"Eye casualty and Emergency Dept"

I attended eye casualty at QMC Nottingham having lost sight in one eye. Staff were pleasant and the department was very busy. The most striking thing was the amount of time wasted going in and out of various consulting and treatment rooms - whether or not there were patients in there - looking for equipment or each other.  Clearly there was no process management. I had a 4 hour wait. 

Two days later with a return of symptoms I had to attend the Emergency Dept (as advised by the doctor at the eye clinic) Having been seen within half an hour by the assessment nurse I was transferred to the Green team. Many people were waiting but few were being treated. Equipment was lying around the department - casts, crutches, bladder scanners, blood pressure monitors, trolleys with dressings etc. There were two doctors, both clicking up and down on computers. One left. In the 5 hours I waited the remaining doctor saw 6 patients.  The nurses say in their room.  At one point a nurse announced that there were 100 patients waiting and at least a 5 hour wait yet still, the doctor sat tapping on his computer.  

After about an hour I was given an ECG and blood tests by a nurse.  After 5 hours I asked the nurses - 3 of whom were sitting together chatting - how much longer the wait might be. I was told, resentfully, that I could go if I wanted, it was my decision.  There were 5 people ahead of me but that might change. I said that I couldn’t make that decision because I didn’t know the results of the tests I’d had four hours previously but given how many people the doctor had seen so far, I was looking at a further 5 hour wait. With this the nurse told me that my ECG was normal but she couldn’t tell me about my blood test.  Said there was nothing they could do and they had completed all their nursing tasks.  It seemed their nursing tasks didn’t extend to talking to the 100 patients, perhaps offering water, informing people of results where possible or even tidying up the department and sorting equipment. 

I spoke to the doctor who was still on his computer and said I was leaving and would see my GP the next day.  It was 4am by now.  With that, the doctor went and got my notes from the nurses and saw me immediately. 

What on earth was the process? 

It looked like the doctor was waiting for the nurses to give him patient results and the nurses were waiting for the doctor to ask!

Those few people seen by the doctor were seen behind a curtain and everyone waiting heard all about their symptoms.  There was no dignity in this at all. 

I was shocked by my experience. The nurses seemed resentful and showed little care.  The department was a mess and processes non existent. A gentleman who had been waiting for hours was seen before me and admitted urgently with a swollen are and possibly blocked artery (so I heard through the curtain) I suspect he could and should have been seen hours earlier. 

It would not be difficult to improve this situation. Introducing efficient process and leadership would make a difference and would be easily done.  What I witnessed was waste at a horrendous scale, lack of dignity for patients, a toxic culture amongst staff, needlessly long waiting times, no apparent leadership and generally an inhuman setting.