"Long waits in A&E"

I recently attended A&E with an elderly relative. She waited >4 hours in the corridor before being seen by a Nurse or Doctor. As a HCP myself, I have some observations.

The ambulance crews were kind, expert and I think were making a huge (clinical) contribution to the A&E service.

Your staff were calm, polite, always introduced themselves and listened to concerns.

The patients waiting to be seen, whether on trolleys or seated (there were many waiting many hours) were calm and uncomplaining, seemingly without expectation that things could be better.

We had waited hours at home already, waiting for a HCP to assess and give advice so that we could manage her illness at home, but ended up in the A&E corridor because no one could visit her at home. After a total >12 hours waiting a preventable admission became inevitable. Discharge was delayed because of home care needs, which had not been an issue at the start of the illness. I believe the problem was not lack of beds or lack of clinical expertise, but lack of TIMELY clinical assessment and appropriate management. The pattern of repeated staff shortages in vital areas compounded the clinical and social problem, only increasing the burden on the NHS in the end.

Your staff in their calmness appeared accepting of a low standard of care (no enquiry or monitoring of fluid intake in a vulnerable person, no attention to the risk of poor skin integrity in a patient unable to move for hours on a trolley).

The use of AHPs for routine observations, ECG and phlebotomy was interesting - efficient for all except those who might need additional or no investigations. Of course there may well have been background conversations we were not aware of...

At no time were either my relative or I given any information on timeframe or process. We were still expecting a decision for discharge home until seen by the doctor late at night (12+ hours after the initial phone call asking for help was greeted with the assurance a doctor would visit her at home soon).

I look forward to hearing how my concerns can be addressed to optimise the patient journey for your future patients. A short quality improvement project with frequent PDSA cycles may be a way forward.