Care Opinion

Failure to manage complex needs

Posted By Treez

"Failure to manage complex needs"

About: Craigavon Area Hospital / Emergency Department Southern Health & Social Care Trust / Volunteer Service

(as a service user),

After visiting My GP I was referred to A&E with suspected blockage in the bowel. We arrived around 11:30 AM, I made the member of staff on reception aware of the need to check my healthcare records as I have multiple complex needs and am immune compromised.

The department was full, both rooms as well as the front foyer. There was a volunteer doing a brilliant job in assisting patients to triage, however sadly their shift ended and everything seemed to go downhill rapidly. Elderly patients left in wheelchairs were being called but were unable to get up to go to be triaged, we mentioned this twice to the nurses and also to the member of staff on reception. They however did nothing.

All patients were not called over the PA system, so many people missed their turn, or if they were called it was impossible to make out the name, this was both through wrong pronunciation and speaking too quickly. Assessment times were 1 to 2 hours and in some cases longer, regardless of presenting symptoms or prior admission (some patients had been recently discharged from hospital). In my experience, the triage system failed miserably. 

I had been triaged after about a 2hr  wait, in a room without an examination bed, given paracetamol and told to go back to A&E, where I stood  for a further 5hrs, until my second OBS were done (I was unable to sit due to pain) only to be told that it shouldn’t be much longer of a wait as I was in the smaller of the two bundles, but they couldn’t say how long. I said I couldn’t go back into the waiting area as I had a compromised immune system and shouldn’t have been in there. I don’t have a problem waiting my turn, but I need to stay away from crowds and infections. We were advised I could sit in the car and wait and we would be phoned.

We stayed in the car for a further 2 hours. I came back in to go to the toilet and heard my name being called. We headed back through A&E and into triage area. There my OBS were taken again and I was told to go back and wait in A&E. I explained that If I wasn’t being seen anytime soon that we would go home as I was exhausted and hadn’t eaten anything all day (due to stomach pain). I was advised to stay as I would soon be able to see a doctor.

I asked why people can’t be allocated a number when they come to A&E and come back closer to their time, rather than 200 people sitting on top of each other in cramped overcrowded rooms. The Nurse agreed and said that they have said this to their department heads that this would be a better system, but no one listens to them. I think it’s time someone starts to listen to those that are effected!

I suffer with Functional Neurological Disorder, and had already had an episode earlier in the day while in A&E. Unfortunately however, I took another attack while in the triage area. My husband is aware how to treat these episodes and had asked the staff to leave me be until it subsided. (usually about 5mins, but longer if people intervene and try to move me or make me get up). I have no control over these epileptic type attacks, I do not fully lose consciousness as I am able to hear throughout them, but can’t open my eyes or communicate.

Sadly the nurses didn’t listen to my husband and began trying to move me and tell me to get up, dragging my arms and poking me in the eyes (believe me although in a semi-conscious state, this was extremely painful and frightening and prolonged my recovery even further). One of the nurses kept saying they have seen this many times before, and that I was pretending, at which point my husband stated clearly and firmly that I was not and to leave me alone and let me come around myself. 

When I was recovering he asked for a chair to take me back out as I was unsteady and the nurse kept repeating I need the chair, go back to the waiting area . My husband said again that I needed a wheelchair and only then did they go and look for one . Meantime with his help I had managed to walk to the triage waiting area to wait for the wheelchair.

After 5 /10 mins or so we were called to the green area . I was examined and sent for an X-ray of my chest & abdomen (this took about 5 mins and was what the GP had requested). We waited on the results and someone from the surgical team came down to re-examine me. They said my infection levels in my blood were high and they believed I had an attack of diverticulitis. I had never had this before. They prescribed medication, painkillers and laxido if required. They said I could go home but if I needed to return to A&E that I was to request to be seen by the surgical team straight away and I would not need to be triaged again. They had organised my medication within 10 mins and we thankfully walked out the door around 11:30 am (12 Hrs after we had came into A&E) and please God I don’t have to ever go through the door to A&E again. I know this is probably wishful thinking.

Best case scenario is that I hope lessons are learned and that the department realises they’re failing patients and making their jobs harder than they need to be. So much for PPI (Patient & Public Involvement). I feel that no-one is listening ,care is not improving, and staff are not aware of how to manage complex needs.

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Responses

Response from Stacey Hardy, Lead Nurse CAH Emergency Department, DHH Emergency Department and STH Minors Injuries Unit, Medicine and Unscheduled Care Directorate, Southern Health and Social Services Trust 2 months ago
We have made a change
Stacey Hardy
Lead Nurse CAH Emergency Department, DHH Emergency Department and STH Minors Injuries Unit, Medicine and Unscheduled Care Directorate,
Southern Health and Social Services Trust

Submitted on 28/10/2024 at 20:18
Published on Care Opinion on 29/10/2024 at 10:56

Thank you for taking the time to share your recent experience at Craigavon area Hospital Emergency department. I will try to answer the concerns you have noted about your attendance.

The Emergency department continues on a daily basis to be busy with an excess about off patients waiting on a bed in the ward. This overcrowding means there is very limited capacity to see and assess new patients meaning the waiting time to see the doctor is very long. This means the waiting rooms can be very overcrowded with limited seats for patients to sit.

The emergency department nurses are trained to use the Manchester triage system to assess new patients presenting to the department. This system allows patients to be allocated a priority to be seen and assessed. The emergency department doctor will assess new patients based on the allocated priority from triage not on the time in which they presented to the department. The staff are not able to give out a time which patients will be seen as this very changeable within the emergency department environment.

The volunteers within the waiting room are a great asset to assist patients while waiting but unfortunately we only have a limited cover where they are available.

The PA system usually works well for patients to be called however I do take note that on occasions it may be hard to make out the pronunciation of some names. Unfortunately it is very difficult for us to correct this. We have found that with the size of the department and the different areas this is the best system to signpost patients to an area.

Recently we have made changes to our allocation of staff and have allocated a staff member to the waiting room to carry out regular observation checks, administer medication and any other necessary care required. I am glad this staff member was able to review and complete your observations. This review also allows nursing staff to escalate to the medical staff if they have any new concerns about a patient from their initial triage.

As a department we try our best to protect patients who are immunocompromised when we are able but unfortunately this is a challenge when the department is overcrowded. We don’t recommend patients sit in their car due to risk of becoming more unwell without medical staff close by. The main foyer is another area which patients may sit in which is less crowded and the PA system can be heard.

I will share this experience with the nursing staff for learning from your experience and how we can change how we manage complex situations with patients while they are in the department.

I am glad to hear that when you were seen and assessed by the doctor you had the relevant tests completed and that you were discharged home. I hope you are recovering well.

Stacey

  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful

Update posted by Treez (a service user)

Hi Stacey, thank you for your reply.

I am glad that some things have already changed regarding how Patients are being treated in the Emergency department waiting area. I know that this is not something that can be addressed all at once, but will take time.

Listening to the Staff in this department is also key as they have first hand knowledge of what’s going wrong and how best to address this. Especially when it comes to managing crowded A&E departments and avoiding unnecessary stress

I feel a that a system of Triage that signposts people to specific waiting areas would be more helpful.. Therefore anyone presenting with an infection would not be seated beside someone who had a compromised immune system. Someone who requires regular monitoring could be placed elsewhere I.e. elderly or disabled.

The Manchester System may work elsewhere but that doesn’t mean it’s the model that best suits N.I.

Hopefully by working together things can improve for everyone,

Best regards

Treez

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