Friday, 25 July 2008

Numpties and Neds

I feel I've got a bit political recently which is not really what I do (it's enough that the writing is on the wall for Gordon Brown), so I've gone back to my first love for this post - the idiots that seem to inhabit my world, or at least my night shift world. In these cases however, I'm sure you will agree that I am not picking on the innocent or the unlucky.

The first young lad I saw had a sad tale to tell, how he was minding his own business and had been attacked and had had to defend himself and hurt his hand in the process. I am always prepared to give the benefit of the doubt to someone and I try not to judge but I was feeling just a bit sorry for him then one of the other sides friends appeared. Screaming and shouting and swearing at him that he had no business here after hitting his pal with a glass and giving him some very nasty facial lacerations. A fight started in the middle of reception, We did not have security and I was on the other side of the reception desk and unable to intervene but luckily an ambulancewoman was passing and got between them and stopped the fight. Turns out far from being the innocent party, he had started the whole thing by hitting some guy with a pint glass for no real reason. He then asked for a loan of my pen and stuck out his hand which was covered in blood - no way mate, if I gave you that I would have to throw the pen out. He was arrested and taken to the cells for assault.

If you are going to threaten to punch your girlfriend, don't do it when I am passing and can overhear and don't do it where there is CCTV camera coverage. You were really unhappy when I told you that if you did punch her you would be on your way to jail as I always called the police and I always ask for arrest not just removal from premises.

The third patient had a minor injury and had had a wait of about 40 minutes. I went into the waiting room to explain that we were busy and he would probably have to wait another hour at least but he was not happy with this. He asked who I was and when I explained I was one of the nurses his only comment was "poof". He was lucky, I wanted to get him arrested but my colleague had a better idea, we kept moving him to the bottom of the queue so that he would not be seen for hours. We told him we were going to do this hoping he would leave but the numptie kept waiting. After 4 hours of this he was eventually seen, by which time he was a bit more sober and a bit apologetic. Unethical I know but understandable under the circumstances.


gab said...

Last month, Esmin Green, a 49-year-old mother of six, tumbled off her chair and onto the floor of the Kings County psychiatric E.R. waiting room in New York City. Members of the hospital staff saw her lying there but did nothing for about an hour. When Green was finally brought into the E.R., she was dead. An autopsy revealed that she died from a pulmonary embolism, which occurs when a blood clot forms in the leg, breaks off, and travels to one or both lungs. This can also kill long-haul airplane passengers who sit in one spot for hours: The blood sits stagnant in their legs for so long that it clots. You could say that Green, too, had been on a plane ride of sorts. She'd waited for a psychiatric-unit bed to open up for more than 24 hours, roughly the same time as a trip from New York to Tanzania.

The surveillance video of Green collapsing and lying untended, as hospital staff at Kings County fail to respond to her collapse, is inexcusable by any stretch. And so Nancy Grace, for one, focused on the negligence. But what's largely missing from this story is the likely cause of Green's pulmonary embolism. The answer lies in a far more systematic and widespread danger in hospital care: E.R. waits. Why was Green sitting and waiting while blood pooled in her legs? Despite increasing evidence that crowded E.R.s can be hazardous to your health, hospitals have incentives to keep their E.R. patients waiting. As a result, there has been an explosion in E.R. wait times over the past few years, even for those who are the sickest.

A major cause for E.R. crowding is the hospital practice of boarding inpatients in emergency departments. This happens when patients who come to the E.R. need to be admitted overnight. If there are no inpatient beds in the hospital (or no extra inpatient nurses on duty that day) then the patient stays in the E.R. long past the completion of the initial emergency work. This is what happened to Green, and it has become widespread and common. The problem is that boarding shifts E.R. resources away from the new patients in the waiting room. While E.R. patients wait for inpatient beds, new patients wait longer to see a doctor. As more new patients come, the waits grow. And an E.R. filled with boarding patients and a full waiting room is an unhappy E.R.: The atmosphere is at once static and chaotic. If you or a loved one has waited for hours in an E.R., you know what we mean. The environment can be unsafe and even deadly. A recent study found that critically ill patients who board for more than six hours in the E.R. are 4 percent more likely to die.

Well looks like we do the waiting thing too yet yours seems more realistic than ours!

Anonymous said...

Sounds like a lot of our patients! I've waded into a couple of waiting room arguements in the last couple of weeks........... must be mad!

GrumpyRN said...

Gab, in UK, A&E's (ER's) must see and treat 98% of all patients who attend within 4 hours. This means that they must have them out of the department, not just a plan for them. That means either treated and discharged or admitted to a ward for further investigation/treatment. A&E's are struggling to achieve this but most are achieving about 95%. A lot depends on whether the hospital has taken the problem on board or left it to the A&E to sort out - my opinion is it is a hospital wide problem, not just an A&E problem.
I saw reports about this lady and have seen the CCTV footage - it made the national news here as well. I can understand patients collapsing in the waiting room, that happens all over, but I think what shocked everyone who saw it was the lack of caring that was demonstrated, the fact that no one went over to see if she was all right and that she was actively ignored by staff.
One thing which makes life in UK A&E's easier is that under the NHS everyone has their own family doctor and therefore does not need to attend A&E for primary care, ie if you have a cough you go to your own doctor not A&E and you do not have to worry about ability to pay. What we are seeing is a lot of eastern European immigrants using A&E as a GP service. Some places have had leaflets printed in Polish etc to let these people know what we do and that they can register with a local GP as a temporary resident.
I think waiting rooms can be the worst places but I have seen some really good nights where a party atmosphere develops and everyone is happy.

Louise, I was well impressed by *Jane* (not her real name) I find that a sensible female authority figure (in uniform) has more control and ability to stop this nonsense than another guy who can sometimes just inflame things.
And anyway I am a woose and too old to be rolling around on the floor.

WKC3 said...

I work in a Surgical/Trauma/Neuro ICU here in the US, and fortunately it's a locked unit. I wouldn't want any angry kids coming back to finish off my GSW patient. That sort of thing is one thing that sort of attracts me to, yet at the same time, keeps me away from the ER.

Yeah, and about that lady who died in the ED waiting area: we have people asleep on the floor in our lounge all the time. I would never think to go check their pulse! Then again, it's not the ED...

gab said...

Its too bad you are so far away from me! I'd go to you for treatment. I suffer migraines and have to go to the hospital often. I usually go to my own hospital but it is about a 10 mile drive so I thought ok we will go to the one thats 3 miles from our house. So I had Mr Gab drive me and I was sorry I went there. There was no one in the waiting room so I thought good Im gonna get right in. Not so. Here I am in the waiting area puking my guts out crying because the littlest noise sounded like it was 100 times louder than it really was. and no one seemed to care. In fact after waiting over 4 1/2 hours I told Mr Gab lets go over to my hospital. I waited another 1 hour at my hospital but got it and got a shot. By this time I was so tired that while I was waiting to see if I would have an reaction I passed out! The nurse on duty for my section thought something bad had happened to me but Mr Gab told her how it was for waiting at the other hospital. She wanted to admit me but he said no he would take me home and put me to bed. I just dont understand this wait thing, but dang when your hurting you would think they would try to see you sooner!

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