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The Canberra Hospital – a patient journey

By John Hargreaves - 24 February 2016 15

The Canberra Hospital

How many of you have had a gall stone or similar? I just had my first and the excruciating pain was a thing to behold.  Idiotically, I thought it would pass and only did something to fix it after ten days of agony. I get the Idiot-of-the-Week Award.

Anyhow, it gave me cause to see from the inside, the goings on in the Canberra Hospital from a visit to the Emergency Department, to a time on a ward, to treatment as an out-patient and everything in between, like blood tests, ultrasounds, X-rays, etc. Let me share with you this experience and you see what you make of it.

After running a decent fever, enduring pain at 9/10, I went to my doctor who said, off to the hospital with you, young man; here’s a letter. Go to Emergency and they will admit you, no worries. So off your correspondent took himself.

Arrival at the ED at 6pm to find a reasonably crowded waiting area and a queue to be triaged. 30 minutes later, I find myself at the head of the queue and being questioned by a triage nurse. So far so good, I hear you say.

Well, it happens that the counting for presentations for stats purposes, starts when you are triaged, not when you get there! So the waiting times at the ED are out by, in my case, 30 minutes.

There are five categories of patient. Life threatening; Emergency; Urgent; Non-urgent; and you really shouldn’t be here, go to your doctor. When triaged, I got an “Urgent: rating.

So with the “Urgent” folks, the time standard is 38 minutes to see a doctor. I might be out a couple of minutes here so don’t lynch me.

I waited another 30 minutes in the waiting room to be able to go to the bowels of the building to a new ED area. Then another 30 minutes before I saw a doctor. Stats blown to smithereens.

The issue for me though, is that there were people in front of me and behind me who could have been in a higher category than me. There was no one obviously checking to see if a presenting person should be advanced in the queue, like the little kiddie with a bandage on her arm.

Once in the ED itself, the inner sanctum, the nurses were fantastic. I had been in 9/10 pain for ten days and the nurse took one look and got me some morphine, administered intravenously. I guess after gang-tackling a phantom doctor. The doctor turns up and says we had better get some tests so I go for an X-ray and later an ultrasound. Ah! All is revealed. You are sick!

It turns out that there is sludge, small stones in the gall bladder and probably one stuck in a duct somewhere thereabouts. I am starting to get pain relief about now and not really interested in what it is, I just want the pain and the fever to recede.

After what seemed to be an eternity, I was taken to the ward, and put on anti-biotics and pain relief through the drip, and also given food via this method as I was to be prepped for an ECRP. NBM means Nil By Mouth which is code for YCCOE – You Can Smell and See Others Eating. The ERCP is a procedure where they stick a camera down your throat, look around and if there is a stone stuck in a duct, they can get it out. This is preferred to happen before the removal of a gallbladder. Young John is all ready for this one!

So, now I’ve been in the place twenty four hours. As the ultrasound said I wasn’t going to die, the ECRP could be done on Monday. Continue on with the drip over the weekend, son and don’t worry about mundane things like food or drink. That’ll happen in its own good time.

So Monday rolls around and young John is ready for the onslaught to his body. Nothing happened. Monday came and went, with no-one telling the anxious patient what’s going on.  Turns out that more urgent people needed attending to (and that’s fine) but no-one bothered to tell the waiting patient.

Complicating the matters further, the intern, (bless her cos she’ only been there a couple of weeks and was most professional in her manner and information, I might add), came at around 5pm to discharge young John, thinking the ERCP had been performed! So one arm of the medical mafia (MM) didn’t talk to another arm, for reasons only known to themselves. The patient becomes an impatient inpatient and blows a blood vessel!

Oh … the good news is that I am allowed a light meal! Yay! Breakfast was porridge, fruit salad and bonox. Yes – Bonox! Who’da thunk it? Dinner was a round of sandwiches, a mug of pumpkin soup and a dollop of custard.  High tea at TCH!

The next morning, along come a couple of junior members of the MM to calm said patient down and promise that something may or might happen, to tell us that we are the emergency player on the bench and that all being well, I might become well. Yeah well! That didn’t happen did it?

Roll on Tuesday night. Our patient patient decides enough is enough, and discharges with an appointment to come back on Thursday as an outpatient, with enough pain reducing drugs needed either to combat the pain or to sell on the streets and buy Hamilton Island.

Wednesday is a slow day at home and a relief not to be connected to tubes and stuff.

Off to the hospital for the 10am appointment. Go to the day surgery area.  “No sir, you have to go to Admissions first. And before that you have to go to Xray.” “Yeah but I had an X-ray only a few days ago” says I. “OK then, don’t worry about X-ray, just go to Admissions and come back.” Okey Dokey.

Five signatures later and 30 minutes, young John wanders into the day surgery area again, hands over the forms and is told to have a seat. I know that I’m in for a long wait so settle in with some work on my tablet and a book of 900 pages.

At about noon or so, my name is called and the adventure starts. I’m taken into a production line of beds, given the obligatory gown and receive my cannula, inserted into the crook of my elbow.  Ready to roll. Bad luck that.  Another 30 minutes rolls by.

Then we go for a ride down this corridor and that, past the main lift well, past the hospital in the home, past the ED, turn right and down to X-ray. Oh great, says your correspondent. I’m then parked with a group of others and told “You’re next, mate”. As I saw the others dwindle in their number, I got the slight thought that maybe I wasn’t quite “next, mate.”

Another 30 minutes roll be. Funny how my life at TCH is cut into 30 minute bites! And a guy comes and off we go. Around the corner to be parked in the sun! Yay.

To be fair though, here we are visited by the anaesthetist, who asks me that same twenty questions I’ve answered (without complaint) multiple times since arriving a week ago. The surgeon also appears and off we go into the surgery area.

Sleep comes quickly and I wake up back at Go, having missed Jail, Regent Street, Pentonville and Fenchurch Stations and Mayfair.

Discharged after another 30 minutes (and a cup of tea and two Jatz). Home at last.

More drugs for the pain and a great night’s sleep. When I woke up this morning, I wondered did I just have a nightmare or was it real? The horror stories might just be right.

Credit where it is due though. The nursing, ward and medical staff were nothing short of amazing.  Professional, empathetic, caring and dedicated.  It is the systems that they have to negotiate which seemed archaic. So much paper, so little information sharing, so little coordination, so little information to the patient along the way.

Thank God I was not in a life-threatening situation.

Just thought I’d share this with you. I didn’t post last week because I was just starting this amazing journey.

See ya.

 

What’s Your opinion?


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15 Responses to
The Canberra Hospital – a patient journey
1
miz 8:01 am
24 Feb 16
#

Glad you made it through the system in one piece!
Yes the staff are generally highly competent, but unfortunately there are lots of places where people can fall through the cracks. If you are very ill/unconscious/delirious and don’t have a person advocating on your behalf to ensure you are receiving treatment, those cracks can be chasms.
I had always envisioned/expected hospitals to be a 24/7 place, but have since found out the hard way that weekends and public holidays are holding pattern only unless it is an emergency situation.
And try not to need admission in January, when the specialists are all on holiday.

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2
John Hargreaves 10:15 am
24 Feb 16
#

miz said :

Glad you made it through the system in one piece!
Yes the staff are generally highly competent, but unfortunately there are lots of places where people can fall through the cracks. If you are very ill/unconscious/delirious and don’t have a person advocating on your behalf to ensure you are receiving treatment, those cracks can be chasms.
I had always envisioned/expected hospitals to be a 24/7 place, but have since found out the hard way that weekends and public holidays are holding pattern only unless it is an emergency situation.
And try not to need admission in January, when the specialists are all on holiday.

Spot on and good advice. the nurses are great and the junior doc that I encountered was fantastic. But the systems that they worked with were archaic and unworkable.

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3
pink little birdie 10:32 am
24 Feb 16
#

I’ve never heard of it being 30 minutes to be triaged.

Gall Stones are unpleasant to say the least.
I had my Gall bladder out a few years ago on the 27th December in Adelaide (I was in Adelaide on holidays at the time and the only Medical attention in Adelaide at 6 am on a public holiday is the hospital) . They gave me the choice of yoinking it then or waiting until I got back to Canberra. I of course chose yoinking it then.

Hospitals tend not to do elective surgeries during the christmas to mid Janurary period so if you present with something that needs surgery that can wait but will still need surgery you still might be lucky and they wwll do it because they have the staff and space to do it as they still need to have a few surgery teams on for the emergency surgeries.

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4
JuliaLP 10:40 am
24 Feb 16
#

We had a similar experience in December/January with my partner and kidney stones. The staff are AMAZING, the administrivia not so much. We wondered how much less chaos there would be if staff were issued with tablets instead of paper, with a decent interface to track obs, pain levels and drug admission, patient history, discharge info etc. half the time staff were just looking for a pen! I really fell for the staff being at the receiving end of a lot of angst and anger, which for the most part is out of their control. I know Calvary is heading the way of the tablet, but like anything it’ll take time.

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5
dungfungus 12:07 pm
24 Feb 16
#

Let’s hope the staph gave you a miss. Is is the biggest problem in all hospitals these days.

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6
Maya123 12:29 pm
24 Feb 16
#

This was a few years ago now, but I was brought in by ambulance after having a post-op bleed and passing out in a pool of blood. I was triaged fairly quickly, but then things slowed down. I guess it was decided I was no longer urgent as the bleeding appeared to have stopped, despite the huge blood loss. I saw a doctor three hours later, and spent about 28 hours in emergency before being transferred to a ward. They struggled to get drips in me and take blood samples, because of fluid loss, but eventually managed it. Most of that time I was on ‘nil by mouth’, in case they had to re-operate. Fortunately this wasn’t needed. After having several bags of saline added to me, the 28 hours in emergency and a night in a ward, I was discharged. I was told they had to wait for a spare bed, and when eventually one was found, it was an unrelated ward to my condition. What I noticed about the ward, was that there only appeared to be one nurse on duty there at night, so very short staffed. I had been operated on in a private hospital and that had lots of nurses. A big difference.
It was a very busy night in emergency when I arrived and I suppose I should be grateful I was given a bed. Plus thinking back, the colour of the pyjamas I was wearing hid the blood that soaked them, making the blood loss seem not so bad. (Like a Red Coat, I guess.)
I keep hearing things have improved, but when I read accounts like the above, it makes me wonder if they have.

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7
Kim F 12:30 pm
24 Feb 16
#

Good tale with a happy ending. The staff are fantastic, the nurses underpaid but the systems underlying the whole shebang are so woeful and have been for such a long time. I don’t think it would break the bank to actually examine those systems and try to fix them.

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8
TuggLife 12:35 pm
24 Feb 16
#

Thanks, John, for this thougthful piece, and I’m pleased you’re recovering well.

“So much paper, so little information sharing, so little coordination, so little information to the patient along the way” has largely been my recent experience of The Canberra Hospital, too. Just about every piece of paper linked to my file has gone missing at various stages, and the whole system seems reliant on answering machines and faxes (both of which seem unchecked most of the time). You would think that reliance on such old technology would be because the existing system was robust, but it’s just a mess. I had someone from surgical bookings phone me last Friday to discuss booking a surgery date for March – a month after I’d already received a letter confirming the (same) date for my surgery.

Frontline staff often feel powerless to challenge practice in the face of what feels like a monolithic system, but at times I think they need to step up to be better advocates for the patients in their care. That was a long time waiting in a hospital bed for sweet FA, when you could have been more comfortable at home with some strong painkillers and Netflix while waiting for an ERCP slot as an outpatient – all because no-one asked “What’s happening with John (or ‘the gallbladder in Bed 23’)?” and shared the answer with you.

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9
sportsmum 5:31 pm
24 Feb 16
#

When my daughter broke her arm recently, we walked in the Canberra Hospital ED on a very busy morning and didn’t even make it to the front window before a nurse had come out to assess and triage her as urgent. She was taken straight back to a bed, received pain relief and was reviewed by a doctor within 30mins of being given a bed in the ED. X rays took another 30 mins and then about 2 hours until a bed opened up in the children’s ward.

I couldn’t believe how fast it was and was very impressed with the care of the nurses and doctors and even the orderlies and food staff who couldn’t do enough for her. Her room in the children’s ward was really nice and she was well taken care of. We couldn’t fault the medical staff. The discharge and administration on the other hand – that was not great and needs urgent attention itself.

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10
JC 1:02 am
25 Feb 16
#

Kim F said :

Good tale with a happy ending. The staff are fantastic, the nurses underpaid but the systems underlying the whole shebang are so woeful and have been for such a long time. I don’t think it would break the bank to actually examine those systems and try to fix them.

If anything the systems that are broken are the processes not the IT systems, which gather is what you are referring to. Sadly procedural systems in places like hospital are so institutionalised no amount of money will fix them.

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11
wildturkeycanoe 6:48 am
25 Feb 16
#

Their outpatient system isn’t quite as fast as this story tells. I’ve been waiting almost 12 months to see a neurosurgeon at the Canberra Hospital due to a disc herniation requiring a lumbar fusion. That is almost 12 months just to speak to the neurosurgeon. If successful in convincing him that the other two neurosurgeons I’ve seen are both correct in saying I need to have this surgery to reduce the chronic pain, I will then go onto the public surgery waiting list to wait probably another 2 years before actually having any procedure done. Being in a certain category for priority doesn’t help, because more urgent cases keep coming through, never letting me get closer to the top of the list. The pain clinic took 9 months to get me in to have a discussion about my options for pain relief. I will attend that shortly, but I already know from previous sessions with them that pain relief is only going to come with the long awaited procedure, not some fantastical psycho babble nonsense about the pain being all in my head.
In the meantime I was forced to quit working, am on strong opiates for pain relief [which barely take the edge off] and my entire life is on hold. There are most likely thousands upon thousands in the same situation as myself, hence the long waiting list to see this magic medicine man. Had I been wealthy enough to afford private health insurance, I’d have been opened up in a matter of weeks, recovered over the next 3 months and possibly gone back to work. But because of our crippled health system I am yet another unproductive member of society, leeching off the taxpayer.
C’mon, it is only a $50,000 procedure, why couldn’t the government simply pay to get it done privately if the public system is so busy? They’d have recouped the money through the taxes I would have been paying during my wait in the public system. Instead, I was another Centerlink drone, collecting money from the taxpayer for sitting on my backside, all because our health system is pathetically slow.

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12
Genie 12:35 pm
25 Feb 16
#

A few years ago I had a pretty severe reaction to an antibiotic I was prescribed due to an infection I had. Decided to call the Medical Hotline number first where they insisted I present to Emergency ASAP.

I arrived at Calvary ED just before midday, pretty empty but I was given lots of painkillers that barely touched the surface of the pain I was experiencing and over the next 3 hours in the waiting room I progressively got worse. My mother was with me and since I was getting quite worse about the hour 2 mark she was told I was “next”. Several other people went in front of me, so we enquired as to when i would be seen and it took them almost 30 mins to track down my chart. A doctor had grabbed it but was then called to deal with an ambulance that arrived. Fair enough, but he still had my chart which meant no other doctor was able to treat me.

Just after 3pm I was in a bed in emergency with dozens of tubes and they were arranging a specialist to see me to run tests and scans. By 6pm they couldn’t wait any longer for said specialist and decided to administer some more antibiotics via the IV. This was done by some fancy needle that pumps it in over the course of an hour. I was zonked out at the time, but a nurse decided to administer it anyway. I woke up moments later screaming in pain that my arm was on fire and to make it stop. No nurse bothered to acknowledge me and my frantic yelling and pushing off the call button. I was located right next to their station.

If it wasn’t for my mother returning about 15 mins into the “treatment” and making a fuss, I doubt anyone would have seen to me. All I got was more drugs to deal with the burning pain.

5 hours after being admitted to emergency and hour 8 of being at the hospital the specialist FINALLY arrives. Oh you’re allergic to latex we’ll have to find latex free gloves and he promptly disappears.

Over the next 90mins the head nurse comes to me a few times saying they’re going to discharge me, they need to bed as they were getting an influx of Friday night drunks. It wasn’t until several drugged up discussions that she finally understood that the specialist STILL hadn’t returned with latex free gloves , she got furious, he’d taken his dinner break. Fair enough, but I was at about hour 26 since I’d last eaten.

Specialist finally returns after 10pm. Now it was too late to run scans and since I was too medicated to be released and they needed to ensure I didn’t eat anything I had to be admitted. They moved me to the extended day surgery unit or something. Where there was NO nurses and I was the only person there.

About 2am in the morning an orderly woke me up to move me to a ward. Hooray !

Despite scans showing I wouldn’t need surgery, I wasn’t back in my room when lunch was served. So I was told I wouldn’t get any food until dinner was served. By this point by hunger pains were worse than the reason I was admitted so I got chucked a tub of melted jelly. Phone call to the family and they brought me McDonalds.

I ended up having to wait another 24 hours before I was even discharged due to it being a weekend. (Oh and they still didn’t feed me dinner as my chart wasn’t updated to reflect that I could eat)

Worst experience ever !!! Hospitals should be a 24/7 place. But heaven forbid anyone who is admitted over a weekend.

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13
rommeldog56 10:10 am
26 Feb 16
#

wildturkeycanoe said :

Their outpatient system isn’t quite as fast as this story tells. I’ve been waiting almost 12 months to see a neurosurgeon at the Canberra Hospital due to a disc herniation requiring a lumbar fusion. That is almost 12 months just to speak to the neurosurgeon. If successful in convincing him that the other two neurosurgeons I’ve seen are both correct in saying I need to have this surgery to reduce the chronic pain, I will then go onto the public surgery waiting list to wait probably another 2 years before actually having any procedure done. Being in a certain category for priority doesn’t help, because more urgent cases keep coming through, never letting me get closer to the top of the list. The pain clinic took 9 months to get me in to have a discussion about my options for pain relief. I will attend that shortly, but I already know from previous sessions with them that pain relief is only going to come with the long awaited procedure, not some fantastical psycho babble nonsense about the pain being all in my head.
In the meantime I was forced to quit working, am on strong opiates for pain relief [which barely take the edge off] and my entire life is on hold. There are most likely thousands upon thousands in the same situation as myself, hence the long waiting list to see this magic medicine man. Had I been wealthy enough to afford private health insurance, I’d have been opened up in a matter of weeks, recovered over the next 3 months and possibly gone back to work. But because of our crippled health system I am yet another unproductive member of society, leeching off the taxpayer.
C’mon, it is only a $50,000 procedure, why couldn’t the government simply pay to get it done privately if the public system is so busy? They’d have recouped the money through the taxes I would have been paying during my wait in the public system. Instead, I was another Centerlink drone, collecting money from the taxpayer for sitting on my backside, all because our health system is pathetically slow.

I feel for u wildturkeycanoe. Not good – but I fear u will not get as much acknowledgement of your situation and what caused that, on RiotAct or in this new “growing up” Canberra. A couple of observations though :

1) I have been taking a disabled relo from Canberra to the Prince of Wales public clinics in Sydney for years. Minimal waiting times (even for surgery as a public patient) – great service and very professional (my experience only). Havent been for years now though, so may have changed.

2) I doubt that the ACT Gov’t really cares about people going onto Centrelink payments because of waiting times for public patients at Canberra Hospital. Whilst the ACT Gov’t under funds public health services at the Hospital, it actually transfers the resultant income support payments to the Feds via Centrelink.

3) This is what I bang on about – the ACT Gov’ts stuffed fiscal priority setting. How can they possibly justify having the worst performing public hospital system in the country while signing up for a b$1+ unneeded (at this point in time) Tram stage 1. I don’t expect the ACT to have to have the best performing hospital, but the worst ???? ACT voters must be so apathetic to accept that sort of treatment from this ACT Labor/Greens Gov’t !!!

4) Whilst the current injection in funds to reduce the absurd backlog of urgent public patient surgery is welcome, I note that it is an ACT LA election year (it’s not that I’m cynical mind you !!) and there appears to be little, if any ongoing funding to keep those surgical waiting lists from blowing out again – but then again, I suppose there will be another ACT LA election in 2010 so any blow out in waiting times will be fixed in the run up to it then t!!!

5) As a self funded retiree, I also can no longer afford private Health cover so will be joining the queues at ACT hospital as a public patient, shortly.

Good luck wildturkeycanoe…….I hope u get seen and treated soonish.

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14
miz 9:46 am
27 Feb 16
#

We have had very poor experiences with outpatient / operation waiting times too – over a year for an orthopaedic appointment (young person on strong analgesia during this period which was most undesirable); and more than a year for a gynae consultation (in the end we rang a private gynaecologist on spec. His consultations were expensive but he was able to get my daughter in for the op with a shorter wait, and the actual operation was done under Medicare). We also had great difficulty with an admitted elderly family member who required necessary medications to be administered at certain times. Unbelievably, this was beyond most staff, which compromised his care including an ‘adverse event’ resulting in a move to intensive care. All these things occurred in the ACT within the last year or two.
I can see that some health system processes are somewhat archaic, but I would also be unsurprised if the ongoing emphasis on financial efficiencies has actually resulted in less efficiency with no one having any time to consider or report on how to improve the system (i.e. critical, permanent understaffing which is seriously compromising important functions – I am personally experiencing just this in my Cth workplace). No amount of blather about ‘patient care’ can actually solve chronic lack of appropriately qualified staff. In my experience, the only place that seems to be staffed adequately is the back of the ED.
It makes me so angry that federal politicians think ‘tax cuts’ are a political winner. I would wager most would be more than happy to pay more (but importantly, fairer) tax if it funded better public health (instead of tipping so much into private health corporations’ pockets).

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15
No_Nose 4:39 pm
28 Feb 16
#

Paper records and systems are archaic, but bringing in a ‘paperless’ system can have just as many, if not more problems.

http://www.abc.net.au/news/2016-02-28/warnings-about-problem-plagued-digitisation-wa-hospitals-ignored/7202416

I’m all for modernising the way things are done, but it has to be researched and tested properly before full implementation.

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