Writing about the latest woes in the nation’s emergency departments is one thing, last night I was experiencing them first hand. And learning a few interesting lessons.
With my son having a wrist fracture I spent half the day and most of the night sat in the ER waiting for his to be called up to have the bones reduced by an orthopod (only to find ourselves ‘bumped’ at 11pm). After reading all the horror stories in the press, it was reassuring to see that nobody appeared to be giving birth in the toilets, no ambulances were ramping and no staff were being assaulted. In fact, not much was happening at all.
Lesson number one was if you’re going to ER, bring a good book. In fact, bring several. And an iPod. And anything else you can use to keep a child entertained during the interminable waits.
Lesson number two was to bring something to eat. I was very grateful for the cheese sandwiches the staff kept in the fridge for use by patients and families, but after eight hours I was craving something a little more substantial, yet couldn’t leave my son alone.
Lesson number three was to bring some earplugs. I don’t know how the staff manage, but being exposed to the cries of children in pain for hours on end must be one of the most mentally stressful and draining experiences for a parent – especially when combined with the background noise of the same Tellytubbies video being played over and over again.
The other lesson that I re-learned is that the doctors and nurses in ER do a great job in very difficult circumstances. I know it’s a cliché but their professionalism, compassion and sense of humour really did make a good impression on this parent.
Interestingly, I was also impressed by the selling and negotiation skills needed by the staff to persuade and reassure worried parents that their sick child was not in serious danger and would be better off at home.
My son is now recovering, slightly groggy, but rather pleased that he has a cast iron (or should I say plaster) excuse to not do any written homework for next few weeks.
Comments
I used to enjoy orthopaedics when I was a student and junior doctor in the Emergency department. I like procedural work, I like making people feel better, and looking after patients and particularly children with fractures was a source of satisfied patients and staff.
Allowing an RMO2 to do Bier's blocks on several patients at a time, with no-one else around and no monitors would fail current safe practice guidelines - but still, it was fun and the patients approved. Luckily, perhaps, I had no problems.
Much of the management has been taken out of the hands of emergency department staff in some hospitals. The initial wait may be because there is nowhere to see you, and the wait for review after xray is very likely to be because the plaster room is occupied by a patient with abdominal pain or something else which needs a bed, and there is no other. A lot of hospitals have lost either plaster technicians or - nearly as good - an orderly in charge of the plaster room, which makes the difference between finding 10 minutes to review you, and finding half an hour because I have to start by clearing up after the last RMO whose time is presumably more important than mine. Indeed, the room may be shared with the fracture clinic and left in chaos.
Worst, some fracture clinics will only accept referrals via, or vetted by, their orthopaedic registrars. Some General Practitioners are happy to follow up straightforward injuries, some are not, and some who would like to do so have been stopped by councils changing the rules for wastewater and demanding hugely expensive dedicated plumbing. We tend to find that after one complaint from a GP or patient "inappropriately" referred to the GP that there is pressure to refer to the fracture clinic instead. As a result, patients wait hours for a junior registrar to see the films and agree to an appointment. This registrar may not see the patient who is therefore unaware of the reason for the delay. Posted by Diane Campbell, emergency physician. on Friday, 29 August 2008
