What to do when it’s all going wrong around you….

It’s winter.  Every ED in the country is getting progressively more crowded, and people are packed into corridors waiting for wards.  There’s nowhere to see new patients, there’s patients getting their second or third dose of antibiotics in cubicles.  There are no beds in the hospital.  The wait to be seen is 3 hours 52 minutes, there are lots of people in suits you don’t recognize (hint; they are managers) crowded around arguing with the ED consultant who looks like they’re deciding whether to break down and cry or haul off and punch someone.

Here are some tips and tricks to remaining sane, and getting stuff done in a department that’s a bomb site.

First off accept these three truths:

  1. This is not your fault. This is not even the fault of the ED, the ambulance service, or the people you are going to look after.
  2. It is rubbish for everyone at work, but it is worse for your patients. Crowded ED’s are more dangerous than uncrowded EDs.
  3. Breaches do not matter. Patient care matters.

Ten Tips

  1. See patients as you normally would. If they need bloods, they need bloods, if they need CT’s, Xrays, and they haven’t been done, get them ordered, get them done.
  2. Don’t try to cut corners or speed up, that way you’ll make mistakes, miss things or end up having to go back and go things again.
  3. Write your notes while with the patient.
  4. If you need to admit someone write a plan that’ll last longer than 4 hours. Make sure more fluid, more antibiotics are prescribed.  Keep a sticker or their name on a cheat sheet, and go back and check on them at 6 hours. You might even be able to discharge them if you’ve had them long enough.
  5. If your patient is well enough to be on a corridor after you’ve seen them, move them out to the corridor yourself. Explain why.
  6. It is okay to apologise for the wait. It is okay to apologise that people cannot get toileted, cleaned, rolled, and fed as they need to be.  It’s not good enough and it’s okay to acknowledge that.  Most patients and families will see everyone is working flat out.
  7. TAKE YOUR BREAK. If you don’t I’ll find you, and I’ll KILL YOU.
  8. Be kind to the receiving teams, the medical team especially will be absolutely swamped.
  9. Ask for advice early. Come up with a plan, by all means but don’t try and cope, find the Reg or consultant and get them to check it with you.  They might streamline things for you.
  10. Communicate with your nurses. Help them if you can.  Commodes, getting patients comfortable, mixing IV’s, putting up fluids.


Good luck.

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