"A stretched ED where the basics are missed"

I write, out of frustration and disappointment, and at the invitation of your ANUM, to make you aware of concerns about your Emergency Department.

To skip to the end of the story, I was discharged against my will, at the end of a 27 hour stay in your Emergency Department. Not only did I receive no diagnostic analysis (other than that my GP had already performed in their clinic) or treatment, but there being no water in your waiting room, and due to the poor practice I will explain below, I felt I actually left in worse condition than when I arrived.

I make every allowance for the delay – seeing more urgent patients with more immediate life-threatening conditions is perfectly understandable, and I was fully prepared to be patient – and for the fact that the hospital was bed-blocked I believe and thus unable to move patients from the ironically named short-stay unit to the ward.

I can make no allowance for what I believe to be the defeatist, unambitious and self-fulfilling attitudes that saw me sent home with no treatment. I attended with a suspected blocked oesophagus and difficulty swallowing and breathing deeply. I agree that this condition is not immediately life threatening. It is however limiting my ability to eat and drink. I attended dehydrated, and was already losing weight. During my admission this trend is likely to continue and your clinicians’ care plan in my opinion, is likely to turn a fit and healthy patient into a weaker, malnourished one. The category 1 referral I was offered, I am convinced, was a ‘carrot’ to get me out of the bed; because 48 hours later it was still not been received by my GP.

But even more concerning, it seems these attitudes leave your staff with the hopeless and helpless view that this is the way the system is, and it will never get better. Wasting time looking for blood pressure cuffs because they so routinely ‘go missing’ is, as I understand it, the status quo, rather than ensuring that each machine is fully equipped in the first place. What adds to my (and your staff’s I believe) frustration is how in my opinion, readily fixable these appalling fundamental errors are. Here’s some more examples:

Your junior doctor instructed me to take 4 analgesia tablets per day on discharge, to help me force food and drink down, while the outpatient referral process (expected to take some weeks) ran its course. They prescribed 10 tablets, some 2.5 days worth.

That same junior doctor was concerned about my dehydration, and said at approximately 1400 they wanted me to have IV fluids. Apparently due to their lack of documentation and handover, those fluids went in at 2130.

When I asked, at 1730, one of your RNs said they couldn’t possibly give me a Panadol, some ibuprofen or IV fluids without a doctor’s say so. This didn’t sound right to me.

At 2043, I received some Panadol and ibuprofen from that RN, which was strange seeing as I hadn’t seen a doctor in the intervening 3 hours.

At 2100, a different (and wonderful junior Doctor), apologised for the poor handover they received from their colleague, which led them to believe that I had received fluids and de-prioritised their attendance to me. To relieve that RN who seemed keen to finish their shift, the junior Doctor offered to put the IV line in themselves. They couldn’t however connect the IV fluids, and so that took another 30 minutes or so.

I believe nurses were waiting for instructions from doctors to appear on their computers, left with nothing to do but to swap soup recipes at their nurses station based on my observations, rather than make additional rounds/checks on patients.

In my opinion, your colleague (who's name I can provide) and team has clearly gone to great lengths to equip your health service with an electronic health records management system, complete with computers that can and should be wheeled by the clinician to the patient. Unfortunately, that system is defeated when it seemed to me that most clinicians prefer to rely on a scrap of paper, write down information, and then run back to a computer to enter it. I believe the opportunities for forgetting, transcription issues, muddling up one patient’s information with another, etc. abound.

I felt it took my RN about 45 minutes to complete the paperwork to denote my move from the waiting room to the short-stay unit. At one stage, as I understand it, they walked the length of the corridor from the computer to me, to ask me if I brought my phone and wallet with me, and then walked away to record my answers I believe. In my opinion, the inefficiency is staggering. If it’s a 45 minute job, why would we need a Nurse to complete it? If it’s a 5 minute job, why would you tolerate a Nurse taking 45 minutes.

I believe 50% of Nurses using my catheter cleaned it before using it, 50% didn’t.

I participated in a quality audit during my stay. It was evidently about patient information only. My observations about quality of care were unable to be recorded. No doubt this will help in your forthcoming accreditation; whereas my observations will not.

I tried to escalate my concerns during my stay at your hospital, including by following the three stage escalation process illustrated by the poster by my bed. Calling the number at stage 3 resulted in a promise that the Director of Emergency Medicine would be asked to come and see me. 20 minutes later your ANUM attended. In my opinion, this was a patient placation strategy, not a clinical review strategy – how could an ANUM realistically question a Consultant FACEM?

Seemingly routinely not being able to find, and wasting time looking for: pumps, cuffs, finger clips. I can provide quotes from your staff that I heard during my time in your Emergency Department. I recall hearing the following:

“I’ve been looking for a pump, I've done a whole lap but I can't find one”.

“Did you check the old eye room? Well I will do that now, I can guarantee, but I'll do my best.”

“I’m busy. I don't even know where your nurse is.”

“What are you slackers eating?”

Some of your Nurses, including Victoria and Izzy, were absolutely wonderful. Ironically, it seems the newer a Nurse is to your ED, the more caring and compassionate they are, based on my experience.