Thread by @DrLukeCraddock

After working in A&E for just a little over a month, I thought I'd share my experiences as one of the front line doctors facing the current/ongoing crisis happening across our country.

A quarter through my placement, I already feel burned out and morally fatigued.

1/20.

Lack of community treatment

Many patients I see do not need to be in A&E, many are there as a result of a failing primary care service.

"I couldn't get a GP appointment, so I have come to A&E" is something I have heard too often whilst working.

2/20.

Many patients are presenting to A&E with conditions better treated in the community, however, as they lack access to services, they either cannot get treatment, or their condition deteriorates to a point that they need admission.

Patients present like this daily.

3/20.

Lack of community care

What many patients need, is for some close supervision in the community. Someone to stay with them, who can keep them fed and hydrated and support their recovery.

As this provision is lacking, often they are admitted as "social admissions".

4/20.

These patients (many elderly) are then put through the ordeal of unnecessary hospital admission. Increasing the likelihood of them developing a new hospital acquired infection, or teams discovering non-symptomatic incidental findings that need treating/investigating.

5/20.

Ambulance times

I recently discovered that a few nights ago, waiting time for a category 2 ambulance was 4 hours, and up to 24 hours for a category 3.

This is dangerous and harmful to patients. Some examples of conditions in each category can be seen below:

6/20.

Stroke as an example, the time window for urgent medical treatment is 4.5 hours. This means that by the time the patient gets to A&E, we have already passed this window. This leaves patients with now life long potentially preventable disability due to poor response times.

7/20.

All those conditions in category 2 require urgent assessment/treatment and will deteriorate as time goes on. As a knock on effect, this pushes category 3 calls to the back of the queue, leaving poor patients like Elizabeth sat at home in pain and suffering.

8/20.

Ambulance queues/waiting

At my hospital, we do not hold ambulances, this means that the department becomes increasingly overcrowded and unsafe. With the same number of staff covering more and more patients. Assessments, medication, interventions, etc are often delayed.

9/20.

This is far from ideal, however, it is a view I share with the department that priority needs to be given to the patients in the community who have not received an initial assessment/treatment from a paramedic. This is a lose/lose situation for all involved.

10/20.

Other departments take a different view, many hospitals refuse to allow ambulances to handover patients if departments are 'at capacity'. As such our ambulances are held for hours at hospitals, decreasing the availability to patients and increasing wait times.

11/20.

Staffing

There is a clear lack of staff in A&E, as the number of patients is ever increasing there is little provision to match that with appropriate staffing levels. Day on day I see staff working flat out, having to cover more patients than ever before.

12/20.

This means patients are waiting longer for assessment and treatment plans.

This means patients are waiting longer for medication and interventions.

This means patients are waiting longer for standard nursing care.

Unacceptable yet accepted in modern Britain.

13/20.

Constant pressure and awful rota patterns due to this staffing crisis very quickly lead to burnout. Again, I have only worked in A&E a month but I am exhausted. I covered every single day over Christmas and New Years because staff are spread so thin.

I feel broken.

14/20.

Lack of capacity/overcrowding

Often 40-60% of our patients within A&E have been accepted by a specialty. However, as there are no available hospital beds, have to remain in the department.

I often see patients waiting 16+ hours for a bed.

15/20.

Overcrowding is unsafe, there is more opportunity for things to be missed and patients to come to harm. As mentioned, it also provides an environment that breeds burnout amongst staff.

To coin a phrase from my local MP, every day feels like "The Battle of the Somme".

16/20.

I joke, but it really is like a battlefield, patients in corridors, on trolleys, on chairs.

Last week I found a patient's relative asleep on hard floor because we could not offer him a chair overnight.

I am tired of apologising for issues I have no control over.

17/20.

To conclude

I have great respect for permanent staff in A&E, every day feels like a venture through Dante's nine circles of Hell, with no Virgil as guide.

Senior support in my department has been amazing and all the staff are commendable.

18/20.

However, it should be better, far better. For patients and for staff. What we are witnessing as the 'new normal' is anything but and epitomises the state of the health service within the UK.

Lack of staff, lack of capacity, lack of funding.

19/20.

I cherish every positive comment I receive from patients about my care, I was taught to give gold standard, and that is what I aim to provide.

The moral fatigue of not being able to do that in this failing system is harrowing, and we need to fight for change.

20/20.