NHS chiefs look to scrap four-hour A&E maximum wait

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Northerner

Northerner

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NHS bosses are considering a shake-up of A&E care that could lead to patients with only minor ailments no longer being guaranteed that they will be treated within four hours.

Under the plans being examined, people with non-urgent medical needs would be advised to seek help at a GP surgery, walk-in centre or pharmacy instead – or face a long wait in A&E.

Senior figures in the NHS are also looking at bringing in extra targets to complement the four-hour waiting time standard under which the most urgent cases are seen within an hour.

https://www.theguardian.com/society...maximum-wait-patients-minor-ailments-miss-out
 
Fair enough, it’s what you might call triage. Minor cuts and grazes that our mums used to treat with Germoline and Elastoplast should get short shrift, not added on to the waiting list to get insulted by a doctor like me:D
 
In a way do wonder why some people go to A&E, as it does make it harder to get seen when one has an emergency that needs treating. On the other hand can see why people do go there as around me it takes at least two weeks to see a doctor and most of the time when you ring to get one of the release on the day appointments is a task in it's self. Then if you ring 111 it's the same problem waiting an age for them to ring back even to the point where the 111 call back to say ring your own doctor as the GP is now open.

When I spent over 6 hours in A&E the other week, with some people one could see that they needed A&E, if one looked at me for instance one could think why I needed to be in A&E. Hopefully the triage team filtered out some of the normal go home and treat yourself cases.
 
Difficulty in getting to see a GP is why, when I was still mobile, if I had a medical problem serious enough that treating it myself wasn't likely to help, I used to go to the Emergency Care Clinic at Guy's -- that's what it's for, to deal with problems not quite serious enough for A&E. (I think St. Thomas' now has an ECC as well.)

Mind you, the last two times I wnet to the ECC, they referred me to A&E at St. Thomas'.
 
In light of this article, I had an interesting experience last week. Walking back to the bus stop from the hospital down a (very) dark path I walked into something on the path, very heavy and placed at shin height. I swore and carried on walking, but when I got home saw this:

shins.JPG

I cleaned it and mopped up the blood with kitchen towel. The following morning I went to the pharmacy and asked for recommendations for a dressing I could use - the pharmacist said I should go to my GP surgery. I did this and got an appointment for later in the day to see a nurse. Nurse 1 looked at it, and decided to seek the opinion of Nurse 2. Nurse 2 sucked in her breath and decided that Nurse 3's counsel should be sought. All 3 stood there debating for a little while, but finally decided that, as it was nearly 24 hours after the injury it was too late to stitch it, so Nurse 1 put a dressing on - I'm back later today to see how things are going.

shins2.JPG

Now - what would have happened if I had turned round and gone back to A&E at the hospital? Would I have sat there for 4 hours or more waiting to be seen and then told to see my GP, or would they have found time to treat it, possibly stitch it? It was an accident, but not really an emergency except insofar as prompt treatment might have meant faster/better healing. It's moot, because I didn't see it properly until I got home, and didn't think it was the sort of thing to take to A&E. What would others have done (if you've looked at the picture! 😱 🙂)
 
According to the e-book In Stitches, by an A&E doctor, what the 4-hour limit means in practice is that a suspiciously large number of patients are recorded as having been seen in 3 hours and 59 minutes. 😱🙄😉
 
Next time take a torch!
We’ve got a minor injuries unit at our nearest cottage hospital ( probably not called a cottage hospital any more) which I'd probably have tried first. They look nasty enough for me to have thought I might not get them clean by myself, and we can never be too careful with feet and legs. (Our A &E is a half hour drive away, minor injuries is 12-15, and more to the point, on a bus route.)
 
Northerner said:
In light of this article, I had an interesting experience last week. Walking back to the bus stop from the hospital down a (very) dark path I walked into something on the path, very heavy and placed at shin height. I swore and carried on walking, but when I got home saw this:

View attachment 10467

I cleaned it and mopped up the blood with kitchen towel. The following morning I went to the pharmacy and asked for recommendations for a dressing I could use - the pharmacist said I should go to my GP surgery. I did this and got an appointment for later in the day to see a nurse. Nurse 1 looked at it, and decided to seek the opinion of Nurse 2. Nurse 2 sucked in her breath and decided that Nurse 3's counsel should be sought. All 3 stood there debating for a little while, but finally decided that, as it was nearly 24 hours after the injury it was too late to stitch it, so Nurse 1 put a dressing on - I'm back later today to see how things are going.

View attachment 10468

Now - what would have happened if I had turned round and gone back to A&E at the hospital? Would I have sat there for 4 hours or more waiting to be seen and then told to see my GP, or would they have found time to treat it, possibly stitch it? It was an accident, but not really an emergency except insofar as prompt treatment might have meant faster/better healing. It's moot, because I didn't see it properly until I got home, and didn't think it was the sort of thing to take to A&E. What would others have done (if you've looked at the picture! 😱 🙂)
Click to expand...

It’s an either/or situation. Stitching isn’t really necessary, you’re not looking for a cosmetic result. Steristrips would work fine, if your practice has some in the cupboard. A&E wouldn’t mind you rolling up, but that’s all they would have done. Does that answer your question?

But I agree with Robin, cleanliness is vital. The front of the shin has a fairly poor blood supply, so you can’t be too careful. If you’d gone to A&E there’d be the telltale yellow stains of iodine visible. At the slightest sign of infection, get back to the nurse.

As far as time in A&E goes, bleeders come first in triage, if you’re sober.
 
mikeyB said:
It’s an either/or situation. Stitching isn’t really necessary, you’re not looking for a cosmetic result. Steristrips would work fine, if your practice has some in the cupboard. A&E wouldn’t mind you rolling up, but that’s all they would have done. Does that answer your question?
Click to expand...
They considered steristrips at the surgery but said the gash was too wide for them to be practical. Initially, they thought I might need to go to Leeds for some 'internal' stitching, whatever that is. Scars don't bother me - I have a 10" one along my right thigh! 😱 🙂 I've been wrapping clingfilm around them in order to shower, but they do get a bit damp and the iodine patches underneath the dressings do turn them a bit yellow! 😱 I've been making sure my legs are not feeling too hot or have any redness. Just feel a bit sore now, will find out later what they look like 😱
 
Robin said:
They look nasty enough for me to have thought I might not get them clean by myself, and we can never be too careful with feet and legs
Click to expand...
My trousers protected me from getting any dirt in them, fortunately, although it's a good job I wasn't wearing my fashionable white drainpipe Levis, they would have been ruined! 😱 😉
 
My daughter once came home from school saying that someone had accidentally hit her in the face with a plastic hockey stick, and that her vision was blurred. There was no sign of any cuts or bruising or redness to the eye, so I probably wouldn't have taken much notice except that she was saying her vision was blurred. So I asked an optician for advice, and he said see your GP. So I rang the GP, made an appointment for later that morning, only for them to ring back 10 minutes later to tell me to take her to A&E in case it was a detached retina. I tried to keep her away from A&E!

Another time she was playing outside in the snow (rare for us to get enough snow to play in!), came running into the house, slipped on the kitchen floor and bashed her foot into the wall. Again I couldn't see anything to be alarmed about but she seemed to be in a lot of pain, one toe in particular, and several hours later when it didn't seem to be easing off at all I rang the GP only to be told to take her to A&E to get it X-rayed. Again I tried!

In both incidents I'm glad to report that nothing was found to be wrong, the eye was fine and symptoms resolved within a few days, the toe was at first suspected to have a hairline fracture but then they decided that what they could see was just an irregularity in the bone that was there anyway, so that was fine too and also resolved within a few days. Which made me feel relieved but a bit guilty for making a fuss, the hospital staff were all lovely though and said it's better to be safe than sorry!
 
I have been in A&E with two sets of police at 4am. All others where Drink or Drug related. Was not like that 10yrs ago ?
 
Northerner said:
They considered steristrips at the surgery but said the gash was too wide for them to be practical. Initially, they thought I might need to go to Leeds for some 'internal' stitching, whatever that is. Scars don't bother me - I have a 10" one along my right thigh! 😱 🙂 I've been wrapping clingfilm around them in order to shower, but they do get a bit damp and the iodine patches underneath the dressings do turn them a bit yellow! 😱 I've been making sure my legs are not feeling too hot or have any redness. Just feel a bit sore now, will find out later what they look like 😱
Click to expand...
Aye, don’t worry about scars, just tell everybody you got them at Goose Green, and see how many free drinks you can blag.
 
Last time I was in A&E, my mum was desperately ill with sepsis and the A&E staff were working on her but running back to a guy in the next cubicle who had ‘crashed’ causing a major response with staff running about like headless chickens. His wife was screaming and the whole scene was fraught.

The main row outside of this area was full of little rooms with the more sick but not desperately ill patients mainly waiting for stabilisation and admission.

As I came out, the place had a fair sprinkling of minor injuries, people who should have gone to a pharmacy and a strong smelling drunk with his head in a bucket shouting incoherently about having to wait to have his sore ankle seen to (he’d obviously fallen off a pavement paralytic). I felt like clipping his head as I passed by!

I firmly support any initiative to keep A&E for urgent cases and emergencies.
 
Northerner said:
NHS bosses are considering a shake-up of A&E care that could lead to patients with only minor ailments no longer being guaranteed that they will be treated within four hours.

Under the plans being examined, people with non-urgent medical needs would be advised to seek help at a GP surgery, walk-in centre or pharmacy instead – or face a long wait in A&E.
Click to expand...
I've just had the same dilemma as to whether A&E was appropriate. Daughter came off her horse when it slipped over, luckily she didn’t get her leg trapped, but she banged her head, ( she was wearing a helmet). She seemed fine at the time, apart from about half an hours memory loss, but at work the next day, her headache was getting worse, she had poor concentration, and she was incredibly grumpy. We checked NHS online, and decided she ticked enough of the boxes, and I thought if I rang 111 for advice, they'd probably say take her in, (because they can’t afford to get a head injury wrong), local minor injuries unit didn’t list 'head injury' in the categories they deal with, So I took her to A&E.

She was triaged and put down for the Registrar, who checked her over, asked some questions, told her the risks of a CT scan outweighed the risk of not having one, said they would expect any problems to have occurred within the first 6hours after the impact, and pronounced her OK (and told her she shouldn’t have been looking at a computer screen for 48hrs afterwards, hence the headache getting worse).

But she now feels she wasted A&E's time. (hindsight is a wonderful thing, at the time we didn’t know if she was Ok or not). The good thing was, they didn’t seem to be particularly busy (around 4pm, the only other 'customers' seemed to be a couple of schoolboys with suspected broken bones) and we were in and out in just over an hour.
 
In many areas there are no Walk in centres or Minor injury units.
 
She shouldn't feel guilty of course - I'm sure A&E staff would rather she went and got checked out, than leave it and leave it - and it WAS something that got worse because she didn't go in the first place. Much more difficult for them to solve then - and I bet it's lovely being able to tell people they're fine - rather than having to break any bad news.
 
No need to feel guilty. Significant head injuries with headaches and brain fog should always be seen in A&E - nowhere else will someone be competent to look in the eyes and check for other signs of raised intracranial pressure. If there isn’t any sign, the diagnosis is concussion- same symptoms, different outcome.

That’s the problem - same symptoms. Nobody will mind in A&E for that reason. Folk have died thinking it was just concussion.
 
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