"A&E staff and pathways"

I was seen by a GP a few days prior to my attendance at A&E and an urgent referral was sent to General Surgery due to a rectal prolapse. I was given clear worsening advice. A few days later, the colour changed and the symptoms changed, I followed the advice & attended A&E with my mother.

When I booked in, it was difficult to give a brief reason, my mum whispered to the member of staff that was booking me in an outline of the problem to keep my privacy and dignity in a waiting room area. I was triaged by a nurse who was very understanding of the situation, offered paracetamol but I had already taken this and asked to sit in the waiting room until a cubicle became available.

An hour or so later, I was in a lot of pain, due more paracetamol and self medicated this. An hour later the pain was increasing, I asked at reception if they could please enquire if I could have some pain relief. I waited half hour for pain relief, I understand behind the scenes it’s busy. 

A little while later the pain was increasing, I asked a member of staff on reception if I was likely to be seen soon as I was the only person in the waiting area. There had been people that had arrived after me were taken. I appreciate care is prioritised. They went and enquired and said I was 3rd to be seen. 

I had been going to the toilet to keep an eye on my situation from when I arrived in the waiting room. Things were escalating, the area was turning to purple to very dark. I was taking pictures of this so the doctor could see the change in a short period of time.

I was in increasing pain, the area visibly going discoloured. I showed my mum the photos and she was very to concerned and said to the member of staff on reception if we could please speak to a Nurse as things have changed whilst I’ve been waiting. The member of staff said - I’ve already told you your third to be seen. My mum replied that she feels I’m very unwell and could they please go and ask a Nurse to speak to me. 

Mum watched the member of staff going to speak to the Nurse, 30 minutes later, nobody had came and seen me. My Mum watched over those 30 minutes, the Nurse that was asked was chatting, and did not seem to have a patient in those 30 minutes.

Mum felt that I was really suffering, and not being taken seriously. We phoned switch board and asked if there was a Senior Charge Nurse or manager in the hospital to highlight that nobody responded to someone reporting a change. 

I was put through to a Nurse in A&E and explained. The nurse said they would come and see me. I felt degraded but showed them a photo of the change in colour of the area affected, my mum reiterated that she really felt I wasn’t very well. The Nurse went and spoke to a Doctor.

I was taken to a cubicle and seen by a Doctor, who was apologetic for my wait. The doctor assessed and felt they required to speak to the surgical team, but first they could see the pain I was in, and gave me pain relief. I was very promptly seen by a member of the surgical team and assessed. 

The surgical doctor assessed and explained things to me. They said that I needed to try cream in the first instance, I had already been using it, told me to continue with this and regularly. They couldn’t see the referral on the system from the GP but would look out for it and try and expedite the appointment but couldn’t promise. They acknowledged I was in pain but said the surgery that may be required can’t be carried out as an inpatient, it requires to be done as an outpatient.

In A&E we couldn’t see notices to advise patients if they feel worsening of symptoms to highlight to a member of staff. 

If a patient highlights worsening symptoms, shouldn’t this be prioritised to be triaged again? Over 30 minutes seems excessive when highlighting a change. 

I appreciated that I may require surgery and this can’t be done as an inpatient. Does pain not matter anymore? Being at home with Oramorph prior to attendance at A&E wasn’t effective, the surgical Doctor would try and expedite the referral but couldn’t promise. I understand pressures on the NHS but shouldn't there be a better pathway for patients who have been referred to a speciality, and struggling with symptoms such as pain despite regular paracetamol and oramorph to be prioritised?