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EDITIONS
Monday, 28 October, 2002, 12:49 GMT
'There is unbelievable pressure'
Trolley with paramedic
Routine cases must wait when emergencies come in
Doctors say the government is painting an "overly optimistic" picture of casualty departments success in meeting waiting time targets.

Simon Eccles, a senior registrar at the Royal London Hospital describes one afternoon working in the A&E department.


Mr Eccles arrived at work to find a full department waiting for him.

"At 2pm, I walked in to find 22 patients waiting to be seen who had major injuries, at least 20 people queuing for treatment for minor injuries, the 'walking wounded', and six people in the five-bed resuscitation unit."

Up to 14 patients were also waiting to be transferred to beds in other parts of the hospital.


I hadn't seen a single routine patient

The government wants all patients admitted, transferred or discharged within four hours, and the department has set its own target that urgent cases must be seen within an hour.

Mr Eccles said: "There is unbelievable pressure."

"I estimate 60 to 70% of patients are seen within four hours."

He said patients with minor injuries could be seen very quickly, sometimes almost instantly.

"They are going to be seen within four hours, bringing the average down.

"Patients waiting on trolleys, little old ladies accompanied by angry relatives, their waiting time is going to remain high, but overall, the average is going to be OK."

He added: "At the London, we don't really have patients waiting over night, but we do have patients waiting four to six hours, and sometimes longer.

"The longest wait that day was 12 hours. That's a long time to be lying on a trolley that's not designed for longer than four, with no privacy and no ward facilities."

Communication

In the A&E unit, urgent cases are classified as yellow, routine as green. Normally there are a few yellow cases, with the bulk green.


We had to put two patients in each bay with a flimsy curtain between them

But that afternoon there was a "wodge" of yellow cards, meaning routine patients would have longer waits.

Mr Eccles' first patient was an 84-year-old woman who had become confused and was complaining about back pain.

"Because she was unable to communicate how she felt with us, it was pretty difficult to work out what was going on.

"I thought she had cracked a vertebrae in her back, so I ordered X-rays and blood tests.

"That all took 40 minutes."

Pressures

A man who had suffered a heart attack was brought in to the resuscitation - which now had seven patients in an area meant for five.

Mr Eccles: "We had to put two patients in each bay with a flimsy curtain between them.

"Patients have to use bedpans because they are hooked up to monitors and can't be moved to the bathrooms, with just this see-through curtain between them.

"When the patient with the cardiac arrest was brought in, he wasn't breathing, but his heart was beating.

"But his heart stopped, so we spent 45 minutes using drugs and electricity to get him reasonably stable."

Both Mr Eccles and the A&E consultant were part of the team treating the patient, meaning neither was available to help more junior doctors deal with routine cases, adding to the time those patients waited for treatment.

"There were five, out of the six, senior house officers queued up, each with a question for us," he said.

'Frustrating'

Half an hour later after dealing with the other doctors' queries, Mr Eccles was able to return to dealing with waiting patients, though he not yet seen any routine cases.

But Mr Eccles then had to go back to the resuscitation area to treat an angina patient there who had started to suffer severe chest pain.

Like a third of patients at the hospital, English was not his first language. Translators, who can help calm the patient and help the doctors understand what is wrong, are not always available for urgent cases.

Mr Eccles said: "For him, it was very frightening. And for doctors, it can be terribly frustrating, and there is a time pressure, because it takes much longer to see them."

It took 35 minutes to treat the angina patient, giving him oxygen and aspirin to thin his blood, then putting in a bid to get him transferred to the coronary care unit.

"Whilst I was doing that, the red phone rang, which means a call from the ambulance service, or as in this case, the helicopter.

"They were bringing in a trauma patient, a man in his 20s who had come off his motorbike bike.

"He had broken bones and a squashed chest.

"He needed care from 10 doctors and 2 nurses for an hour.

"By the end of that three hours, I hadn't seen a single routine patient."

And the situation facing the registrar coming in for the night-shift was no better than that faced by Mr Eccles earlier in the day, with 20 patients with major injuries waiting to be seen.


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28 Oct 02 | Health
10 Sep 02 | Health
28 May 02 | Health
28 May 02 | Health
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