"Concerns about care for older people in the Emergency Admissions Ward at City Hospital, Nottingham"

About: City Hospital campus / Older people's healthcare

(as the patient),

I recently aquired an urine infection that required admission via the Emergency Admissions Ward at the City Hospital in Nottingham. I oberserved some worrying behaviours and practices by the staff towards patients in their care.

First, I arrived at 5.15pm and was placed in a waiting room with people awaiting discharge. I had a very high temperature (over 39 degrees) and was in pain. I had to wait over 30 minutes for someone to come and take a history/observations but in that time I couldn't fail to hear staff moaning about how fed up and tired they were and ambulance men gossiping about colleagues and their jobs. When I was finally seen, they told me they would move me to a bed, but someone else was in it and I'd have to wait. I was then seen in a side room by a junior doctor who was unable to cannulate after three attempts.

A small blood sample was taken which showed low haemoglobin (5) which led to a discussion and investigation as to whether I could be anaemic or have tumours. This was quite alarming as I thought I was there to be treated for a UTI. The test was repeated and the result came back at 14.1 and the doctor apologised for causing me any worry. A phlebotomist came and sited a cannula but was openly discussing with a nurse that she was not trained/authorised to do cannulation but was just getting on with it.

The ward was extremely noisy and the main lights did not go out until past 1am and then staff persisted in shouting to one another up and down the ward and equipment and trollies were rattling and banging all night long.

The staff appeared largely to be from an agency. I was in a bay of six beds, one of which was occupied by a male but who was later moved on to another area. The woman in the next bed to me appeared very elderly, was immobile and possibly suffering from dementia. The staff openly told me that she was a 'regular' and were fed up with her calling constantly and imitated her in a mocking voice. At one stage two staff pulled the curtains around this woman and when she called out they mouthed and gesticulated for her to 'shut up'. The woman did call constantly for attention, but I think this was because that staff did not put a call button within reach. This may have been the same situation for other elderly people that I heard calling out throughout the night.

On a number of occasions the woman asked for help to toilet. The staff were slow to respond and one member of staff was quite severe and scolded the woman by saying 'I am busy giving out medicines, you will have to wait'. I decided that the next time the woman called for assistance to toilet I would time how long it took for someone to meet this need. A member of staff acknowledged that she was asking for help and it was a further 47 minutes before they came back. In this time the woman had been incontinent and was very distressed. The staff appeared to be patient when cleaning her up, but I felt frustrated that this woman had been put in this position and might get labelled as incontinent when really she wasn't.

A number of the staff had international accents and I was aware that many of the elderly patients who were hearing impaired had difficulty in understanding them. The staff did not appear to appreciate that this was a barrier to effective communication and appeared to shout at clients in what could be perceived as quite an intimidating way.

I was transferred to another ward within the hospital approximately 24 hours after admission and had a completely different and largely positive experience in that environment for the next few days.

As a younger person, this experience gave me much to reflect on. I felt desperately miserable for the elderly clients in this ward and shed many tears thinking about how awful it must be for them. I felt I could appreciate why elderly people are often frightened of hospitals and avoid admission at all costs. The ward was clearly very busy, but the staff seemed unhappy and overworked and I think this culture was spilling over into the standard of care they provided to clients. I saw little evidence of respect for the dignity of elderly clients and would shudder to think that anyone I loved might have to endure any time in this particular ward.

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Response from Nottingham University Hospitals NHS Trust

I am sorry that on this occasion that you felt some of our services fell below the high standards we expect at our hospitals. As the Trust has a duty to protect patient confidentiality, I am not able to comment on the individual care issues that you have raised. However, we would be happy to discuss your concerns with you directly, if you wish to contact us. In the meantime, I do hope the following will be of value and offer you some reassurance. The Emergency Admissions Unit (EAU) on the City Campus is a very busy unit and patients are admitted throughout the 24hr period. This means that the unit can often be noisy, though staff do make every effort to reduce noise as much as possible. The bays on EAU all have 4 beds and the staff try, as much as possible, to ensure that bays are single sex. All patients admitted to EAU undergo an initial assessment before being transferred to appropriate wards for further treatment, or being discharged. The ward has few vacancies. Agency staff are only used in exceptional circumstances to cover staff sickness. The staff on EAU work as a team and as far as complaints from patients, the Trust has not received a complaint about patient care since earlier this year. The Trust is involved in a national benchmarking exercise and the EAU scored high in many categories for care and communication. The clinic room is used for patients who are reviewed and assessed as being able to sit. All clinical discussions about patients are carried out, as far as possible, in a separate assessment room to maintain privacy and dignity for patients. I am pleased your experience on another non–emergency unit within the Trust was positive. If you would like us to further investigate and respond to the issues you have raised about your care please contact us in the first instance via PALS on 0800 052 1195 or by email.
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