I entered A&E for the third time somewhat relieved 😕 that, on this occasion, I had a diagnosis. While waiting to be seen I heard a nurse 👩🔧 call out to everyone, and no-one in particular, that they were at 4 breaches (presumably of the four hour waiting time). The four-hour A&E waiting time 🕰 target is a pledge set out in the NHS Mandate. The operational standard is that at least 95% of patients attending A&E should be admitted, transferred or discharged within four hours. On this visit, as with the previous two, I was discharged around the 4 hour mark.
I would argue this level of performance is more applicable to McDonalds 🍔 than our hospitals.🏨 It is only likely to hinder treatment and hamper diagnosis especially in situations a little bit more complex than ordinary. It’s not just patients🤒 who suffer, staff are likely to be frustrated and constrained 😡 in their effectiveness by such measures. It’s not unrealistic to presume that in my situation this measure did impact on the effectiveness or accuracy of my diagnosis.
Additionally, without question, on each visit I made resources were stretched 🤯 to the limit with the sheer volume of people presenting. I have no idea to what extent the people waiting required to attend A&E but I’d put my pension on at least a quarter of them being able to be treated elsewhere. 🤧 This compounds the 4 hour measurement exponentially and its not difficult to see why errors are made, it also underlines why our expectations can rarely be met.
There was a very different response on my third visit, and this was entirely due to the intervention of the Musculoskeletal Consultant Radiologist. 🤩 Thanks to his personal representation of the facts (and his opinion of them), the on call A&E Consultant managed my admission. This by no means resulted in favourable treatment, I still had to lay on a bed 🛏 in the corridor for the most part of the visit. But she did have a purpose as I was to find out later.
For the first time bloods 💉 and blood pressure 📿 were taken. Both were low and explained by the large blood loss when the hamstring ruptured suggesting why I was feeling so poorly and lacked any appetite. My blood count hadn’t been taken on the first or second visits so it was difficult to see if it was improving 🔬 but on the plus side I had just managed to avoid transfusion this visit.
The Trauma Team (you may recall I was referred on the first visit) take referrals 📥 from A&E. They hadn’t yet contacted me but I was still hopeful they would. However the Consultant disavowed me of that expectation; having reviewed my notes 🗂 following the first discharge, they determined that their intervention in my case was unnecessary.
The Consultant was surprised 😳 about this herself admitting she had made an assumption that referrals for similar injuries would at least warrant contact. I slowly realised why the radiologist had been so angry and she saw this. Without prompt she offered an apology on behalf of the NHS. I could see this was an uncomfortable truth for us both and awkwardly 🙄 I dismissed it as if it didn’t matter, but it had. It mattered a lot that she did that and I was so thankful.
There’s very little you can do for a stage 3 hamstring other than wait for it to heal, but the consultant re-referred me to the Trauma Team and summoned the Occupational Therapist to assess my mobility needs. My husband was dispatched to collect my medication 💊💊 and I began to relax to the point of sharing a joke, we’d mended the professional rift between us, order had been restored. We even shared a laugh 🤼♀️ about the need to provide me (at my age) with some assistance at home.
Then the OT arrived with a zimmer and raised toilet seat…………………………………