What happens when I get to A&E?

What happens when I get to A&E?

What happens when I get to A&E? Before we describe this, remember not all NHS hospitals have an A&E Department. Find out where your local A&E is.

Visits to A&E can take a long time and you are likely to see a lot of different people, from receptionists to emergency doctors. A&E departments are often very busy and very noisy.

The process will take 2-6 hours (longer if you are admitted to hospital). So take something quiet to do (a book or your phone) and, if you are taking a young child with you, take something for him/her to play with that won’t disturb others and something to eat/drink.

Because of Covid-19, people with you may be sent away. If the patient or your companion is a child, you will be allowed to stay.

But what happens when I get to A&E?  There are 5 stages:

1. Arrive and book in

You will register at reception, and be asked some simple questions about why you have come to A&E. Your personal details will be checked to make sure the hospital has a correct record.

Don’t forget to show the person who books you in, any letter that your GP, walk in centre or NHS111 has asked you to bring.

You will then be asked to wait in the waiting room or be sent to another part of the hospital – e.g. eye casualty, a minor injuries unit (MIU; where you may see a nurse), or an urgent treatment centre (UTC; where you may see a GP) – for your emergency assessment depending on what is wrong with you.

It can be 20 minutes or more to the next stage.

2. Triage

A triage nurse will see you in a private room and ask you some more questions. They will take ‘observations’, which may include temperature, pulse rate, blood pressure and oxygen levels.

They may arrange some other tests such as a chest x-ray, ECG (a measure of the how the heart is beating), blood tests or a urine sample.

The results of these tests, all of which can be done in an hour or so, will help the hospital work out what is wrong with you and if you need treatment urgently.

After you have seen the triage nurse (and the tests done or requested), you will be asked to wait either back in the waiting room or in a cubicle.

The wait at this point can be very long – hours sometimes.

3. First assessment – by an Emergency Practitioner

A doctor, advanced clinical or nurse practitioner (ACP or ANP), or physicians associate (PA) will see you next. They can discuss your care with other more senior A&E (and other specialist) doctors called consultants and registrars.

People who are sicker will be seen ahead of people who have minor illness or injury. This is why you may see people who came to A&E after you, being seen before you.

They will ask you more questions about your illness and also examine you. If you would like someone else to be present as a chaperone please say so. The emergency practitioner will check the results of any tests you have had and inform you of the results. They may request more tests.

Don’t forget to ask questions if you are unsure or ask them to write the information down if you are worried about forgetting it.

This part can take 10-30 minutes depending on your problem.

4. Second assessment – diagnosis (what is wrong with you), plan and treatment

Your emergency practitioner will explain what they think is going on and how they plan to treat you. Next steps could be as follows:

1. No further tests or treatment – you will be told what is wrong with you, be reassured, and be told how to manage your symptoms – and what to do if they worsen or don’t get better. This is all that is needed for 3 out of 10 people
2. Medicines – you may be prescribed medication. This will be given to you by A&E or you may need to take a prescription to the hospital pharmacy or a local community pharmacy
3. Assessment by a specialist – you may need to be seen by a specialist doctor who may do additional tests in order to make a diagnosis
4. Admission to hospital as an in-patient – a minority of people are admitted from A&E, i.e. as an inpatient onto a ward in the hospital. You may be admitted so that you can be observed overnight or you may need some further medical or surgical treatment.

This part can take 30-60 mins depending on your problem.

5. Admission or discharge

Discharge

Fortunately, 7 out of 10 patients go home. If you are discharged, an electronic letter will be sent to your GP describing the diagnosis and any medicine/treatment you have been given. You should be given a copy of this letter, in paper form or electronically. If not, ask for a copy.

Sometimes patients are asked to come back for more tests or to be seen in a specialist clinic either at the same hospital or elsewhere. The ways that this might be done include:

• Asking you to contact your GP to make the referral
• Being given a letter with an clinic appointment before you leave the A+E. This may be a telephone appointment
• Being sent a clinic appointment letter by post. Again, this may be a telephone appointment.

It’s very important that you know exactly what the next steps are going to be and who to contact if nothing happens. If it is not clear, ask staff  to explain again.

Up to this point – from arrival to discharge – can take anything from two to six hours; sometimes more at very busy times of the day and night.

Admission

3 in 10 people that go to A&E, are admitted for further tests and/or treatment. You may stay as little as a few hours or overnight to ensure that a treatment has worked. If you are more unwell you may need to stay in hospital for longer. The average length of stay is 6-7 days.

If you are being admitted to hospital, it usually takes four or more hours (maximum is 12 hours) at this point, for the next part of your journey.

Summary

We have described what happens when I get to A&E. Quite a lot actually. The five main stages are described above. Be prepared for a wait. Bring a book or something to do.