharing! Great stuff

MrCreosote · 02-03-2014 9:42am

BHSFINALY wrote: »

That's great, exactly the kind of information I'm looking for.

BHSFINALY wrote: »

Thanks a million for sharing! Great stuff

In fairness, it's a bit unfair just to cherry pick the bad stories- there's plenty of others above who've been seen pretty quickly.

Not saying your friend doesn't have a legitimate gripe- the worst thing I can see with A&E is how unpredictable it is from one hospital to another, or from day to day. At least in the NHS you know you'll either be "treated-and-streeted" in 4 hours (or else fobbed off into some holding ward specifically set up to get around the 4 hour rule)

Xeyn · 02-03-2014 6:04pm

People getting angry about waiting times and blaming those actually working to get them seen. Thats my biggest gripe. The waiting times are due to understaffed, underequipped hospitals. Nursing staff, radiographers, physios doctors etc try very hard to get through a ridiculous patient load yet they are the ones that get blamed for the waiting times most often, not the managers or the HSE. If someone has to wait 10 hours in an emergency room its because they are deemed not critical and there are 10 hours of patients to get through before them.
Opposed to something someone suggested earlier - getting angry and demanding to be seen will not get you anywhere. If a timid triage nurse is on duty you might get escorted out of the department by security or if a feistier nurse is on you will be put in your place rather quickly.
Its terrible that the waiting times are so long but people need to put pressure on the political side.

In keeping with this thread, you'll all be glad to know that the system doesnt cast favours (well for the most part) I am a doctor and had to attend A+E recently with a limb problem. I called ahead and got my own GP to do the same, he even accompanied me to a major dublin hospital A+E. He had taken all my bloods in his home and we walked up to the A+E reg he spoke to on the phone as soon as i limped in and got him to order me an X-Ray straight away. So within 10 minutes I had all my investigations sorted. It still took me 6 hours to be seen by the last doctor I was to see in A+E. No gripes for me though, I know how the system works and I know why I had to wait.
Most people get by with silly games on their phone or chats with the people that accompany them.

If youre really sick, you get seen quickly. If youre lucky enough to attend at a quiet time, youre seen quickly. If youre not very sick, youlll undoubtedly have to wait.

Sitric · 02-03-2014 7:47pm

I would second everything in the post above (I have worked in an A&E). The facilities and environment are generally substandard, they are understaffed and overcrowded. The staff rarely get breaks and regularly stay after their shift has finished to make sure people get treated appropriately. If you or a relative have ever had to wait for hours (or days) you should write to your TDs and local representatives and complain.

Apologies if a bit off topic

coffeepls · 02-03-2014 8:36pm

This thread just caught my eye by chance - as I was recently (last week) in A&E in a major Dublin Hospital - I haven't been there in years so I really didn't know what to expect. It wasn't for me (thank god) but for my Mum. She was hit by a bike on a city centre street as she and my Dad were crossing, and had fallen straight back and hit the back of her head. My Mum is in her late 60s and had a major DVT a couple of years ago, so she is on a rather high dose of warfarin. There was a doctor passing nearby who helped her to get into a taxi to get to the hosp, but she was quite faint by the time she got there.
She was brought through within minutes, and when I arrived an hour later, she'd already had a cat scan. They had her cleaned up and glue stitched for the wound and home within around 5 hours. I thought the staff were amazing - they are so obviously very much understaffed, and oh my god - how small is that A&E? It's incredible they don't completely go mental working in that tiny area - and yet they were so lovely and patient.
As there was only one person allowed with my Mum, me and my Dad took turns. While in the waiting area, a nurse did come out and say to everyone in the room re. the waiting time, she said the next person to go through had been there since 2.30pm - at the time that was around 5 hours waiting. She made sure also to check that everyone had 'registered' - there was nobody sitting there that they didn't know about.

I noticed most people seemed to have someone with them, and there’s sandwiches etc in the nearby main entrance, canteen too. Feeding my Dad was the only issue because he was so worried he forgot he needed to eat. If I had to go there again in similar circumstances, I don’t think I could do a whole lot different.

BHSFINALY · 02-03-2014 9:08pm

Xeyn wrote: »

People getting angry about waiting times and blaming those actually working to get them seen. Thats my biggest gripe. The waiting times are due to understaffed, underequipped hospitals. Nursing staff, radiographers, physios doctors etc try very hard to get through a ridiculous patient load yet they are the ones that get blamed for the waiting times most often, not the managers or the HSE. If someone has to wait 10 hours in an emergency room its because they are deemed not critical and there are 10 hours of patients to get through before them.
Opposed to something someone suggested earlier - getting angry and demanding to be seen will not get you anywhere. If a timid triage nurse is on duty you might get escorted out of the department by security or if a feistier nurse is on you will be put in your place rather quickly.
Its terrible that the waiting times are so long but people need to put pressure on the political side.

In keeping with this thread, you'll all be glad to know that the system doesnt cast favours (well for the most part) I am a doctor and had to attend A+E recently with a limb problem. I called ahead and got my own GP to do the same, he even accompanied me to a major dublin hospital A+E. He had taken all my bloods in his home and we walked up to the A+E reg he spoke to on the phone as soon as i limped in and got him to order me an X-Ray straight away. So within 10 minutes I had all my investigations sorted. It still took me 6 hours to be seen by the last doctor I was to see in A+E. No gripes for me though, I know how the system works and I know why I had to wait.
Most people get by with silly games on their phone or chats with the people that accompany them.

If youre really sick, you get seen quickly. If youre lucky enough to attend at a quiet time, youre seen quickly. If youre not very sick, youlll undoubtedly have to wait.

Of course I really do feel for the staff too, it's clearly not their fault!

Thread was simply put up to advise people on how to best get through the long waits !

Caledonia · 07-03-2014 1:37am

AndrewJD wrote: »

I had a 'category 3' presenting complaint (abdominal pain) and went to a certain Dublin 8 based A&E department with a GP referral letter at about 11am. Waited about 80 minutes before eventually being seen by an intern, waited another 3 hours with no clue as to how I was being managed in a plastic chair, got a CT scan, waited another 2 hours for an SHO to give me the results of that (or indeed mention the bloods were fine), waited another 20 minutes to speak to the specialty registrar (who I'll see at my '6 week appointment' I'm currently 3 months waiting for), and it took about an hour from there to get an X-ray KUB and to be discharged with a prescription. I left some time after 7pm. Having spent a month as a student in a medium sized ED in Scotland (with the infamous but now I see fantastic 4-hour rule) I was fairly appalled at how bad the experience was.

Since you can't leave, the ideal scenario is a friend who lives nearby who can come and go with entertainment devices, food and company. Definitely bring sandwiches, snacks, bottles of water. I brought some study material to take my mind off things and try to make the experience vaguely productive. There's unfortunately not much else you can do.

Apart from the delay now in your outpatients apt what was the problem? You got thoroughly investigated -bloods, a ct scan and an X-ray and were seen by at least two doctors-and were well enough to go home with a prescription. Given the demands on the system I think you were looked after v well medically. A bit of gratitude wouldn't go astray.

RobbingBandit · 07-03-2014 1:42am

Have been five times in the past four years, each time ranged between five hours and fourteen in a public A&E in Dublin. Fourteen one they did several tests over the course of afternoon and early morning and discharged me as I refused to be admitted as I wanted to go home and sleep.

porsche959 · 07-03-2014 1:46am

In my personal experience, present with a head injury - however minor - and you'll be seen without delay.

Nonoperational · 07-03-2014 1:44pm

porsche959 wrote: »

In my personal experience, present with a head injury - however minor - and you'll be seen without delay.

Any real emergency will be seen asap to be fair.

spurious · 10-03-2014 1:32pm

Xeyn wrote: »

People getting angry about waiting times and blaming those actually working to get them seen. Thats my biggest gripe. The waiting times are due to understaffed, underequipped hospitals. Nursing staff, radiographers, physios doctors etc try very hard to get through a ridiculous patient load yet they are the ones that get blamed for the waiting times most often, not the managers or the HSE. If someone has to wait 10 hours in an emergency room its because they are deemed not critical and there are 10 hours of patients to get through before them.
<snip>

If youre really sick, you get seen quickly. If youre lucky enough to attend at a quiet time, youre seen quickly. If youre not very sick, youlll undoubtedly have to wait.

I would agree it is not in any way the fault of the staff. What I saw in my perforated appendix visit was quite a number of people who really should have been at GPs, not in A&E. I saw the same thing in the ward. People who did not require nursing care as such, simply care. In the old days they would have been at home with family.

I was unlucky I suppose as I presented to A&E without the extreme pain most people with appendicitis do. Yes, there was pain, but it wasn't agony. Thus it may have been my own fault I was waiting 8 hours to go through the doors to get sitting on a chair and eventually seen by a doctor.

A spectacular sudden attack of the rigors in the middle of the night inside in A&E alerted everyone, including me, to the fact that I was a bit more serious than I thought.

What I saw almost everywhere was horrendously overworked and stressed frontline staff.

chanste · 10-03-2014 2:48pm

porsche959 wrote: »

In my personal experience, present with a head injury - however minor - and you'll be seen without delay.

I think it needs to be clarified that if you present saying you have something that you don't you are going to cause even further felays for genuine patients (I don't doubt your own head injury was genuine - but just in case people get the idea that they should say that have one to get seen quicker).

I recall a pt who had been worked up in all the usual ways for chest pain only to have the consultant arrive at her bedside at the morning ward round to be told that she actually had "a pain in her belly - but a friend had told her to say chest pain so she would be admitted quicker". Not only was the time of the doctors who worked her up wasted meaning other people with potentially serious complaints were delayed, but also her own complaint of abdo pain was not investigated because this was the 1st time she mentioned it.

Corruptedmorals · 10-03-2014 8:17pm

Private a&e's are restricted, don't forget. Nothing beyond stitches really for children and they won't take trauma/ambulances. If you get scans/bloods taken and don't get admitted then you'll pay a few hundred and not receive much back by insurance.

Getting someone to bring in food for you is great advice, but checking first that it's okay- you don't want to break fasting and have a scan etc. delayed or postponed as a result.

Pretzill · 11-03-2014 2:01am

I've been in a&e probably too many times, not always for myself but with others too. I find that the wait time is truly based on the assesment of the problem. Triaged often between 5-30 minutes - on one occaission with chest pain and dodgy heart trace I was seen by a doctor in minutes - another time for a pretty bad cut I was waiting over 5 hours - an hour for every stitch. I do think it depends on the day of the week and the time of the you present regarding wait times but none of us fall ill or get injured at the right time! Most times as a patient the wait time can be very uncomfortable particularly as your not well. But for the person keeping you company it can be just as intolerable.

If I'm the patient I send my company off on an errand or tell them to go home for a couple of hours - what's the point in us both being bored and rest assured the prolonged wait time normally means you're not too severe and if worried you can talk to the triage nurse about pain relief etc. Also as a patient whether you are allowed to eat something - they may need you nil by mouth.

If, and it's often not the case, you have time to think before arriving at A&E I would suggest bringing a soft cushion for the patient (plastic chairs get real uncomfortable.) Headphone music/radio. Magazines or book if anyone can concentrate. And if one is up to it chatting to the other people waiting can also help pass the time. But it's a waiting game, and when it's a long one at least you know those with greater need are being seen to first - there's a comfort in that.

IrishGal24 · 12-03-2014 4:28pm

During my time in A&E I definitely find that whatever makes your stay more comfortable is beneficial (comfy warm clothes, a cushion, fluffy blanket etc). As previously mentioned, company, sources of entertainment (magazine, phone) is great to help pass the time. Also if you can get someone to bring food can be major help !

AndrewJD · 13-03-2014 1:09am

Caledonia wrote: »

Apart from the delay now in your outpatients apt what was the problem? You got thoroughly investigated -bloods, a ct scan and an X-ray and were seen by at least two doctors-and were well enough to go home with a prescription. Given the demands on the system I think you were looked after v well medically. A bit of gratitude wouldn't go astray.

Sorry should I be grateful that I wasn't given treatment below the standard of care? Of course I was thankful for the staff who dealt with me, none of my issues were their fault. Without going through my medical history on boards.ie it wasn't like they were doing me a favour with some bloods and a CT scan with my presenting symptoms. I'm not blaming any particular individual, or the department (I've met the head, he's a lovely bloke), I was painting a picture of what it's like to be in an ED with a not insignificant illness during a relatively quiet time, with a view to how you can make it easier on yourself. As I explained, my experience was particularly surprising because of how differently someone with the same problem would have been seen in a similarly pressured hospital running under the NHS. Not amazingly, but at least quicker. I'm acutely aware of what it's like to be on both sides of the issue in emergency departments, but thanks for your assessment of my case all the same.

IrishGal24 · 18-03-2014 12:30am

Oh and also, Be vigilant !!! A&E can be a scary place at times.

paul4green · 22-03-2014 8:58pm

Worst I seen was my sister. I made her go to A&E in Tallaght as she couldn't stand with her headache, was photophobic and Kernig's pos. Triage didn't treat it as serious as I did. The "nurse" on duty honestly was lacking basic medical training to the point she whipped out and started reading from the clinical handbook of emergency medicine. This was after 4 hours beside a junkie "in so much pain"

Shock horror, I went crazy and requested a reg immediately to the point they almost called security because I was actively telling the nurse she was wrong. An American locum consultant ED doc came and knew straight away it was meningitis .Spinal tab taken, came back pos for meningococcal meningitis.

ICU for my sister, IV antibiotics and a lot of support care. No long term damage. You just couldn't make it up. If I didn't know what I know, she'd probably be dead

Graces7 · 23-03-2014 3:26pm

Had I read this thread last November I would probably have refused to send for an ambulance when the dr on call told me to as the situation was a "medical emergency," so I am glad to be reading this only now.

I was seen quickly and expertly and the only real wait was to get a bed when they were admitting me. Treatment had started by then and I was on a trolley.

I was impressed by staff and facilities .

My first real encounter with an Irish hospital and I am impressed.

NB there will always be staff and situations where you have to insist and make waves; had the first dr I had seen at home done a better job..

NB also. someone remarked that many who attend A and E could be better seen by their GP and that is also the impression I have.

LONG WAITS IN EMERGENCY DEPARTMENTS!

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