A & E Expectations and Outcomes.

[Prada47]

Hello

I am just trying to understand what the expectation of the A & E dept of a Hospital is ? You arrive at A & E You explain what has happened to You, you say you believe it to be your Heart, give your History etc then

MY understanding is they carry out tests to a Set Procedure, and Check your Medical History. Bloods, ECG, Blood Pressure, possibly Chest X - ray they all say there is nothing wrong with You. What is the then Expectation ? You feel you should be admitted to the Coronary Care Unit for observation, but there is nothing to indicate there is anything wrong with you. CC Units are normally full so No beds there. If you have presented with an iffy ECG they may connect you up to a Telemetry system to monitor you for a few hours. Which again in my understanding is monitored in the CCU then if there is nothing it's, Bye Bye oh and see your GP to organise an appointment with someone !!

I think that's all that can be done for anyone presenting within the A & E system. It's difficult with a system that is under pressure, they don't have time to diagnose just asses and move you on either to Admissions or Home to your GPs Care.

My understanding again is once the Cardiologist has carried out the Procedure/ Angiography or Stents. You are then passed on to a Surgeon for By Pass work or for Valves should that be the diagnosis from the Cardiologist. If there is nothing to report after you have been fixed you may see a Cardiologist/Registrar after a year then it's You and your GP.

Personal experience if I didn't feel Right I would either phone GP or Heart Nurse or 111 999.

I may be wrong on this but I think GPs can only have patients admitted to a General Observation Ward for assessment, they can not have patients admitted to the Coronary Unit Direct hence A & E.

Really interested in other peoples understanding of the System.

Regards

[Hidden]

I think your perception is spot on. I also think that a percentage of people who do go to A& E are driven by fear - which is quite understandable, especially when they have undergone treatments or surgery for a heart condition. My post the the person asking for advice was to say that until they actually go and get an NHS Standard check out of their heart problem, they will never know whether there is anything wrong or not.

That person, from my perspective, could be feeling these feelings whilst being stressed or depressed or just plain afraid and needs some assurances, which can be a mighty strong medicine.

I don't know what the answer is all I know is that they need some help to get over this hurdle that could be anxiety or actually is something worrying. However, sometimes a kick in the pants can just make the difference to a good outcome and something else.

Other than that, you are spot on. But there is a duty of care and if they do miss something it can go badly for them and the hospital. Just as an ambulance crew are loathe to leave a 999 patient at home when they have rang about a complex problem above their pay grade.

[Prada47 in reply to Hidden]

Hi Ticking

I wasn't being Critical just passing on an Observation on other peoples posts. I was just trying to understand what the expectation is from A & E as everyone seem to be looking for something else !!

I think once the Cardiologist has done his Stuff we all feel a little adrift, it takes a few months or even years to accept that we have been fixed and we have been let go from the Specialist to the General Practitioner.

I think this is where the system falls down if you don't have trust in your GP your stuffed. I must admit I do fall in to a different category having had By pass surgery, followed by Stents and then diagnosed with Moderate/Severe Heart Failure which does give me ongoing Heart Rhythm problems

So I do get a little more attention coming under a Heart Failure Nurse for monitoring and titration of Medication.

My understanding of the Heart Failure system is to try to prevent patients needing to be admitted to Hospital so saving on A & E resources, which I think is the Role of a GP and I do think the GP is the best chance of being looked after, better than A & E.

For me what's missing from the system after discharge is having Heart Specialist Nurses in GP practices I am sure these would prevent 1000s of A & E visits and help settle patients Nerves after being Let Go.

Regards

[Hidden in reply to Prada47]

Absolutely no problem what so ever - the post you made was quite true and did raise important issues about expectations and the "wizardly powers" of A&E as seen on 24 Hours in A&E. As you say and what I always bang on about that we are all different and experiences differing hugely.

I have been so very lucky - I had a mild HA and the 111 was called, but because it was heart related, they sent the Paramedic who made his own decisions, called for an ambulance and commandeered it when it turned up and then arranged me to be taken immediately to the heart and lung hospital, completely bypassing the other hospital and A&E and to be frank, I have wondered if I would have been so lucky had I actually been taken to A&E.

Once in the heart hospital system I had many tests then off within 24 hours for a stent and it was then that things took a turn for the worse, diagnosing a severe blockage to my arteries where the decision was made to give me a bypass - once that was done and got over it, I have moved from strength to strength, but not without my own personal worries, however I do try and keep a sensible head on, when all about me are blaming it on etc etc.

When I was released, my practice doctor had been superb and do try to participate as an interested party and not to turn up, get a script and shove off again. Pro active - thats the word! Perhaps it is our background, but can say I really know no different. No, your post will hopefully raise issues and questions for others and allow reality to set in a bit. Speak soon - opps

[lettingoffsteam in reply to Prada47]

I had chest burning in June probably as a side effect of bp meds,but that is still under investigation.Since I was in some pain I went to A&E.Now my resting ECG is off due to left ventricular hypertrophy due my bp so they did the blood tests as well.All was OK but the doctor told me if I was ever concerned again I should come back to A&E and they would help.I would therefore not hesitate to darken their doors if I deemed it necessary.

Now that said I wouldn't usualy even consult the walk in centre for my medical needs, preferring to see the GP and then only where strictly necessary but I don't muck about with chest pain.

However it's a good job I went to A&E last March with palpitations, temperature and feeling rough as my bp was 244/133 which was how my high bp was discovered.If I had waited to arrange a GP appointment I might have not been able to comment on the forum today!

I think we need to make a decision on whether we need a hospital trip based on our symptoms and our medical history.There are no hard or fast rules.

[Lezzers]

For the moment when I read your post I was afraid you were in A&E!! However you have answered a question that's bothered me for 20 years.

Kevins unstable angina was getting worse so he went to his GP who phoned the hospital and told the cardiologist who said send him to the hospital we'll admit him. So off we went to the hospital with a letter from the GP only to be told when we got there that its not up to the Dr to admit patients and that they were not gonna admit him. After arguing with the A&E Dr for 4 hrs they did admit him (they probably thought it was the only way they could get rid of me 😂) but I've always wondered if A&E were right in what they said. I had no faith as this was the same hospital who sent him home 3 times saying he had a muscle virus/strain before he went into Cardiac arrest because he'd been having a heart attack for 3 days! Fortunately the hospital has now closed.

[Prada47 in reply to Lezzers]

Hi Lesley

It was just a response to a post I couldn't understand what people expected from A & E . I have a good GP and Heart Failure Nurse and should I need A & E I wouldn't hesitate to go there should I feel unwell. That's a bit of a fib I would need to be feeling really awful before I went to A & E and my oh would have called for help by then. I suppose it's all how we deal with this hand we have been dealt . You are welcome to sit at the same card table as me I am sure you would play a great hand

Best Regards

[Milkfairy Heart Star in reply to Prada47]

My Cardiologist would love to be able to admit me directly to CCU.

I always contact him as I am going off the boil and follow his advice about my medication. He tells his colleagues I am coming in.

Even the Head of A&E thought it would be a great idea to be able to directly admit me too.

However the answer is always going to be no. I have to go through A&E and be checked that my unstable angina is just that not a heart attack or any other serious life threatening condition.

The longest I have had to wait for a Cardiology bed was 12 hours 😱

[Lezzers in reply to Prada47]

Gin rummy? ☺