Patient priority in A&E

[enigma]

Should an intoxicated patient be given priority in treatment in an A&E dept in hospital ? After having spent an exhausting four and a half hours in the A&E dept yesterday with my eight year old daughter - who as it turns out has a broken wrist following an accident at school yesterday - I was dismayed to see an intoxicated male who was being abusive towards other patients and becoming aggressive with staff , being given priority treatment - well ahead of my daughter who evidently was in a lot of pain , as indeed were many others. We had to wait to initially see the triage nurse , who in turn referred us to the x-ray dept (after a further hours wait) , then we had to wait to speak with a doctor who finally arranged for my daughter's arm to be set in plaster - following another lengthy wait. I fully appreciate that the doctors and nurses work gruelling shifts and toil endlessly , often without thanks for this service and so my argument does not lie with them per se , rather the patient priority. Why should an obnoxious , intoxicated patient , who seeks to antagonise hospital staff and patients be fast tracked to the treatment rooms ? I thought that priority was given - apart from those in dire need of medical assistance - to children and yet my daughter's wait was prolonged whilst this male jumped ahead of her to be treated for facial injuries. Whilst I accknowledge the importance of removing this man from the waiting room for the safety of the staff and patients , surely instead of rewarding his anti-social behaviour , he should have been issued with a stern warning and faced with an ultimatum ie cesssation of the hostile behaviour or treatment would be postponed until he could act in a civillised manner. What is the longest fellow ABers have had to wait in A&E and is this the norm ?

[joko]

I cannot believe you got offended merely for me pointing out the fact that a broken wrist is not life threatening so the staff won't treat you with priority! I suppose you think its 'women and children first' too? There is no chivalry in hospitals. Yes its upsetting to be in cubicle near to him but what did you expect them to do? Keep all cubicles empty while he was being treated? Why do you think your daughter should get special treatment? Do you really think they nurses have the time to make all thes little considerations? They want to get through the queue a quickly as possible as they know people are distressed and have waited a long time.
I know this incident was upsetting and frustrating for you and your daughter but jumping down the throats and over analysing every comment someone makes is not good for you and won't change what happened.
I was trying to add another perspective and all I got was abuse. I expect your 'panic stricken mother' act made your daughter even more scared! If mummy is not worried then a child feels safe, but if you're fretting the child will fret too.
Why not write a letter to the hospital? - At least you will get an official answer rather than all of our speculations. Perhaps that will put your mind at rest.
I don't wish to sound unsympathetic but your attack of everything I say just because I don't agree 100% with you makes it hard to be sympathetic. Or did you just want people on here to back you up and rant along with you? Didn't you want real answers?
Anyway this is getting us nowhere so lets end it here
I hope your daughter feels better soon and is not too upset about all this
peace
And no need to bother to rate my answers - I couldn't care less

[gessoo]

At a recent visit to A&E locally, I was quite impressed that an man obviously under the influence of alchohol was put in a separate waiting area on his own where he could constantly be supervised from the reception desk, who could call security if he started to cause any problems. This seemed a great idea to me. I do not think drunks should be allowed to wait in general waiting areas under any circumstances. It puts other patients at risk and causes upset to people who are obviously ill and injured. Our hospital assesses patients on arrival and priorities patients at four levels - A to D.

[gessoo]

The longest I have had to wait is five hours when I had a severe infection in my toe during a Christmas Holiday. I was in a lot of pain, but obviously my local doctors was not accessible. What people often don't realise is that things like Heart Attacks and strokes are being dealt with in Accident and Emergency Departments. These are usually stretcher cases and people in the waiting room don't see them as they come in through a separate entrance, or realise that the staff are having to deal with these urgent cases as priority.

[Litchick]

I have heard that some illicit drugs will give the odor of alcohol on the breath. Perhaps there was a danger of overdose on this man's part and that's why he was at the A&E. And as we all know, drugs will also contribute to someone's behaving erratically.

[flaming]

What tosh replies I have just been reading. A. & E. staff have been putting up with violence and abuse for years. Yes they probably do take such aggressive people out of turn - but why should the rest of us put up with it? I'm very right-wing on this issue. The fact that he might have been drunk and the fact that an 8 year old's wrist was not life threatening are both beside the point. The thing is that he was treated out of turn, without triage say-so simply because he was abusive enough. Suppose everyone in the waiting room had made a nuisance of themselves in order to get seen more quickly? People are much too docile in these circumstances. Where were the boys in blue to give back-up to the A&E staff?

[MrPahoehoe]

Flaming you seem to be missing the point about half of these posts have tried to make. Quite simply, the guy was hammered and being an idiot. This probably happens every night in every A&E room in the country. Would you like all hosiptals to have a standing police force? and would you be prepared to fund this with an extra 1% on your income tax?? The hospital staff are trained professionals and likely made a conscious decision to treat this idiot as quickly, as high priority cases would allow; the most expedient way to nutrilse the danger, realising that we are not living in a perfect world and public spending is a limited commodity. You start by saying that "A. & E. staff have been putting up with violence and abuse for years. Yes they probably do take such aggressive people out of turn - but why should the rest of us put up with it?", are you suggesting that the police should come and arrest this man, whom you know nothing about, just for some mild inconvience to someone like yourself??

To an individual in enigma's situation this would be a trying time, as this idiot benefited from his own idiocy. However, the professionals have to (and in my opinion, did) remain objective: get the danger out for the benefit of the many at the (seemingly minimal) expense of the few. Quite frankly I could not imagine a better way of handling this extremely common type of occurance.

[kazza12345]

I wonder if maybe the man who went in ahead of you had something that wasnt readily apprent, that needed more urgent treatment? Bleeding varicies? poor blood tests etc?

anyway ive had various waiting times - once when i had a dvt i gathered up a book, sandwich and drink before driving myself to a and e knowing i would be a low priority. Once i went with a nose bleed and was dealt with immeadiately as i was pouring blood all over the floor!

[emmagleb]

To offer another perspective.... my brother was skipped to the front of the queue when he went to A&E with a dislocated shoulder he sustained playing football in goal (another kid kicked him when he was on the ground). He was 15, and so a minor, and was seen ahead of other patients with similar problems (ie - ahead of a broken leg, fractured jaw etc). Again, not life threatening though he was heavily dosed up on morphine for the pain. So at this particular hospital, kids are seen first. He was since had an operation to stable the ligament back onto the bone (the perillous results of fooball!!) when he was 17, and was seen with the adults like the rest of us.

I appreciate that kids aren't usually seen first, though I think the younger they are the sooner they should be seen, purely on being scared and perhaps not fully comprehending on whats going on. Though perhaps their cases should be considered alongside similar patients, like all the broken bones over here, and the knife woulds over there. A separate A&E list for kids? For another slant, if a woman well into a breach delivery was skipped ahead of a kid, would this still be wrong?

I'm not implying that I know the ins and outs of A&E, and parents naturally want the best for their child. I think the fact here is that the FIRST IMPRESSION of this prioritised bloke is that he was drunk and shouldn't be offered any sympathy - I totally agree. Kids should be skipped ahead but only when this is practical, ie - not ahead of the breach labour but in front of a grown man with the same injury, if anything to stop them from screaming in the waiting room!

[FTVS]

I had ti wait with my (very) drunk in A&E for five hours. I was asked by teh staff to keep him teher until he sobered up enough to articulate where it hurt - he was subsequentlky discovered onn X-ray that e had fractured his spine (that is how drink he was). However they wouldn't have x-rayed his neck but he had sobered up enough to complain about the pain. So i AM very surprised he was treated first as I wonder whether he would have been truly aware of all his injuries if that drunk. My understanding of the delay in treating drunk patients is to let them sober up enough to properly describe their symptoms. Is it possible his injuries were simply so minor he was looked at by a nurse and then sent on his way?

[doc_steve]

Every patient who attends A&E undergoes a Triage assessment. This is a method of assessing the severity of a patients clinical condition and assigning them a clinical priority in which to be seen by either a Doctor / Emergency Nurse Practitioner / Nurse Specialist.

Following assessment the patient will be allocated a specific category described by colour, description or category number. This system allows staff to prioritise those patients whose immediate medical needs needs are greatest.

To sum up, patients are seen in order of medical need, regardless of their behaviour or attitude.

With reference to waiting times, some hospitals still have patients waiting over the 4hour target time, some waiting upto 8 or 9 hours to be seen by a doctor.

[Sallykins]

I think unless the said intoxicated patient has life threatening injuries or illnesses they should not be given priority.

I think all patients should be treated in order of severity of injury or illness regardless of their age, status or any other factor.

However i do agree that intoxicated patients are aggravating. I spent 6 hours in hospital one Saturday night after having my drink spiked with Ketamine, and although completely paralysed and unable to talk i was aware of everything that was going on around me. Mostly all i was aware of was the level of noise coming from the nearby waiting room that was packed full of intoxicated people (mostly males I'm afraid to say) whom had either been involved in drink fuelled fights or accident due to severe intoxication. Unfortunately some of them decided to carry on their fights in the waiting room! I can assure you that i was feeling extremely poorly and their were other patients who were also feeling ill and the last thing any of us needed was to listen to and witness a brawl!

I find it very irritating that much of the doctors and nurses in A&E are spending their weekends attending to those who are off their faces!

[doc_steve]

As a newly qualified Doctor, I whole heartedly agree with the last paragraph of the last post!!

Its now 12:15 and this is my 18th hour of a very long shift!

[enigma]

Part 1 : Joko - I did not take offence with the fact that you did not agree with me. On the contrary , as I have always said on AB , I welcome the comments of everyone and fully respect that everyone has the fundamental right to a difference of opinion. Are you oblivious to the fact that no-one really agreed with my sentiments and yet I did not take issue with them ? Perhaps I read too much into your original post - as I stated previously , this is the difficulty with non verbal communication whereby it can be difficult to pick up on tone. Your name was immediately recognisable to me from previous posts where you had launched into scathing attacks on certain people and could quite frankly be rather rude to fellow ABers. (Does your comments on the celebrity BB thread where you called certain ABers 'Braindead idiots' ring any bells ?) Perhaps I did read too much into your answer and believed it to be the case that it was indeed my turn for some caustic remarks and to be fair , if you review your answers in your profile , it should be evident what I am getting at. You are by no means in a position to advise anyone to stop getting irate - which as I have already stated , I am most certainly not. My comments are borne out of frustration and weariness , that's all. I have never resorted to personally insulting fellow ABers - regardless of a differing opinion - and I usually sign off with 'hope this helps' if I have been offering advice. I did not ask this question to have 'a rant' in the vain hope that I would draw support from fellow ABers. I simply asked the question to glean information about the running of an A&E dept as I am not familiar with the process involved in prioritising patients.

[enigma]

Part 2 : . If you had properly digested my posts instead of partly dissecting them and drawing out the salient points , you would have been aware of the following points :

1. I have NEVER claimed to be medically qualified to answer questions about the injuries a person or persons may or may not have sustained - therefore I did not need you to point this out to me after by my own admission , I had already highlighted this point.

2. On what occasion did I say that I had displayed the 'panic stricken mother act' ? I quite clearly stated that I was worried for my daughter's safety (I would have been failing in my duty as a mother to NOT have been concerned for my daughter nor feel that her safety and well being was of paramount importance to me) due to the actions of the intoxicated male in the waiting room. I mentioned that she was distressed due to the fact that she was in pain - not because I was running about in a flap ! I take umbrage with that comment because aside from the fact that you do not know me , I am more than capable of composing myself and maintaining a sense of decorum and not just for the sake of my daughter. On the contrary to how you seem to assume I reacted , I sat quietly singing with my daughter , telling her jokes to keep her spirits up and informed her that we were moving seats to another part of the waiting room (away from the intoxicated male) to get a better view of the Simpsons which was showing on the television , thus detracting her attention from the actions of the aggressive male in the waiting room. I did not allow my own fears to come to the fore as I was acutely aware of the need to allay my daughter's apprehensions regarding her impending treatment.

[enigma]

Part 3 : 3. I NEVER claimed that my daughter should get 'special treatment' ! You continuosly spout this nonsense , completely misquoting me. If you review my original question and subsequent answers , you will - or at least should - see that I was asking why an intoxicated patient should be given priority over not just my daughter but EVERY patient in general - with or without life threatening illnesses , who had the decency to sit and wait their turn without resorting to verbally abusing the staff and patients to jump the queue. I also stated that I am fully aware of the fact that my daughter's injury was non life threatening but felt that it was unfair that this man bypassed the whole triage process. I had been informed by friends in the past , that children were given priority in an A&E dept - apart from obviously those in dire need of medical attention. I had assumed that this was correct , as I have had no prior dealings with an A&E dept in the past - thankfully. I thought that I had made that abundantly clear , so for you to continuosly pick up on that point is either a case of ignorance by not fully reading my answers or a puerile attempt to gauge some sort of reaction from me.

4. I did not read your answers nor reply to them 'in a blind rage'. Perhaps this is just wishful thinking on your part.

[enigma]

Part 4 : 5. I did not say that the man should not be treated. Simply that I could not understand why he was fast tracked to the treatment room ahead of ALL the patients , simply by displaying bouts of aggressive behaviour. As I previously stated , we could all have resorted to anti-social behaviour to bypass the waiting process but most of us managed to maintain some semblance of a sense of decorum. I admit that I was ignorant to the whole process involved in terms of waiting times and patient priority - hence the reason for my question. I am most grateful to everyone who took the time to reply - even you.

I accept that I may have misinterpreted your answer and allowed my judgement to be clouded by memories of your answers on previous posts , thus concluding that your use of exclamation marks was to slight my intellectual capabilities. (I am acutely aware of the possible rammifications of an untreated ectopic pregnancy and did not need it spelled out to me.) If indeed your answer served only to provide information on your personal experience of an A&E unit and you were as you say highlighting the issue of your duration in the waiting room , then of course you have my full apologies and I will make a note in future to read every post on it's individual merit - not as memory serves me from previous answers.Your comments are noted so perhaps now we can draw closure on this futile bickering. On the plus side , my daughter has bounced back as children often do and is a little star. I am counting my blessings that it was not indeed worse than it was

[enigma]

Thank you to everyone who answered. It is indeed very humbling reading your stories and has been extremely useful in helping me to put things in perspective. I accept that my daughter's situation could have been far worse and won't patronise anyone by saying that I know how they feel. Some of your stories are awful and I can't begin to imagine how you must have felt - especially you Sallykins. Being rendered unable to move would have completely terrified me ! Joko , I indeed appreciate your situation at the hospital and of course I understand why it was imperative for you to see a doctor asap. You all seem to have had your time of it.This was the point I was trying to make but perhaps not successfully articulating. Too much time is taken up in the hospital by the actions of an irresponsible minority who make what is an already unpleasant situation and sometimes critical wait , even more impossible to bear. Whilst I recognise the need to treat such individuals , I take exception with them being moved quickly to the hub of the treatment area to await attention whilst still quite volatile. Can they not perhaps be treated in isolation ? I appreciate the shortage of beds and availability of rooms but surely there must be some solution to this problem or do we just have to suffer in silence , watching our children's terrified faces at displays of violence ?

Thank you for your answer doc_steve. It has given me a great deal of clarity on the running of an A&E dept. You have my full respect for having the stamina to endure such gruelling shifts and tolerance in dealing with aggressive patients. I had no idea until posting this question that a trip to A&E could be so time consuming - not just for the patients ! I hope that you find time to get your head down for a while and get some well deserved rest. Keep up the good work x

[kazza12345]

i cant believe this post is still going ... it's the post that keeps on giving

[Andy008]

Has it occurred to you that the people having to wait a long time in casualty, indeed for anything, is merely another example of the fact that we live in an imperfect world, and that life, believe it or not, isn't, never has been, and never will be fair?

[joko]

as i said enigma, i gave a simple answer to give another perspective, and backed up your point about long waiting times and you bit my head off about punctuation and seemed think the exclamation mark was an insult! (?) - and you wonder why i sometimes get angry on here?

I don't get angry with people unless they start it, and they will be left in no doubt whatsoever of my meaning - and that fact that you judged me based on a previous unrelated comment says it all really.

in a few weeks when you've calmed down you will read this and see exactly what people are saying clearly -and see how your own posts sounded to others.

peace