|
Mater Hospital
3
Communication and information in Accident and Emergency department
Attending A&E
The majority of the sample had previously
attended the Mater A&E department on more than one occasion.
Only one patient had not recently attended either the Mater
hospital or another hospital. In addition, most of the sample
were patients with chronic illnesses or recurring health
problems. Consequently, they were already familiar with
the process involved when attending an A&E department, and
knew what to expect.
Waiting
times for assessment
The majority of the patients (12/19) were
assessed immediately by a doctor in the A&E department.
In addition, three patients were assessed within fifteen
minutes and one patient was seen within an hour:
| MSO1 (seen within 15 mins.): Now,
the girl pushed it - I got taken within ten, fifteen
minutes of arrival.Very good. I got into - see, I don't
know whether it was a doctor or a nurse - and he says,
'look, there's a lot of people in front of you, but
I'll get you a cubicle and move you up to the top of
the queue'. I couldn't ask for better than that. |
However, the remaining three patients were unsure how long
they had been waiting to be assessed by a doctor.
Explaining
to staff about illnesses/health problems
All the patients felt that the staff in
the A&E department had given them sufficient opportunity
to explain their health problems, and felt that their problems
were taken seriously:
| MM05 (staff clarified what he said,
to ensure they understood him): .there was maybe sometimes
they would pick up what I was saying wrong or that,
you know. But they weren't cheeky or anything - they
would just say 'could you repeat what you said that
time, I thought you said something else?'. |
However, two of the patients, who had previously been hospitalised,
felt that the staff in A&E should have been able to access
details of their medical histories on a computer. In addition,
MS01 felt that it should not have been necessary for different
members of staff to ask him the same questions on a number
of occasions:
| They ask you the same questions over
and over. Every form that they fill in is the exact
same. it's a waste of time, it's a waste of material.
Do you know what I mean? But, alright, they're only
doing their job. They're only doing what they were told.
|
Although being admitted to casualty was
generally a stressful experience for the patients, they
all felt that the casualty staff had tried to reassure them
about their health problems:
| MSO3: Yes, they told me what could
be wrong and what couldn't be wrong. You know what I
mean - they weren't sure until they get all the results.
|
| MM12: He (the doctor) said I'd be
all right. I asked him was I going to kick the bucket
and he said, 'no, you're not'. |
Adequacy
of explanations given of tests or procedures carried out
The specific purpose of carrying out tests
such as x-rays or blood tests was not always explained to
the patients. However, as the majority of the patients were
repeat patients, they were aware that the tests were carried
out to inform the doctors' general diagnoses:
| MM15 (Patient already understood need
for x-ray): It was just a chest x-ray to check out my
lungs to see if there was much fluid had gathered on
my lungs.I know the procedure now because, I mean, I
suffer, as I say, from heart failure and it is usually
brought about by a build-up of fluid on the lungs. And
then, once they get the fluid away it helps to ease
the condition. |
| FM09: (the staff explained) why they
were doing it (the x-ray), and they also told me, too,
after I had the x-ray - they gave me the results of
the x-ray right away. They told me that I had about
two pints of fluid on the lung and they were going to
bring me up the stairs to see if they could get me admitted,
for to drain all the fluid away from the lung. |
As regards patients who had procedures
carried out in casualty, the staff generally explained in
advance what the procedures would involve. However, a surgical
patient (who had previously undergone surgery and was admitted
with a swelling), complained that the doctor involved did
not adequately explain in advance why local anaesthetic
was not administered or the pain that the procedure would
involve:
| .the doctor came in.I says,
'are you going to freeze this?'. He says 'no'. He just
got my skin and he just pushed the needle right through.
And I risked crying: I says, 'you're only a bloody butcher'.
He doesn't give two hoots how he gets to the top. He
wasn't thinking of his patients. He was climbing over
the top of everybody to get to the top, now that's my
opinion, you know. |
Adequacy
of explanations given of treatment provided
As many of the patient were repeat patients
with chronic illnesses, they were often familiar with the
nature of the treatment provided in casualty. In addition,
in some cases, the staff explained the treatment that was
provided:
| MM06: Well, only an injection
for pain: it was a painkiller - morphine.The doctor
that was giving me the injection: he just told me, 'this
is for your pain - it'll ease it'. |
However, in other cases, the treatment
given was not always explained, or was not adequately explained:
MM12 (Re intravenous injection
received): I've no idea.It could have been poison for
all I know.
FM10: They gave me steroid tablets - I got eight of
those.For to help me with the breathing - I think that
was what it was for - and that was all the treatment
I got. (The doctor) just gave them to me and just said
they were steroids. He probably (had explained them),
you know, but I had myself all worked up because I don't
like coming into hospital. |
A few patients said the doctors had not
asked them how they felt about having treatment. However,
some patients felt this issue was irrelevant as the treatment
was essential anyway:
| MM15:
.I need it because it is a very serious situation, so
you don't really have the choice. |
Adequacy
of explanations given relating to need for admission
All the patients seemed to have a good
understanding of why they needed to be admitted. In the
majority of cases, the admissions were required because
the patients needed to be monitored generally and/or had
to undergo further tests and treatment:
| FM19: He took me for an x-ray and,
after I go for the x-ray, the doctor told me they were
keeping me in for a few days, more or less for observation.
|
However, in one case, the staff told the
patient's relative, rather than the patient herself, that
she was going to be admitted:
| FM10: I think it was my daughter
- my daughters were with me - and they told her I was
going to be admitted. |
Waiting
times for hospital beds
Seven patients were admitted to the admissions
ward from A&E within two hours. One patient waited three
hours for a bed. However, FM11 waited all night in casualty
for a hospital bed. In ten cases, the patients were unsure
how long they had to wait for beds:
MM18: Well, I had to wait a while in the place.Well,
they had beds, (but) they had to wait on other people
going out to get them in. It 's a terrible system, but
it's not their fault, they can't do a thing about it.They
said as soon as they had a bed ready then I would be
going up. |
However, all the patients who had to wait
for beds said the staff explained the reasons for any delays
and checked on them frequently whilst they were in the casualty
department. In addition, where appropriate, the patients
were offered something to eat or a cup of tea by the staff,
if they had been waiting for any length of time.
Keeping
relatives informed
All the patients were satisfied that their
relatives were kept informed of what was happening to them
while they were in casualty:
| FM16: Yes, they're (staff) very good
because we baby-sit a wee grandson and he would have
been coming out of school and my husband had brought
me down so he had to go to get the boy. So, they (the
staff) rang him and told him what was happening. |
In addition, where the patients were accompanied
by relatives when they arrived, the relatives were permitted
to wait with them until they were admitted to a ward.
Information
or communication gaps
The patients were asked if there was any
other information which they would like to have been given
during their time in the A&E department. In general, the
patients felt that either they had received whatever information
they required or the staff would tell them if there was
anything else they should know:
FM11: No, not really. They (the staff) gave me all I
wanted to know.
MM12: If there's anything I need to know, they'll (the
staff) tell me. |
However, a number of patients appeared
unwilling or reluctant to seek information, believing that
the doctors knew best:
| MM18: .No, not really. I left it in
their hands. I mean they are the experts. They could
tell me, but I wouldn't understand what they were talking
about. |
In addition, one medical patient was confused
by the information which he had been given about his condition
by different doctors, although he also recognised that the
medical staff had to carry out a number of tests in order
to make a clear diagnosis:
| MM05: .Sometimes, one doctor says
one thing and another doctor says another thing. I actually
asked them myself.'What was he saying - (was it) the
(asthma) attacks I was having that were actually damaging
my heart and wearing my heart down, or my heart goes
that fast when I'm taking the attacks?'.Dr. ---- said
there was no damage done to the heart because she done
the blood test. When you ask, you get a straight answer.they
have to try this that and the other until they find
out what is wrong with you. |
In addition, a surgical patient (MSO1)
who had previously had bypass surgery in another hospital
and recently underwent abdominal surgery in the Mater Hospital,
said that his wife was finding it difficult to cope generally.
He felt that his wife would have benefited from a support
group at the time of the bypass surgery, but also felt that
she could have benefited from a support group during his
current period of ill-health:
| My wife finds it very hard to cope
- very, very hard to cope.(He was given little information
at the time of the bypass) - So, there was nothing really.
I accepted that, but then again, the support, you need
a support group. Especially the other partner needs
somebody to talk to, you know. |
However, it should be noted that MSO1's
wife had contacted the patient's Macmillan nurse for information
about his current ill-health and she had been "brilliant".
|
