What I Have Learned From My A & E Experiences.....

The issue of overcrowding in Irish Emergency hospital departments have been very newsworthy stories for some years now. Stories that never seem to go away. So much so that nurses in a certain Dublin hospital engaged in a work-to-rule this week - an activity that allowed them to make their point without risking patient safety - in order to bring this overcrowding issue to the attention of the Government once more. I support them in their efforts. particularly since this week's budget did nothing to relieve this burden.

That said I have had on four separate occasions in the past year, in respect of both myself and an elderly loved-one, cause to experience this particular Emergency department. And I have learned the following from these experiences.......

Although there was overcrowding evident on all my visits here, and medical staff always seemed very busy, there was never a sense of panic, with calmness and professionalism being the order of the day.

I noticed that there was a lot of clerical work involved for our nurses, with the same nurses sitting at the same computers for the hours that I spent there. On one of my visits I also noticed two doctors engaged in a lengthy conversation with an ex-patient with regard to some forms that required signing. Well, locating first, then signing.

From my personal experience in this hospital it appeared that medical decisions are made on a very clinical basis and are, understandably I suppose, dependent on their considered best use of the resources available on any given day and not necessarily on all patients' immediate needs.

It appeared to me that patients, like me, may not be considered 'bad enough' for a hospital bed - perhaps with reference to beds available and in comparison to other patients' needs on the day? They may, despite a referral from their GP stressing some urgency, be sent home (on two separate occasions) to continue to be cared for at home and by said GP. Even though this may be entirely unsuitable for someone with an extremely painful back injury. I base these conclusions of mine on my ultimate referral, due to the request that I finally had the sense to make when I was being sent home on the second occasion, to the nearby Private wing of this hospital; where I was retained for the three whole weeks that it took to bring my condition and pain levels under control.

I learned that the well known method of judging such over-crowding is not fully reflected by the number of bodies on trolleys alone. They need also to consider those sent home who are actually in need of hospital care. Sending as many patients home as you can is, after all, one way to deal with some of the overcrowding. This could perhaps be measured with reference to the number of necessary patient re-visits and the ultimate need for hospitalisation? In any hospital, not necessarily the one they initially presented to.

I learned to be very, very grateful for my basic private health insurance and vow to never let it go. It is very wrong that this can be a necessity in order to receive proper medical attention. I honestly believe that having this cover prevented some unnecessary complications for me, and perhaps even the ultimate need for a back operation, had I stayed under public care.

I also learned that although elderly stroke-survivor patients are dealt with respect and kindness they are not guaranteed any special treatment, and will also be dealt with on a very clinical basis. These patients can definitely expect to be sent back to their homes, or nursing homes, if at all possible. And this I do understand, as it is far better for them to be in their familiar surroundings if a hospital stay is not necessary.

Although it went unsaid it did appear to me that medical decisions are very clinically made with regard to 'likely outcomes', or the considered 'ultimate prognosis', of these patients. This I also understand to an extent, but sending a patient, who has a severely reduced capacity to swallow, home with a prescription for oral antibiotics at 5.30 pm of an evening might need a re-think.

I learned that there does not appear to be any facility for dealing with the personal care needs of such incapacitated elderly patients. On a clinical level, I suppose, Emergency departments are there to primarily deal with a patient's medical needs, feeding them if necessary, but if these compromised elderly patients have to join the lengthy queues like everyone else then this issue needs addressing.

I learned that although the catering staff are lovely there are no special food menus in this Emergency department for these patients, who cannot even sip water that has not been specially prepared for them. If you have the presence of mind to think of it do bring some Nutilis powder with you, so at least you can thicken drinks for them, if they are allowed fluids.

I learned that when these elderly patients are discharged after spending many hours on a trolley they then have to join the equally lengthy queue for an ambulance transfer, which is the only suitable transport option for some of them. This can take up to (and possibly more than) six hours. Yep, you read that right. Six hours. Although ready to go home, where they need to be to have their nutritional and personal care needs properly attended to, they face the likely possibility of waiting many more hours. And being very clinical, that's six more hours that a valuable trolley is being unnecessarily occupied. I have no idea how this issue can be dealt with but it clearly needs addressing.

I therefore learned that those who can afford it can of course book a private ambulance with the wonderful, and relatively reasonable, Lifeline Ambulance people.

I learned that it is a good idea for all patients in our emergency departments to have someone with them to act as their advocate. To speak up for them when maybe they are not able to think straight, especially the elderly patients who may be unable to speak for themselves at all.

These are my personal thoughts from my personal experiences here. It is written with honesty, whilst also protecting privacy.

I support all nurses and doctors in our hospitals who work in such difficult circumstances. I understand, but don't always agree with, the need for the clinical decisions as they must make the best use they can of the resources available to them.

It's the available resources that I have a problem with.

I note that earlier this week, according to the article I linked to at the top of this piece, the nurses at this hospital's Emergency Department withdrew from 'clerical work, non-nursing duties and the use of computers and non-emergency phones as part of the industrial action.'

While I do not have any answers for our overcrowding issues I do wonder if, based on one of my observations above, some cannot be found in the nature of the duties the nurses withdrew from this week?


  1. Sounds like you need TEREM. We have a network of clinics open 24hrs/day for minor emergencies. They can x-ray for broken bones and set simple fractures, they can sew up cuts, give antibiotics and other drugs on prescription (they work in cooedination with all the health funds), They can give you injections and drips. In short, anything that doesn't need full hospital facilities. Obviously if you think you are having a heart attack or stroke you go straight to A&E and some patients who arrive at TEREM are sent to the hospital by ambulence. It means that many non-critical emergencies don't clog up A&E and for us it's great as we have a TEREM around the corner.

    1. @Midlife Singlemum: Great that you have one of these clinics beside you. We do have a similar set up here with the VHI ( one of our health care providers) Swift Clinics. Other health care providers cover some visits here on some of their plans but they are private clinics and again most people, especially with the austere cuts in recent years, will attend A & E if they need to. We are encouraged to let our GPs be the first port of call and if you go skip that step and go straight to A & E it will cost you €100. In that case, if your injury/complaint can be dealt with by the Swift Clinic (similar restrictions to your TEREM clinics) you'd probably be better off going there! Unfortunately an A & E visit was necessary in all four of my recent experiences. xx

    2. I know you needed to go to A&E on all four occassions. I was thinking about the aspect of A&E only having real emergency cases and so being less crowded. Lets hope you don't have to visit either facility again! xx

    3. @Midlife Singlemum: Yes, you are absolutely right and Irish patients are encouraged to go to GP first. Private clinic for non-emergency.... if not covered by your private health insurance then this costs and most can't afford it. We need a public version of this perhaps, or GP clinics to be expanded so that they can deal with non-emergencies? A & E should be for emergencies only as you rightly point out, and then they might be able to deal with the over-crowding issue. properly. Thanks for your valued comments :) xx

  2. Luckily I have not had to attend an adult A&E for many years, and I'm terrified of having to do so. The health service is such a giant mess that it's hard to know what would improve things. Everyone is fighting their own corner so you never know whether their solution is going to work. And it's all interlinked, so improving things in one area can just put pressure on another. If only things could be sorted as soon as problems arise, but it seems that no-one will cooperate with that. Good to raise this important issue xx

    1. @Looking for Blue Sky: I certainly hope you don't need to visit one anytime soon. They only enforce my opinion that hospitals are no places for sick people! I agree totally with all the points you make. We need to combine a few areas to get it all moving better, similar to as discussed with @Midlife Singlemum above perhaps?
      Thanks for your valued comment too :) xx

  3. Oh no, not a good plan to be elderly and in need of care. I guess, at the end of the day, it all comes down to money. Private health insurance is a necessity.

    1. @Bright Side of Life: No, it is not. And yes you are right.... private health insurance IS a necessity. There are however so many families in Ireland who can't afford it and others who had to let policies go that they'd held for years when austerity measures were enforced by our Government and the IMF/Troika. I blame them wholeheartedly.


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