It’s 8.00am on a Thursday morning in the A&E department at the Cumberland Infirmary. The team has come into a very busy department with 38 patients handed over from the nightshift team.
Dr Emma Farrow, clinical director for emergency medicine, has arrived for her shift. She explains what happens now:
“The nightshift team have done a great job, they had 60 patients in the department at 4.00am this morning. Despite that, they kept everyone safe and have provided a brilliant handover to us this morning.
“Having a high number of patients at this time of the morning already puts us on the back foot so we need to make sure those patients who need to be admitted onto a ward for treatment get there as soon as we are able. This causes delays for those other patients who are coming into the department.
“So far I have done a safety round with the nurse in charge to check on all patients and identify anyone I have particular concerns about. That’s really important when you are in charge of the department to continually go around and make sure everyone is safe.”
As well as a busy department, the team has a number of issues to deal with on a daily basis including patients who need one-to-one attention because they may be at risk of wandering due to dementia, confusion or a mental health issue. Safeguarding is another big consideration and the team work very closely with the Trust’s Safeguarding team. Every patient is now asked ‘how safe do you feel’ when they come into the department which may come as a shock to some people but research suggests that being asked the question may lead to somebody disclosing an issue such as domestic violence. If someone tells us they don’t feel safe then we have specialists who can help and advise that patient.
The national focus in A&E is around waiting times. At the start of today, the waiting time was six hours and by the afternoon the team has reduced that to one hour forty minutes.
Dr Farrow explains: “We work with a command and control structure in the department which is pretty successful for us. I think maybe the general population don’t know what a good job we do because it can be hidden with long waits for beds but if you are in our department you are being looked after from the moment you are triaged. I’m really proud of the work our team have done in seeing patients in a timely fashion and making sure our department is as safe as it can be.”
One of the biggest issues which leads to long waits in A&E is the lack of beds available. Patients may be medically fit and ready for discharge but they are waiting further care in a different setting so they have to stay in hospital until that care can be put in place. Another aspect is the pressures GP surgeries are facing which means sometimes members of the public come to A&E if they cannot get an appointment with their GP. The team sympathises with those people but sometimes they have to redirect them in order to focus on the people who are very poorly and need specialist care and treatment.
Dr Farrow explains: “When you come to the emergency department you go through a process called triage which assesses if you need to be in the emergency department. Sometimes it’s appropriate to redirect to other services because while we understand the challenges that are in primary care and in the community sometimes the emergency department needs to be kept for emergencies and those things that we specialise in so if you are redirected it’s not because we don’t want to see you, it’s because we want to make sure that we have the right patients in the right place.”
Back to the day in question and it has been a busy afternoon with a lot of attendances and ambulance arrivals. As the day goes on, patients have to be moved around to accommodate those coming in via ambulance or patients who need an isolated cubicle such as a patient who has come in due to complications of chemotherapy.
Dr Farrow comments: “There can be a lot of moving around to make sure you meet the demands of patients as best as you can so we have been looking at the risks and then deciding who is the most stable and can be moved out of a cubicle. Sometimes it doesn’t feel like the best patient experience to be moved around but we are doing the best we can to keep everyone safe.”
Towards the end of Dr Farrow’s shift, there are 50 patients waiting and half of them need a bed on a ward. She has been on another safety round of all patients and getting ready to handover which is extremely important to make sure no vital information is missed.
One of the most striking parts about spending time in A&E is how well the team work together and look out for each other. Despite the pressure, staff keep smiling and there is never a doubt that they are working extremely hard. Dr Farrow spends a lot of time looking out for her team.
She comments: “The reason I do my job is because of my team. I’ve got a dynamic, caring and really special team to be honest; I care that they are happy, hydrated and well fed. If you have a happy team then you will have safe patients who are being well looked after. It is really important we don’t shy away from any issues and work to deal with them to look after our colleagues.”
After watching Dr Farrow on her feet all day, how does she unwind?
“Well I go home to two small children so no unwinding for me!”
With that, Dr Farrow starts a handover with the consultant starting his shift and gets ready for another busy day tomorrow.