"Long waiting time in A & E"

About: Wishaw General Hospital / Emergency department

(as a relative),

• Mum fell in a shop, required assistance getting up, in great deal of pain, unable to move her left arm.

• An ambulance was called; she was advised to get a taxi to Wishaw General Hospital A & E Dept, where she would be seen immediately.

• Arrived at WGH 40 minutes after her fall, was advised by receptionist that she was a “minor” and asked to take a seat

• Spoke to receptionist 2 h later and and then again after another hour and was advised again that she was a “minor” and there were two people in front of her.

• Approx 4 hours after getting to A&E she was called to be seen by nurse, after being seen she was advised that she had broken her humerus bone. Was given a sling, pain relief and an appointment for fracture clinic.

1. I would like to know why my mum wasn't seen by a triage nurse?

2. Is this because receptionists are medically trained to make assessments and decide who is to be seen by triage?

3. If this is the case, should the receptionist not ask further medical details?

If the receptionist had asked my mum about her medical history they would have discovered the following –

My mum has COPD, Angina, High Blood Pressure, Rheumatoid Arthritis and more importantly suffered a heart attack 2 months ago.

My mum was in a great deal of pain, extremely anxious and concerned that her stents may have moved.

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Responses

Response from Andy Pender, Senior Nurse, Emergency Medicine, Wishaw General Hospital We have made a change

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Dear Joanie mac

Thank you for taking the time to share your recent experience. I am sorry that your Mums experience was not as you would have expected.

We strive hard to ensure that all patients are seen promptly and work together as a team to ensure patients are prioritised appropriately. I would expect reception staff to inform the nurse in charge of any patient who is distressed and in pain. I will share your concerns with the whole team to convey any patient concerns directly to nursing staff and apologise for any delay caused.

The patients that are allocated to the minor injuries area are normally assessed very quickly. However there were several days last week when activity peaked and there were some delays to assessment. For this I would apologise.

Due to this we have reviewed our escalation process and to ensure that the Duty Senior Managers on site has a clear plan to resolve such a situation. This change in our management of the patient flow will hopefully resolve the issue that you encountered last week. When escalation of this sort is made there will be a clear plan to reduce waiting time, support the Nursing Staff and ensure patients are seen timeously.

It would not be normal practice for the reception staff to take a detailed previous medical history at the reception desk as the reception staff are not medically trained and also to ensure we are maintaining confidentiality for the patient within the waiting area.

I hope your Mum continues to make a good recovery.

Best wishes

Andy

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Update posted by Joanniemac (a relative)

Hi Andy

Thank you for taking the time to respond, however this doesnt answer my question as to why my mum wasnt seen by a triage nurse? My mum is 68 years old with various health complaints, including her recent heart attack. If Wishaw General Hospital think that a receptionist is medically trained enough to assess a patient as Minor, surely they should be able to ask questions about health, possibly in a private area.

Regards

Response from Andy Pender, Senior Nurse, Emergency Medicine, Wishaw General Hospital

picture of Andy Pender

Dear Joannie mac

In order for me to provide you with a more detailed targeted response could you please contact the Patient Affairs Manager so that I can review your Mums individual case.

The patient affairs manager may be contacted on 01698 366558

I will gladly review this and get back to you once I have additional information.

Best Wishes

Andy

The

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Response from Andy Pender, Senior Nurse, Emergency Medicine, Wishaw General Hospital

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Dear Joannie mac,

I have spoke with our Patient Affairs Manager and I believe that she has advised you of the NHS Lanarkshire complaints process.

I will review the time line of care assessment to treatment when we receive additional details from you.

In respect to the triage of your Mum. Patients with minor injuries or illnesses may be directed to alternative services which may be more appropriate for them, and triage is not routine with this presentation as the minor injuries area operates a ‘See and Treat’ system which is designed to ensure that patients with minor problems are seen without delay. However on this day this was not the case and there is obvious delays with the main department full with critically ill patients and others waiting with minor injuries longer than we would expect. This is not the standard that we strive for.

The See and Treat service normally sees 98 % of patients that have minor injuries within the 4 hour standard that we aspire to. On this day we were facing a particularly challenging day within the Hospital.

I would agree with you the Reception Staff are not medically trained to assess patients with acute medical illness and emergency presentations had your Mum presented with this I can reassure you that she would have been seen by a triage Nurse.

I would like again to convey my sincere apologies to you once again for any distress that was caused.

I look forward to hearing from you through our Patient Affairs Manager and the Hospital Director will be in touch with the outcome of the investigation that we will conduct regarding your concerns.

I hope your Mum is feeling better today and making progress.

Best Wishes

Andy

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Response from Andy Pender, Senior Nurse, Emergency Medicine, Wishaw General Hospital We are preparing to make a change

picture of Andy Pender

Dear Joaniemac,

I wanted to keep you informed that a response will be sent out to you by the end of the week.

I have discussed this with the clinical staff and a change will be implemented within the ED to improve pain assessment and management. We have decided to trial a poster placed at reception asking patient’s “Have you taken analgesia prior to arrival?” “Do you need analgesia?” and if so, please inform reception staff at time of booking in. Hopefully this will in turn prevent any other patient’s having this negative experience.

I hope that your Mum is making good progress.

Best wishes

Andy

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