I can not say we admit everyone who is elderly who arrives overnight, but we
usually arrange transport back, and make sure they are safely back in their
own homes. We hopefully carry out a risk assessment of admission versus
discharge. It is something nursing staff are usually more sensible over,
perhaps cautious than medical staff.
Andy
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Cosson, Philip
Sent: 24 March 2007 12:59
To: [log in to unmask]
Subject: Re: Recent experiences: Hospitals and the curates egg
To follow on Vic's thread for recent experiences, I just have to get this
off my chest...
My mum and dad are in their 80's and live 6 miles from the nearest town in
the middle of the fens - their house is 1 mile from the next nearest
neigbour down a single track lane.
My mum is 4 years into lukeamia - with the chemo having been stopped when
she could not tollerate it (about a year ago) and steroids now stopped also.
She has blood transfusions. She also has alzheimers.
Dad could not cope the other week - as she had stopped eating and was very
weak - so he rang the GP, who arranged for the ambulance to come and take
her to the local hospital. They arrived at 5pm and took mum away and he
followed in the car. The MAU staff did nothing, and decided it was a good
idea to discharge her into dad's care at 2am (because that was what she
wanted) Dad had to take her to the car in a hospital wheelchair, get her
into his car, drive 18 miles over unlit country roads, somehow get her from
the car into the house (a trip of 20 yards with no wheelchair).
Unsurprisngly the ambulance was called again by 1:00 the next day. She has
been in hospital now 7 days.
In total dad had gone 36 hours without food or sleep during this episode - I
frankly could not believe anyone would dischage someone in this state into
this situation. I have since heard on good authority that patients are often
discharged to go home to empty hosuses in the middle of the night.
Sorry to share this - as i know we can all 'have a go' but I would not
believe this if it had not happened to my family
Philip
________________________________
From: Accident and Emergency Academic List on behalf of Vic
Sent: Fri 3/23/2007 18:42
To: [log in to unmask]
Subject: Recent experiences: Hospitals and the curates egg
To open a new thread. George, my life partner, developed unstable angina 2
weeks ago after only ten days of angina whilst exercising. After waking
three times in 2 hours with chest pain needing GTN I got him admitted to the
Royal Preston. He had been in there seven years ago when he got cellulites
from a cat scratch, and was dreading the dirty wards, hopeless staff and
dreadful food. We were pleasantly surprised, the same ward was acceptably
clean, the staff were generally kind, considerate and competent and the food
was bland but edible. He made the following observations:
Health care assistants serving food with no presentation skills, and no-one
helping patients to sit up, move bedside tables etc to get ready to eat. Why
were roast potatoes a healthy heart option some days and not others?
Ward cleaners who mop the floor twice a day, but never in two weeks moved
the waste bins to mop under them, or mopped behind the open doors.
Personal entertainment units that advertised Internet that the engineers
acknowledged didn't work and phones that called out at 10p per minute (calls
in were 50p per minute - but that hidden in the small print)
Toilet on the ward that had a faulty ball cock and overflowing cistern for
two weeks, and corrosion on a leaking pipe that was never cleaned.
Junior doctors who seemed afraid to touch patients. Doctors who didn't read
what was already in the notes. Being recorded as allergic to NSAI's when he
is intolerant to them. Nurses who didn't realise firm pressure over the site
of the Fragmin injection for six minutes reduced the bruising dramatically.
A physiotherapist who thought helping a patient provide a sputum sample
involved asking them to cough after they had walked the length of the ward.
My mother was a physio, she could have got a lung biopsy coughed up, let
alone a sputum sample!
A delay of two weeks (all in hospital) before the angioplasty (OK, not long,
but how much is a hospital bed each day, and how much an angioplasty?)
He was transferred to Blackpool for the angioplasty. Brand new unit, but how
does that explain the food being much better, with made, not packet soup,
and food that was infected with flavour?
One patient had angina in the night and was given a GTN spray by a nurse -
who never then came back to check up on him.
The details of his MRSA status hadn't been transferred over, so he was
barrier nursed. He had his own sphyg cuff for his potentially MRSA laden
biceps but shared the pulse oximeter probe with everyone else on the finger
he picks his nose with.
After the angioplasty he spent the night on a ward that seemed to be staffed
only by a health care assistant who didn't know how to adjust the pneumatic
cuff he had on his radial artery when it was too loose to stop the oozing.
In the morning he was discharged with a single sheet of instructions and a
"Go and see your Doctor". He doesn't know what sort of stent was inserted or
much else for that matter. Oh, and the barrier nursing was forgotten, even
though there were still no results from Preston.
I'm not complaining, I think overall the service delivered was superb. He
had a 90% occlusion of the proximal LAD and now he is walking about again.
Its just that I feel the service is rough at the edges even when it's good.
Alcohol hand rubs and disposable sphyg cuffs are pointless if the same pulse
ox probe goes on everyone.
Perhaps we all need to see what the patients see, but do we ever have the
time to sit down and listen to them tell us? Patient questionnaires and
complaint forms will never pick up these details, perhaps that's why
hospital administrators use them, "Only ask the question that gives you an
answer you want to hear". It applies to me as a GP as much as it does in
hospital I suspect....
Vic Calland
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