Speed in new A&E is no accident
14 June, 2018 — By John Gulliver
University College Hospital
DEFYING the laws of physics, a pot on my kitchen shelf suddenly toppled down, struck my foot and fractured my toes. I knew kitchens were dangerous places – war zones, in fact – but I never thought I would become a casualty of it.
That was on Sunday. By Tuesday I retreated to the A&E at the University College Hospital – and there discovered the new era of medicine.
The new A&E department in Gower Street is much larger, brighter and better designed than the old one, and it was standing-room only, packed with nearly 100 patients.
It seems that A&E departments are like motorways: the bigger and better they are, the more they are filled up!
As I waited in the crowded room I thought of the government experts who in the 1990s came to the weighty judgment that the UCH should be closed because of falling patient demand.
But the turnover of patients on Tuesday afternoon was remarkable – it was so speedy it reminded me of a very well-run conveyor belt in a factory.
Fordism at its best. Or industrialised medicine at its best. Patients are seen within a few minutes by the triage nurse – and the doors are opening and shutting at a remarkable speed.
But then, of course, comes the wait as treatment is sorted out. To “entertain” the crowded reception a young woman came out of a treatment room and demanded in a loud voice that she needed a wheelchair because she couldn’t walk to the hospital chemist to collect her medication. She yelled at the room she was not “bi-polar” and started swearing. A few minutes later she gave up – and walked away.
According to a white board in the treatment section the number of “complaints” on Monday were 10, compliments 30. But the staggering figure that struck me was that 413 patients had been seen on Monday which means that the A&E department attends to nearly 3,000 patients a week or 150,000 a year.
I reckon there are about 20 doctors on call at any given time but, as one told me, more are needed.
Speed, efficiency, is the hallmark of the new A&E. But I suspect that in the process there is little time allocated for consultation with the doctors.
But does that really matter?