"A&E Assessments - avoiding extra costs"

My mother fell dramatically at home just two days before her 90th birthday, hitting her face on the wooden arm of the couch before she landed on the floor. This resulted in a huge black eye and severe swelling of the face.

The ambulance was called at around 7 a.m., and the impression was that she had perhaps fractured a cheekbone. She was lifted from the floor and put to bed by the ambulance crew and given 2 Paracetamol.

My sister was the sole carer for my mother that weekend. I am the elder daughter and a trained Nurse but unfortunately was alerted after a time delay when the ambulance had departed.

I found it difficult to explain the rationale of the ambulance crew, and therefore dialled 111. Explaining the situation on the phone, it was obvious that another ambulance should be sent. All this took time, and the second ambulance did not arrive until 3.15 p. m.

By the time we reached Raigmore, it was after 4 p.m., but the ambulance crew were exceptionally kind, this time delivering Morphine to my mother, which kept her comfortable. It was unfortunate that we had to travel the 45 miles in what felt like a fridge as the heating could not be adjusted to be effective.

Staff at A&E Unit were friendly and helpful, but it took five hours for all the results to come back for my mother, and the medical decision made.

They had also discovered a pathological fracture of her humerus which they decided to treat by the standard collar and cuff. I explained that this could not be tolerated because of her brachial plexus damage, which had resulted in total paralysis of the affected hand and arm.

That is the recommended treatment, was the response.

I then encouraged them to try it, to see what happened, and the light began to dawn. Because her hand was completely paralysed, it fell unsupported at the cuff. My mother's automatic response was to try to support her paralysed hand by lifting it with her other hand. There was puzzlement, as the staff realised that what I had said was correct, and how could it be made to work? I suggested a velcro wrist splint might solve the problem, and it did.

When the A&E doctor obviously felt she could go home, I had to say very strongly:

"HOME IS NOT AN OPTION"

This had to be repeated several times, eventually to a senior doctor (?Registrar). Only first names were given, so you really have no idea who you are talking to. I had to stand very strongly against medical opinion, but the end result was that my mother only spent 17 days in the hospital before I managed to identify a bed in a Nursing Home.

After this length of time, her discharge form says that she is ambulant with the use of a zimmer frame, which is NOT possible. The paralysis of her right arm is NOT mentioned.She apparently has NO problem communicating, which is astonishing to hear. They do admit that she needs help with all care.

I think a complex case such as this should never have been considered able to go home to one carer. I believe:

1. It was an unsafe situation for an untrained sole carer.

2. There would have been a readmission within 48 hours.

3. There would have been yet another ambulance.

4. There would have been unnecessary stress on the whole family.

5. All the movement would have further confused an elderly lady.

BUT LASTLY... and MOST IMPORTANTLY....I urge you to consider the extra cost this would have imposed on the NHS. Extra ambulances covering many miles, procedures all done again, a situation which would have deteriorated.

Trying to avoid admissions is all very well, but postponing the inevitable is something else altogether. How A&E is used is tremendously important. It is a tragic use of resources if a considerable percentage of those seeking help are individuals who should have been admitted, but whose assessment was incorrect, or who were not heard.