31 May 2011

Anti Rant - The Canberra Hospital ER

| Danman
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Just about everyone has a rant story about ER’s but no one ever hears when things go according to plan, because it does not make great news.

So with that in mind, I thought I would break the mold and recount my ER experience from the sunday just gone.

Miss Danman, a cochlear implant recipient was suffering a fever that was not self resolving, so at 8am Sunday, with a temp of 40.4 we decided we needed to go to the ER.

We presented at the ER and were assessed by the nurse on duty and were given an urgency of 3, where 1 is life threatening and 5 is non urgent (My definition; not clinical).

We sat down and waited and were eventually taken to the pediatric ER ward.

Without getting into specifics, we were seen to by a nurse Initially and obs taken around every hour.

Yes, we had to hydrate and medicate and collect a urine sample from our daughter ourself,under advice from staff, but were supplied all things required to do so.

At the change of shift, the nurses did changeover with staff and also done the rounds to introduce themselves to the patients and their family and further assess the patients.

In all, we were in the paediatric ER for around 7 hours.

I think where people get disappointed is when they think a hospital is like some kind of silver service 1 staff for 1 customer type of establishment. Unless you are dying, hospitals are all about waiting. And waiting your turn.

We were finally given the ok to go home around 1400, and given discharge papers, a script and home care directives. Furthermore, the nurse on duty stopped Mrs Danman, Miss Danman and I from going home so she could finish with a patient and then gave us some gastrolyte drink, gastrolyte icy poles and some regular icy poles, totally non protocol, but none the less a very nice gesture, saving us some money at the chemist later that day.

In all, we were in attendance for around 7 hours.

Sure, it was long, and boring, as hospitals mostly are, but we had great nurses and would just like to say thank you, and that we appreciate the thankless job they do.

No one really notes when they do a great job, finding it easier to complain about not having their cough addressed before a serious road trauma.

So if you’re reading this and an ER staffer that was on duty Sunday, thank you, your efforts do not go un-noticed by all.

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A couple of months ago, Mr Catty experienced dizziness, nausea, sweating and low pulse rate. Calvary A & E took him straight in (and got a wheelchair under him as he collapsed). The AE staff were fantastic. He was there for about 6 hours and then was transferred to the ward for overnight, with 4 hourly neuro obs. It was at the ward level that the rot set in. He was checked ONCE from about 7 pm to his discharge at 1 pm next day. And that was just a check for BP and temp – no neuro. He was almost given the wrong meds twice – only the fact that he was lucid by then stopped them administering drugs. They did not ever get his name right and he was often confused with someone else. Pressing the buzzer so that the drip could be unhooked to allow him to go to the toilet meant a 15 min wait before someone answered the buzzer. He would get better care at home!

I have also been to Calvary A & E with chest pains and have been seen straight away, even though there proved to be nothing seriously wrong. The staff work to a defined system of triage, and although they probably get it wrong sometimes, by and large they do a great job, often in very difficult circumstances.

Danman said :

I think that the being pedantic in the comments has really gotten away from the intended spirit of this post, as it was my point to highlight the thankless jobs that the ER staff do. Concentrating on correcting my terminology just makes it clear that people are not concentrating on the message I have, rather the words that comprise it. And just to clarify, we were in and out in 7 hours, as it was 2 when we got tur word we will be going. It still took time to get a doctor to write a script and letter for our GP. As to how long we sat in the waiting area, that really is irrelevant, as it would not change the outcome or satisfaction. And to avoid speculation, Mrs Danman is a nurse, but we did not know any nurses staffing the ER/ED/A&E (or your chosen generic term) that day.

+1 and a great story Danman. They deserve all the credit they can get.

+1 I had a bout of mastitis a couple of weeks ago and decided that it wasn’t worth waiting to see a GP the next day because my arm had gone tingly and I couldn’t feel my fingers. I packed up the little family and I was triaged at 12.30am. There were about 7 people ahead of me and I had no resentment as they all were processed ahead of me. Even though my boob was on fire I was an otherwise healthy person and the people ahead of me were in more urgent need for care.

Anyway, we saw a doctor at around 4.30am, they sorted me out with some panadine forte and a breast pump and I was out the door with my antibiotics by 5am. Mr Jessieduck was tired senseless but at least the bubba slept through most of the wait.

It was worth the trip to the ER but I had no right expecting to be seen quickly so I was genuinely happy to have been treated as well as I was.

Re alternatives to A&E – the Walk in Centre can’t treat respiratory illnesses, so can’t treat people with the flu if they have cough/chest infection, and can’t see people if they have already been seen by a GP (eg went to doc last week but I am still sick). Unfortunately, they have a very limited remit.

I was there on Monday, extremely busy, but the poor nurse on the reception desk had to continually ask people what they were presenting with and more than half got sent away as unable to be treated by the nurse practitioners. Some were told to go to A&E and some to a GP (however, if the latter were me, that would mean no treatment until payday).

Yeah, they deserve more recognition. They took great care of me after a nasty motorcycle crash in 2008. Thanks guys!

What’s wrong with going to CALMS, sure it costs, but you get almost 3/4 back from medicare.

We’ve been in there twice in the last two months, and both times they were fantastic.

When my husband realised he couldn’t understand what his workmates were saying, couldn’t speak, felt tingling in his hands and nausea/blinding headache (all of a sudden) on a Friday, I drove him in and they took him straight through. He was observed for about 4 hours, including an hour or so of reflex testing and monitoring his heart etc, provided painkillers and anti nausea meds, and got a brain scan too. All of the staff were lovely and very helpful and reassuring for what was a very stressful afternoon for both of us. Even though it turned out to be a migraine (he’s never had them before) he was never made to feel like he was clogging up the system (he was classed as a 4).

When my GP sent me in for a suspected blood clot (she couldn’t see me until the next day), I only had an hour or so wait and was then advised to come back 90 minutes later for a scan. Again, all of the staff were really friendly and understanding, and they made it very clear that I was doing the right thing by being there rather than just waiting to see what happened.

I think they’re doing a fantastic job and don’t always get the credit they deserve. I’m glad you also had such a positive experience.

Not questioning the central message.

The emergency people do a great job under challenging conditions.

+infinity

Like other people on the front line of the public service nurses and other hospital staff do a fantastic job under often difficult circumstances. Great to see it being recognised.

As to how long we sat in the waiting area, that really is irrelevant, as it would not change the outcome or satisfaction

No, but it would set the scene somewhat. Spending 2h in the waiting area and 5h in the ED is a completely different experience than 5h in the waiting area and 2h in the ED.

I “spent 7 hours” at TCH relatively recently with a paeds head injury that Health Direct told me should be seen by a doctor within 4h. When we did see the doctor after 6h he checked her over and sent us home since “she needs to be under observation for at least 6h, but you’ve done that now”.

Agreed it was the same outcome as if we spent 1h waiting and 6h in the ED, however much of the addional 5h in the waiting room was spent with a sleeping child too big for my lap, who was waking to spew at regular intervals. I alerted triage when the vomiting started (about 3h after a knock to the head) and triage checked her over again so was not alarmed at her condition, nor am I blaming the nurses for the wait time.

Had a family member spend over 36h in the ED a few years back (non paeds) and I know the staff do the best they can all things considered. That was a bed-blocking issue elsewhere in the hospital. Generally my experience has been that the looooong waits are mainly due to number of doctors available, sometimes beds too.

I think that the being pedantic in the comments has really gotten away from the intended spirit of this post, as it was my point to highlight the thankless jobs that the ER staff do. Concentrating on correcting my terminology just makes it clear that people are not concentrating on the message I have, rather the words that comprise it. And just to clarify, we were in and out in 7 hours, as it was 2 when we got tur word we will be going. It still took time to get a doctor to write a script and letter for our GP. As to how long we sat in the waiting area, that really is irrelevant, as it would not change the outcome or satisfaction. And to avoid speculation, Mrs Danman is a nurse, but we did not know any nurses staffing the ER/ED/A&E (or your chosen generic term) that day.

We sat down and waited and were eventually taken to the pediatric ER ward.

Care to define the time period that equates to “eventually” in this case?

shadow boxer said :

Surely there must be a better system so people with the flu aren’t being treated in the Emergency room.

Does the walk in centre not open on Sunday ?

Since we are all being so pedantic, the Royal Childrens Hospital recommends that you seek medical attention if your child has a fever over 40 degrees celcius. Most GPs will tell you to go to the hospital in this case.

Queen_of_the_Bun12:52 pm 31 May 11

Great story. But if we are being pedantic, 0800 to 1400 is six hours, not seven.
Nice work on the icy poles!

Pedantry, hey? If we’re going that way, at TCH it’s the Emergency Department.

shadow boxer said :

Surely there must be a better system so people with the flu aren’t being treated in the Emergency room.

Does the walk in centre not open on Sunday ?

You’re discounting the possibility that people intentionally go to the ED to be treated for their minor ailments, despite having other options. It could be that the other options aren’t seen as viable, or that the person doesn’t realise the ailment is minor. It could also be that the presentation is a misguided GP referral, or that the person presenting feels entitled to treatment by an Emergency Physician regardless of the nature of the complaint.

fgzk said :

“So if you’re reading this and an ER staffer that was on duty Sunday, thank you, your efforts do not go un-noticed by all.”

To all those on duty early Saturday morning, thank you.

To the brawling drunks covered in blood and talking loudly because “There only bogans here”, GET STUFFED.

Love it!

shadow boxer11:46 am 31 May 11

Surely there must be a better system so people with the flu aren’t being treated in the Emergency room.

Does the walk in centre not open on Sunday ?

ConanOfCooma11:25 am 31 May 11

Top story. A lot of people don’t comprehend the fact that their medical issues usually aren’t that important, and get cranky when they have to wait.

Oh, and if you’re in to pedantics Overheard, ER is not an American TV show, it’s a NORTH American TV show, and every hospital I’ve ever been in calls it the “ER” or “Emergency”.

I spent some time working with the staff there last year, and yeah, there’s no way I could work there all the time.

Just a little ‘psssst’, though, Danman. It’s A&E at Canberra Hospital.

‘ER’ is an American TV show!

(Unless they’ve decided to Amercanise themselves sometime in the last 6-8 months.)

“So if you’re reading this and an ER staffer that was on duty Sunday, thank you, your efforts do not go un-noticed by all.”

To all those on duty early Saturday morning, thank you.

To the brawling drunks covered in blood and talking loudly because “There only bogans here”, GET STUFFED.

+1 Danman. I’ve had the full spectrum of experiences at TCH, but the one common factor has always been the helpfulness and commitment shown by staff in what must be really tough circumstances.

TCH staff – you have my thanks as well.

ACT Health – please listen to your staff and allocate resources accordingly.

Firstly, great news that your daughter is okay. It’s a good outcome for you and I think that, as you said, the nursing and medical staff at the hospitals do a fantastic job – they are underpaid, overworked and should have the admiration of the community for what they do. And I really think they do.

Seven hours seems a damn long time though? Don’t get me wrong, it’s not the fault of the nurses – but it seems we could do with more staff to reduce these times.

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