10 Things to know about your visit to A&E
There is likely to be a lot of waiting around.
The 4 hour target means that the emergency department will want you fully assessed and either discharged or admitted to the hospital under a specific team within 4 hours.
This being said there is still likely to be a lot of waiting around - to see the nurse for triage, to see the medical professional who will assess you, for tests, for the results of those tests and possibly to see other teams (e.g medical, surgical or orthopaedic who can be on call for the whole hospital so make take a while to get to you).
During the current NHS struggles it is also very possible that the 4 hour target is missed, so don’t be surprised if you have to wait longer than 4 hours - especially at peak times.
It’s definitely worth taking a book or something to keep you occupied.
Arriving in an ambulance will not necessarily get you seen any quicker.
All patients arriving in the emergency department will be triaged by a nurse or doctor - this means a quick set of your vital signs and brief discussion about what your symptoms are. During this assessment you may be offered pain relief and some tests may be ordered depending on your presenting issue.
Patients who arrive in an ambulance will not automatically ‘skip the queue’ as is a common misconception - they are triaged the same as if they came in through the waiting room (but possibly in a different section of the department) and then seen in order of need. Ambulance patients also often get moved into the waiting room if it is deemed that they do not need a bed or more intensive monitoring whilst they wait for a more detailed assessment.
Ambulances are for life threatening emergencies only.
https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-call-999/
You also won’t get an ambulance to take you home if you arrived in one. Hospital transport can be arranged for those who need it, but most patients will need to arrange their own transport home.
You may not need to be seen by a Doctor during your visit.
There are many different types of practitioners working within the emergency department and assessing patients.
You may be assessed by a nurse practitioner, a paramedic or a physician associate. These are all skilled professionals who are trained in emergency department assessments. They are all being supervised by an Emergency Medicine Consultant (or other senior emergency doctor) who will be on hand to discuss issues and review patients if needed. These professionals are actually sometimes more experienced than the junior doctors who work in the emergency department.
Some patients may be seen to ‘skip the queue’.
This can be very frustrating when you have been waiting a long time but there will always be a good reason for someone jumping the queue. They may have had some abnormalities on their initial tests or have a concerning background medical history. They may be able to be seen by a nurse practitioner who has a shorter waiting list. They may have been sent in by a GP or practitioner outside the hospital who has referred them directly to a specific team. Please be mindful that everyone is in the emergency department for their own reason (some much less visible than others) and many are scared and in pain.
You may be redirected away from the emergency department.
After your initial assessment with the triage nurse or doctor it may be decided that you can be reviewed in an alternative setting - perhaps a co-located GP practice, a minor injuries unit, a specialised emergency eye clinic or an emergency assessment unit within the hospital.
There are lots of different areas within the department.
-The resuscitation room (or resus as it is more commonly known) for the sickest patients who need much more intensive treatment and monitoring.
-Majors is an area for patients who are likely to need to be in a bed and sometimes on a monitor. This area is for the next sickest patients.
-Minors is a mixed area - often with some beds and chair spaces. This area may have simple consultation rooms for assessment of patients who will then go back out to the waiting room.
-Side rooms - both the majors and minors will have isolation rooms for patients suspected of having an infectious disease (such as diarrhoea and vomiting bugs) or patients needing more privacy.
-The waiting room - for those less sick and not in need of a bed. This area will be by reception (usually the first area you come to in the department) and will have lots of chairs.
-Radiology - Most emergency departments have their own x-ray area - where all the emergency x-rays are done. If you are needing other more complex imaging/tests - like a CT scan or an MRI these are likely to be done in the main radiology department of the hospital - this is usually close by. You will likely be taken here by a porter, nurse or healthcare assistant.
-Paediatric emergency department - this area of the department is occasionally combined with the adult side but should ideally be separated. Children (usually up to the age of 16) will be directed here on arrival to A&E and there will be a separate waiting room, assessment room, majors and minors areas specifically for children to be seen in.
-Some emergency departments will also have special rooms (or even mini-wards) for patients experiencing acute mental health issues. These can have 2 doors, less furniture and sometimes observation windows for safety reasons.
Everyone is stressed!
The emergency department is a very busy and stressful place to be - for the staff and patients. It is the first port of call for pretty much all those coming to the hospital with an acute problem.
We are all aware how much pressure the NHS is under - the emergency department is one area of the hospital where you might see this magnified. All the staff will be trying their best and will be working under a lot of pressure - please be kind whenever possible.
You may be able to have someone with you - especially if you have a disability or need a carer with you and this can help.
It's all FREE!!
The NHS is an amazing organisation - free at the point of use! The emergency department goes one step further and is free to all - even non-uk residents.
The only thing you may be asked to pay for is an outpatient prescription (if you usually pay for your prescriptions) if you need medication to take home with you.
It’s ok to ask questions.
In fact, I would strongly encourage it! Ask for pain relief if you need it. Make sure you understand what is happening at each stage in your assessment. Make sure you understand your diagnosis (if one has been found) and any treatment or tests that have been done. If you are being discharged make sure you know what steps you should take to look after yourself at home and if there needs to be any follow-up or further investigations.
You may leave not knowing what has caused your symptoms.
Sadly it is often the case that the cause of your symptoms can’t be found but importantly all serious causes have been ruled out as best they can be. If this is the case you may need follow-up or more tests as an outpatient or be advised to see your GP/return to A&E for further assessment if things don’t settle down.
If you are feeling overwhelmed or have lots of questions I can help. My passion is helping people feel in control of their health and lives. I am an experienced NHS doctor turned health coach and I can help you understand what is going on with your health. I can also help you look at all aspects of your health and wellbeing to get you in control and make the changes you want. Step by step we will get you back in the driver's seat of your health and wellbeing.
Thanks for reading
Katy
