"Staff attitude at the Emergency Department"

My spouse and I recently visited our adult child from Interstate. We spent the day at Rottnest Island where unfortunately my spouse got a splinter from one of the railings. We went to the Nursing Service on the Island who were fantastic, but unable to remove the splinter. They referred us to the Fiona Stanely Hospital (FSH) Emergency Department (ED).

We considered using the ED for a splinter was a little overkill so we went to the Urgent Care Service at Cockburn where two lovely doctors attempted to remove the splinter but were also defeated. They provided us with a letter and referred us to FSH ED.

We arrived at the FSH ED and were guided to some red chairs to wait to be triaged. Approximately, 20 minutes later we were guided by the volunteers to the Triage window where we produced the referral letter and went through the process of describing the events of the afternoon. We were then registered and advised to wait on the black chairs.

While waiting on the black chairs, we had plenty of time to read what we felt was misinformation on the information screen about Cat 4 wait times and watch the people come and go through the doors. About an hour or so later we were called through to I am guessing the minor injury section. The three of us followed instructions and waited in the cubicle that was partitioned with a blue curtain and had a bed. The nursing staff said for us to sit down and wait to be seen.

My spouse sat on the bed and after awhile my child and I joined them, where we sat for the next 30 minutes. In that 30 minutes, we heard the entire gynaecological and obstetric history of the poor patient next door. I felt very embarrassed for this poor patient and consider that there should be greater care given to privacy and dignity for these matters. (Would the doctor have asked the same questions without the thin blue curtain divide?).

A Nurse Practitioner (NP) came to see my spouse. Their first task was to scold us for sitting on the bed as they didn't have any cleaners that night and wanted to keep the beds clean for those who need them. We promptly did as we were told and the NP put up the bed rails so that we couldn’t return.

The NP then advised that only one carer was allowed (although we had seen many patients with, who we believed, were two family visitors) and so my child left as requested. The NP got a chair for my spouse and a stool for themselves and then proceeded to review my spouse.

They removed the dressing placed by the Urgent Care doctors then prodded and poked and sent my spouse for an X-ray. The NP said they would have to discuss with a doctor because they will need an ultrasound to find the splinter. My spouse went for the X-ray and while they were away, the young person from next door was wheeled off and I observed the cleaners come and attend to their cubicle (perhaps the NP wasn’t aware that there were cleaners).

My spouse came back from X-ray quite cheerful about discussing their home country with the Radiographer. I want to thank that Radiographer for his patient-centred care.

The NP returned after reportedly discussing the case with someone and told us we would have to come back the next day as there were no ultrasound services as they had gone home for the day. I then asked the NP if the wound should be covered? They replied with a personal anecdote which didn’t really answer my question so I asked it again and their rather curt response was that they could give us a bandaid which I felt still didn’t answer my question.

I believe the NP must have felt my annoyance and so a band aid was ordered. The NP then asked about tetanus and whooping cough status of which we were unsure. The NP and an RN returned with an injection, an antibiotic, and a prescription. While the RN was providing the antibiotic and injection the NP printed off a letter for us to bring with us the next day.

Fortunately, we have the letter so we know what was in the injection and what is the plan for the removal of the splinter. Even more fortunately, we found a Pharmacy open who was able to instruct us on the dosage of the antibiotics.

So now our saga continues as the next day we had to pack and check out of our hotel and return to FSH ED from 8.00 am and before our afternoon flight home. The only good thing about that is that the NP, who we believe had absolutely zero patient-centred care attitude, will not be there. Up to this point, this splinter (thickish, long and deep) has defeated 3 medical services. 

My thoughts are that the design of the FSH seems poor. Nursing staff do not have direct visual of the patients sitting on the red chairs who are yet to be triaged or those on the black chairs - yet their signs advise that the contents of the vending machines are protected by CCTV. What about the patients? Could there not be some assurance for them also?

Patients who have a problem that involves gynaecology/urology type issues be questioned in the interview room for privacy? My spouse is from another country and has language difficulties but there was no offer of an Interpreter. I, of course, don’t mind interpreting for my spouse but I feel it is not very professional. This issue was exacerbated when the NP talked at my spouse without even once checking to see if they understood a single word (which they didn’t).

My next thought is why did the NP bother to order an X-ray knowing that wood wouldn’t show up? There are so many “whys” - why have an information screen with, what I believe, is false information - I guess the caveat is “average” wait time.

Why does the letter say presented at the ED at “a time”, when it should actually say was Triaged at “a time”. I feel that’s almost like the secret waitlist for the waitlist. Why did they think that shooing us off a bed that we had been sitting on for half an hour, didn’t need to have a sheet change for the next patient? Why doesn’t a tertiary hospital have ultrasound available at 8pm?

I felt we were made to feel like 3rd class citizens. I am not sure if it was because we are out-of-staters, because we were scruffy from spending the day at Rottnest, because my spouse only had a splinter or because between us we spoke in another language and it’s a racial thing. Whatever the reason, our experience of FSH was unpleasant and I just hope it will be a different story when we return. I feel that the NP who treated my spouse has a terrible approach and zero care factor for those they are treating.