I know this will come as a terrible shock to regular readers, but the Guardian has 'discovered' that A&E departments up and down the country are keeping sick patients in ambulances for hours to meet their '4 hour targets'.
Who would have guessed it?
Well, I suppose if the Mainstream Media (MSM) had actually bothered to read the medical blogs A YEAR AGO, they might realise that this is NOT NEWS.
Still, better late than never.
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9 comments:
I will accept that the 4hr target is not humane as soon as doctors (or their relatives) refrain from using their status to try to jump the queue whenever they pitch up - even relatively minor complaints seem to take on a different perspective when it's doctor turn to be ill, or injured.
If you want to go back to 12+hr waits, then fine, but these waits should apply equally to everybody, in my experience this has never been the case.
2hrs in ambulance verses 3 days on a trolley, neither are acceptable and both have obvious dangers.
My own view is that the NHS should make minimum standards explicit (in key areas) - we need an honest debate about how far the cash goes and what standard of service it will afford.
The Observer also ran an article today on 700,000 patients with dementia, another sphere where the NHS is trying to do too much with too little (and pleasing nobody).
NuLab will be gone soon, but I suspect these problems will only get worse, I mean look at the so called medical and nursing leaders, Darzi and Rose Gibb, how fucking depressing is that, eh ?
"If you want to go back to 12+hr waits, then fine, but these waits should apply equally to everybody, in my experience this has never been the case."
I take issue with this, A&ECN
I don't think anyone is suggesting going back to 12 hour waits. Neither do I see how having corrupt targets helps patients.
I did A&E for a couple of years in the 'bad' days of the 1990s when it was one doctor pilling through and minor patients could wait up to 8 hours (I never saw anyone who was going home wait longer than 8 hours).
Is it a real problem if you have to wait 8 hours with a twisted ankle? I don't think so.
Is it a real problem if you have chest pain and the ambulance takes an hour to reach you because it was sitting outside A&E to game a target and make politicians look good? Too fucking right it's a problem.
Oh, and I twisted my ankle badly in the 1990s and spent three hours waiting my turn with everyone else.
But that was in the days when I actually believed the staff had my best interests at heart. Today, I'd be begging to get flown to a real first world country that values lives more than statistics.
I went to A+E twice in the UKs ince the inception of the 4 hour target.
Once the triage nurses offered to bump me up the queue. I declined. The second time, I waited my turn (though was seen quickly as was in pretty bad kidney stone pain).
Last time I remember treating a doctor's kid was when I did paeds A+E about a year ago. He used to work in the department, but he still waited his turn.
I think the issues of doctors skipping the queue is a red herrig in this debate.
Dr. Thunder
www.twoweeksonatrolley.blogspot.com
We have had 2 doctors kids in paeds A&E recently.
As the medical student i was surprised tht they didn't just swipe in and ask someont to have a look so they didn't have to miss a theatre list by waiting.
I hope i am as good in the future...but i see how proactive you need to be in some situations (plus if i know my ankle wil need an x-ray why not just get someone i know to fill in the form and make my own way and save time?).
A&ECN
are you claiming that doctors are bigger queue jumpers than politicians in Casualty ?
Anonymous I'm not having a go at doctors, honestly (especially the venerable Dr Drant).
But if every patient attending A&E received the same standard of treatment as VIPs (here I'm thinking about hospital consultants, senior managers, and yes the odd politico) - then A&E would probably be a very good service, indeed.
The simple logistics of the matter dictate that time has become increasingly critical in managing demand.
Once A&E becomes gridlocked/overwhelmed then the risk of well documented horror stories, such as;
*missed meningitis.
*slow haemorrhage from a leaky aneurysm.
*delay in obtaining head C/T.
*atypical MI, etc, etc become a reality.
All of these diagnosis can be overlooked even in fair conditions but when the there are 40 or 50 patients plus various hangers on, well, the dangers are there for all to see.
The corrosive effect of chronic frustration almost always accompanies long waits - not for nothing are there endless epithets about A&E nurse.
For example, whats the difference between an A&E nurse and a rottweiler - the rottweiler is the one wearing lippy.
Or should that be the other way round......see, you had to think about it ?
Some interesting letters in todays Observer in response to last weeks front page item on the 4hr target.
Some commentators rightly pick up on the scams which (appear to) enable A&E departments to achieve the unachievable 98%.
Others accuse senior medical and nursing staff of being 'suppine' in allowing this 'appalling collusion' (if in doubt blame the grunts, eh).
Now compare and contrast with 'Casualty Watch' reports from the late 90's/early noughties.
(type 'casualty trolley watch' into google for a juicy selection of horror stories).
Comments like, 'This is a desperate situation and what is worse is that so many of the victims of these conditions seem to be the elderly who have paid all their lives for the health service and are often the least able to make a fuss', were pretty commonplace
http://news.bbc.co.uk/1/hi/health/263214.stm
According to the BMJ a Swindon man set the record for the longest A&E trolley wait (77hrs 30mins) and this marvellous testinomy to NHS efficiency was even recorded in the Guiness Book of Records
http://student.bmj.com/issues/03/03/news/48a.php
Although other reports claim that waiting times were actually LONGER (95hrs at Aintree..... now that's almost 3 and a half days according to my reckoning)
http://findarticles.com/p/articles/mi_qn4158/is_20020528/ai_n12618422
Ahhh, I remember it well - lots of gnashing of teeth, but for many years little substantial improvement.
As an ED Sister myself, I'm afraid I do not necessarily agree with previous comments made about doctors/relatives queue jumping for treatment! The long waits have not been caused by multiple staff attendance. There are many reasons:
1) Inability to admit patients to a ward-the dreaded 'NO BEDS' scenario-either as a direct referral from GP or from ED.
2)We have become a nation of ppl not taking responsibility for themselves ie not taking painkillers, trying first aid treatment in first instance.
3)Inability to get GP appt.
4)Lack of common sense-trying to treat themselves first ie plaster on scraped knee.
5)Using other available facilities first before going staight to ED ie Practise Nurse, Walk-In-Centre.
The Government have cheated the NHS out of money for many years, therefore it will take many more years worth of cash injection to get it back on its feet!
Sister Anan
I don't think I implied that doctors (or their relatives) were responsible for the queues in A&E, Sister Anan.
My point was that if ALL patients received the same attention as the VIPs then A&E would be a rather less stressful place to work.
As Napolean (the pig) snorted;
'all animals are equal, but some are more equal than others'.
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