I find it is very hard to be overly sympathetic for the non-critical patient complaining about a nine hour wait when there are nurses and docs busting their asses to treat really, really genuinely ill people behind other curtains. One teenager who had been admitted after a few too many bacardi breezers (and had been quite, shall we say, obnoxious on arrival) I think learned what a & e is for when she was put on a trolley just beside the resucitation bays and saw at least three cardiac arrests come in. I actually did feel bad for her, she was very subdued and quiet after that, I don't think she went out that evening expecting to see those sights.
An advertising campaign is badly needed, along with fines for messers.
Front line staff can be very hard working, very noble, and very good intentioned: but it still doesn't mean that the system and those people cannot be criticised. As GermanFred alluded to, the operational aspects of A&E (or at least the Mater, which I have been through) are terrible, and serve to create work and overhead for the staff there and to worsen outcomes for the patients. (I'm going to rant... get the juices going for the day)
It's really like the story of the man in the woods cutting trees with a blunt axe. He says he can't take time to sharpen the axe as he's too busy cutting wood.
A&E story: close relative (young man) ended up in A&E with a bang on the head during the most recent icy winter. Also hurt arm (put in sling) scuffed knees etc., Had taken a few drinks (was St. Stephen's night), but main self-inflicted aspect of injury was he had leather soled shoes. Was clearly concussed (after phoning me to tell me what happened, he then phoned me again 30 mins later to tell me what happened, and when I arrived into hospital he was "how did you get here?"). When I went down to A&E, whole place is in chaos, as usual. After several hours he's discharged. Had a symptom of feeling his ear blocked (which he had that night) but had not asked whether he could fly with that (was due to go to NY). Went up to VHI Swift Care next day to pay the money to get an answer. Doctor there looks in his hear, says "did you just walk out of the hospital?", "no, I was discharged", "did they XRay/CT your skull, you've bleeding in your ear, you might have a Basal Skull Fracture
, that could kill you". "No, they mostly looked at my arm" (because the arm in sling was the most obvious injury, though not at all serious, and they seemed not to have looked further).
She phones hospital, makes lots of dark sounds "I'm sure you understand how serious this is, this patient should never have been discharged, it's vital he get reexamined quickly" etc., Gets us name of a doctor there, and we head back to A&E. Back in A&E, we then get sort of "readmitted" but without paperwork (because we have the name of the doctor and he's been briefed somewhat). Once we were on the "inside" of the glass doors, I didn't want to get out for fear of ending up right at back of entire queue trying to explain to admin at front desk about basal skull fractures. Met the doctor the VHI doc had spoken to, he went away. Then, nothing happened for ages and nothing was communicated. That's maybe OK, but my persistent fear was that this doc would finish shift, and we'd be sort of stranded in no man's land. I watched my watch, once per hour I nabbed the doc on his way through the corridor to ask him status or what next step was going to be (mostly not to be forgotten). On the last of these interactions, he snapped at me "look around you, see all the sick people, he is not my top priority". I genuinely wondered at that instant whether I was being provoked to get a reaction that would get me thrown out. I very calmly responded that he was my
priority so I had to ask the question, and we wouldn't be here if he'd been fully examined 2 nights ago. I don't remember what was said immediately after that. However, about 15 mins later the doc came back with a post-it with the name of the doctor from the previous night "you might want to have that" and a calmer attitude.
Finally he did get a CT, bone was cracked but it wasn't serious, he could travel. I never saw a doctor look in his ear, and by the time we were getting discharged the shift had changed so yet another doctor was dealing with him, and the first interaction we had was the discharge. I asked him for the details on the investigation and diagnosis/situation. Also asked him had anyone looked into the ear. He said he couldn't see it on the charts but someone must have done so. I asked him if he was sure he was happy to sign the discharge without having evidence it was done. He at least went through the motions and did it.
There are tonnes of things wrong with that system, both efficiency and effectiveness driven. It showed up clearly again in the aftermath because the CT picked up another small thing to get checked. The appointment to see the neurologist took so long to get (3 or 6 months, mad) that the CT was no longer valid (standard time-frame expiry, whatever it was, months in any case) so the first thing he did was schedule another CT (cue further wait, wasted time for patient, radiographer, radiologist, etc.,).
There's a whole collection of problems in the system
- Poor handling of information (between staff, across time)
- Lack of standard procedures and checklists
- Poor communication to patients
- No streamlining of process (a quickly investigated and discharged patient frees physical space in the hospital, and mental space for the medics who can then file and forget, and not have the likes of me nagging them once per hour for half their shift)
For many of these, it comes down to doctors to make the changes. No administrator can provide the medic with a checklist for examining a head injury. At the same time, the medics need to be able to take on board innovations and ideas from operations specialists, as the training a hospital consultant gets is clearly not the kind of training that lends itself to large scale systems thinking. The culture seems to me to be one of work harder and harder, but not necessarily question the systems.