"Experience in IAU"

Queen Elizabeth University Hospital - referral by GP to Initial Assessment Unit.

Our experience was as follows.

(Times are elapsed hr.min from arrival)

0h00 arrive, check in: asked about wait - told approximately 1h to first assessment, 4h total to see medic

waiting time 1h30 - nurse checked personal details; first BP measurement, PO2, temp

waiting time 1h40 - return to waiting area

waiting time 4h00 - asked whether should take current prescribed medication; told to wait for medic.

waiting time 4h25 - taken to cubicle

waiting time 4h30 - told Ok by nurse to take medication, told bloods to be taken shortly

waiting time 5h50 - BP, PO2, temp remeasured; details taken again, assured bloods to be taken shortly

waiting time 6h35 - ECG taken

waiting time 7h05 - to X-ray

waiting time 7h35 - return to cubicle

waiting time 7h40 - bloods taken after reminder to nursing staff

waiting time 8h05 - examination by and discussion with medic (no blood data available)

waiting time 8h25 - to X-ray

waiting time 8h45 - return to cubicle

waiting time 9h35 - discussion with medic (inc blood data)

waiting time 9h40 - treatment administered

waiting time 9h45 - discharged home to return for further X-ray.

As can be seen, the total time spent purely waiting was around 8hrs with an individual treatment cubicle occupied for some 5.5hrs. This suggests that the system requires a total rethink to make better use of staff and facilities.

We felt that nursing staff (with one exception assisting from A&E) came over as largely disinterested with only a few minutes of patient contact and focussed on desk-work. Discussions on holiday destinations and eating out venues took up significant time; this did not give patients and carers a good impression.

We would like to note that X-ray staff (including porters) were extremely efficient, friendly and helpful.

Blood samples have a turnaround time of some 2hrs. Critical path analysis would suggest adding blood sampling and ECG measurement to the initial assessment. A decision on whether an X-ray investigation is necessary would then be made and the patient transferred if necessary.

This would mean that clinical examination would be possible around 2hrs after the initial assessment and the use of treatment cubicles as a waiting area minimised.