Emergency department

• The front door nurse does an infection control screen and directs patients with injuries to the urgent treatment centre (UTC), children to paediatrics, and infectious patients to our amber area.
• Next, please book in at reception.
• The receptionist checks your details on the computer and confirms why you are here
• Please let us know if you have been referred by your GP to a speciality team (e.g. surgery, medicine, gynaecology etc.)
• If you have not been referred then you will be seen by the emergency medicine staff.

• You then wait for triage.
• We try to minimise the wait for triage but when a lot of patients arrive quickly this might be delayed as there are only 2 or 3 triage staff.
• While you are waiting, you may have an observations, an ECG or a urine test taken by the health care assistants (HCAs).
• ECGs and observations are reviewed by doctors to check that you are ok to wait.

• The triage nurse will order blood tests for certain conditions.
• If tests are ordered then a physicians assistant (PA) will call you from the waiting room to do the blood test.
• They usually put a tiny plastic tube, called a cannula, into your vein. This is in case we need to give you any intravenous medicine.
• The cannula must be removed if you are discharged, so please let us know to take it out if you are discharged.

• The triage nurse will ask details about your condition.
• This enables us to prioritise who needs to be seen most urgently.
• If you have been referred to a speciality team by your GP, or by a hospital doctor, we will contact them and organise any tests that you need.
• There are speciality assessment unit elsewhere in the hospital, e.g. the surgical, medical and cancer assessment units and gynae clinics. We may stream you to these areas if you are to be seen by their doctors, if there is space.
• Non-referred patients will be seen by the emergency department doctors, in priority.

• Our different groups of staff wear different colour scrubs.
• Nurses wear blue scrubs, darker blue for more senior nurses.
• Emergency department doctors wear green scrubs.
• The nurse in charge of the department wears dark blue scrubs

Here is one of our charge nurses (a nursing “sister”.) The senior nurses run the various areas in the department.

• You may be assessed by a emergency nurse practitioner (ENP) or an advanced care practitioner (ACP) rather than a doctor.
• These staff are highly experienced, and are trained and accredited to see specific groups of emergency department patients.

• The doctor or ACP working in Area D will call you when it is your turn.
• They assess you and look at the results of tests already done (blood tests, urine dip, XRs, ECG)
• They may be able to treat and discharge you.
• They may need to order more tests or scans to diagnose your illness. They will explain what these are for and how long they take.
• If they think you will need to stay in hospital, they will refer you to a speciality team. You might wait in the emergency department to see them, or be sent to a speciality assessment unit.

Sick notes

• You can sign yourself off for five working days. If your illness or injury will clearly require longer off then the doctor can provide a sick note. Please ask them.

Outpatient pharmacy

• If you are prescribed medicines to take home please collect these from Rowlands in the main outpatients department. Opening hours are 0900-1800 monday –Friday, 0900-1300 on Saturday and Sunday.
• If you need medicine outside of these times we may write you a prescription or dispense medication from our stock.

• You may be told to book an outpatient clinic appointment, eg for
• Medical ambulatory care
• Fracture clinic
• ENT, Eye or other clinic
• Please go to Reception team at the front desk to book your appointment.

Before you go, have still got a cannula in?

• Before you leave please make sure we have removed your cannula. We will should always check, but if we have not done so please prompt us!

• We are not able to say exactly how long you will have to wait.
• This is partly because sicker patients who arrive after you elsewhere in the department may need to be prioritised.
• This may leave only one doctor for the waiting room, which rapidly increases your waiting time.
• Speciality patients may also be seen before (or after) Emergency Medicine patients.
• You can ask the waiting room nurse for updates on the waiting time and how many patients are currently ahead of you in the queue.

• The number of patients coming to the emergency department has increased by about 15% over the last two years.
• Our doctor staffing levels are on average only three quarters of what they should be, mainly due to unfilled shifts.
• The wait to see a doctor on average is about 2 and half hours, but this increases in the evening and overnight.
• Monday is our busiest day, when patients stay the longest.

• The Trust allows relatives to attend with patients.
• However due to the lack of space we can only allow one relative in per patient. This is the case in all areas of the emergency department.
• When we run out of space and chairs for patients we will ask relatives to leave, unless they are accompanying a confused patient or providing nursing care.
• This is so we can observe, nurse and treat our patients and keep them safe.
• Please be understanding with the emergency department staff who have to enforce this Trust policy.

In pain or feeling sick?

• If you need painkillers or your condition is getting worse while you are waiting, please let the waiting room nurse know. They look after the waiting room patients and carry out any treatments you need.

Chest pain?

• Your ECG will be taken and checked as soon as possible. Tell the nurse or HCA if your pain gets worse so we can repeat your ECG.

Been asked for a urine test?

• Give your sample to the nurse or HCA for testing.

• Our housekeeping team will bring a tea trolley and sandwiches at mealtimes from 0900 to 1700.
• There is a water dispenser and vending machine in the waiting room.
• There is also food available in the hospital concourse:
• M&S : Monday to Friday 0830-2100
• Costa : Open 24 hours
• Burger King : 1100-2300
• If you do leave the department to get some refreshments then please let the nurse in charge of the waiting room know.

If you are being admitted to hospital, you wait until a bed is available. Waits can be prolonged, up to 24 hours for certain types of bed.

• There are typically 20-30 patients waiting in the ED for beds, some on trollies and some in the waiting room.
• If you are waiting for admission and need to lie down please let us know. We will find you a trolley space as soon as we can.
• We have limited trolley spaces (47 in the whole ED) and we also use these to offload ambulance patients, so there may be a delay until we can find a space for you. Please let the nurse know if you feel more unwell while waiting.

• We understand that the wait to be reviewed by a clinician can be very long, and much longer than we wish.
• If you decide that you would like to leave before being seen by a doctor then please discuss this with one of the nurses so that they can check this is safe for you. If needed they will check with a doctor.
• The nurses will also ask you to sign a form confirming that you accept the risks if you do leave.
• If you discharge yourself your GP doesn’t receive a discharge letter or your test results. However you can access your own results via MyChart.

*** Please do not leave without telling one of the nurses so that we can check that it is safe for you to do so ***