"Reflections on an inpatient stay. Improvements Needed."

Toward the end of September 2022 I experienced a serious road traffic accident. Suffering from back and chest pain paramedics checked me over. They were not concerned and I opted to be dropped off at a hotel.

In hindsight the shock, adrenaline, and relief to be alive masked the extent of my injuries and my ability to self-appraise was impaired. I don’t feel that this was factored into the assessment and decision not to pursue further investigation.

The following day it became clear that I had sustained a significant injury and I attended Crosshouse A&E. A CT scan identified a spinal fracture.

Cleanliness and maintenance of A&E was unacceptable. The floor was sticky in places and the seating benches vinyl had perished exposing large areas of foam which was ingrained with dirt. My partner is a clinician working in a different region of Scotland and was appalled at infection control standards. There was an air of neglect about the environment resulting from various details, e.g. empty leaflet racks. The ‘young people’ leaflet rack contained just a single offering (about STD’s), depressing and reductionist.

All seats in A&E are low, hard to access and uncomfortable. For my injury, I had only been comfortable lying down, which is the position I was advised I had to remain in post scan. After two hours of waiting I struggled to stand from the low armless benches that were the only seats I could tolerate. The triage nurse witnessed this difficulty, but still directed me back to the same seating options following the consultation, where I waited for a further hour in significant pain on inappropriate furniture in a position that I now know was potentially dangerous for me.

Once the decision to admit was made, I was left on a bed in a room in A&E for 15 hours with only a brief diagnosis of a likely spinal fracture. I had been standing up and walking to toilet as nobody had explained to me that I shouldn’t be and the risks of doing this with the fracture I had. It was about 20hrs after arriving, and 12hrs after the initial scan that I received a full explanation.

My basic needs were not met during this time where I did not advocate for myself, meal times passed with no offer of food, my light was left on despite it being the middle of the night and no opportunity to wash was provided. I eventually had to request these needs be attended to, but was reliant on waiting until staff entered my room.

There was no communication with my partner, who was not allowed through to A&E, and I didn’t have a phone to inform her. There doesn’t seem to be a system for acknowledging if a relative is waiting in A&E and for them to receive an update if their relative is taken away and doesn’t return. This shows a lack of consideration for how distressing this experience can be for a carer or relative to be waiting with no information.

The next day I was transferred to an orthopaedic ward and during this transfer the details of my injury changed. I was advised that I had an L1 fracture in A&E and a T1 fracture on the ward. I eventually challenged this and was advised a notes error had occurred. This further concerned me and impacted my confidence in the clinical treatment and standards at the hospital.

I remained on the orthopaedic ward for a week awaiting an MRI. This wait of 7 days from news of my fracture and being told to lie sedentary on my back felt like a lifetime. I question the efficiency and humanity of leaving me on a bed for week. With retrospect, I occupied a hospital bed for 6 days awaiting diagnosis for an injury that I was able to recover from safely at home. The MRI was the key to this being known and the length of my stay in hospital is a reflection of radiography wait times rather than my clinical need for hospitalisation.

After my eventual MRI scan, I was efficiently and competently assessed and provided with a back brace by physiotherapists which resulted in my discharge that same day, which was a relief. On the topic of the staff at the hospital, I was treated with care and compassion throughout my stay and my main observations were that the demands upon staff were immense and they did their best in the face of conflicting pressures.

A final point to note is that I learnt from my discharge paperwork that my initial CT scan had showed atelectasis of one of my lung lobes. This was never acknowledged or discussed with me during my admission.

In summary my main areas of feedback are:

Hygiene / Infection control - Furniture in A&E should be condemned. The general cleanliness was unacceptable.

Communication – I was not told about scan findings. I was not informed what it meant (i.e. no walking to toilet, sitting up, etc), Notes errors detailed the wrong bone. I wasn’t told my partner had not been updated about events in A&E.

Transition from A&E to inpatient. Uncertainty about timescales, with basic needs unmet.

My patient journey being dictated by wait times rather than clinical need, occupying a bed that could have been used by someone who required nursing care on the ward.

Patient / carer experience feels overlooked throughout the patient journey. Environmental and service conditions are not conducive to having a positive experience, confidence in the service or general thriving.

Hospital services should be easier to navigate if you have a clinical relative, but this is certainly not the case.

I’ve recently had a confused elderly relative stuck in A&E for days and my experience has highlighted to me that individuals who aren’t able to advocate for themselves or notice errors could be vulnerable at the hospital and A&E’s policy of no visitors prevents relatives from checking on and advocating for their loved ones.