As more than 76,000 seriously ill or injured patients packed into the North East’s busy emergency departments last month, we saw a warning from one local NHS boss that really, the winter surge could just be beginning.
All but two of the region’s NHS trusts saw an increase in ‘type one’ emergency attendances in December, compared to the same month last year.
After reporting a four per cent increase in ‘type one’ attendances, the Newcastle Hospitals NHS trust allowed us to spend an afternoon with the Royal Victoria Infirmary ’s A&E department to get a taste of life on the frontline.
My host for the day is the A&E head of department Reuben Saharia, who gave me an overview of the situation at 11.30am.
At the time there were 35 patients in the department, spread across adult “majors”, minor injuries and paediatric emergency.
From the patients waiting, there were cases of hypoglycaemia, abdominal and chest pain, and shortness of breath – all “appropriate attendances” for A&E.
Although the “q word” is usually banned in A&E, all the staff agreed I had come on a relatively quiet day.
But they were facing problems with staff illness, with three doctors having called in sick.
One of the main issues facing the department is patients waiting for beds elsewhere in the hospital.
The morning nurse in charge, Pam Rostron, told us that trusts all over the country were experiencing a shortage of beds, primarily due to problems with social care.
She said: “We end up having to look after a ward full of patients as well as patients coming through the door. It becomes a space issue.”
Another common theme is the pressure on emergency departments caused by an ageing population.
Consultant Nigel Fox said: “That’s a lot of the pressure we have seen over the last 10 or 15 years. Any small change against a background of existing medical conditions is enough to bring you to hospital.”
In the assessment area at midday, for example, a lady comes in with a fractured neck of femur, who is given X-rays and fast tracked through the department.
Mr Saharia tells me that “fragility fractures” are a very common presentation, adding, “The population is getting older and we see a lot of patients having falls.”
We then go through to the paediatric emergency department, where staff had seen a three-month-old baby with a fever, as well as a few patients returning for review, and several other ill or injured children.
The atmosphere in the department was relatively calm, but at around 1pm, a man came in who was verbally abusive towards staff.
Mr Fox told me, “I’m satisfied he’s not ill but if he won’t calm down we can’t assess him. We aren’t here to be shouted at and abused.”
As we headed into the afternoon, patients continued to flow through the assessment area, including a lady with a possible hip fracture, a woman believed to have had an ectopic pregnancy, and a man who had suffered a seizure.
In the minor injuries unit, nurse practitioner Nicola Moore had spent the morning dealing with a number of work related injuries this morning, mainly from building sites, including some hand injuries and one “quite nasty” facial injury. Many of them were sent to see the hospital’s team of plastic surgeons.
These were all genuine emergencies, but another nurse practitioner, Jennifer Paton, had been dealing with primary care in the unit, and said the majority of patients this morning could have been seen by their GP, with things like coughs and colds.
Mr Saharia said: “The key message we want to get across about the minor injuries unit is to ask people to think carefully about whether they need emergency treatment – is there somewhere else they could be treated, could they go to their GP?”
Shortly after 1.30pm an emergency call comes in for a lady with a pre-existing medical condition who has become critically unwell.
A team starts assembling for when she arrives, after which she is taken to Resuscitation and then goes up to the critical care unit.
Throughout the afternoon the department starts to see the usual spike in the number of patients arriving.
By the time I leave at 3pm there are around 30 patients within the A&E department. One of these has had an accident- a road collision- and all the others are unwell.
Ellie Straker, the nurse in charge in the afternoon said 10 patients were waiting for beds on a ward at that time.
She said: “The fact that we have got 10 patients waiting for beds is worrying because if it gets a lot busier later we are already on the back foot.”
And Mr Fox said: “We’re entering a really important two hours that will govern how the next six hours go.
“If it’s a normal evening we would be expecting to remain busy for the next six to eight hours.”
As I prepared to leave the team to get on with the rest of their shift, Mr Saharia had one final message for his staff, thanking them for the way they had coped so far with the winter pressures.
He said: “We are very proud of the way they’ve handled what has been an incredibly busy and challenging festive period.
“Despite the challenging conditions they have showed tremendous compassion and that’s a credit to them.”
Source : Chroniclelive