Original research
Table 1 Participant characteristics ID Age
Gender
Ethnicity
Accompanied
ED area
Wait
A B C D
60–69 20–29 20–29 50–59 40–49 80–89 40–49
Female Female Female Female Female
White White Indian White Black White
Partner
Triage waiting room Triage waiting room Ambulatory majors Ambulatory majors Ambulatory majors Ambulance overflow Ambulance overflow
2.5 hours
No
3 hours
Partner
0.5 hours
No No
1 hour
E F
13 hours
Male Male
Partner Partner
2 hours
G
British Asian
1.5 hours
Wait: emergency department length of stay at the time of recruitment. Ambulance overflow: a 10-bed temporary structure extending the adult ambulance assessment zone. ED, emergency department .
Loss of autonomy Participants felt that they resigned themselves to the ED process and that there were no available alternatives to acquiescing and tolerating their situation. Three people who were queuing to see a clinician felt they had no choice other than to wait: I feel upset but there’s nothing else I can do. I need to be seen. Person C We’re hoping it’s going to be fixed, but like I said until we get the results through, we don’t know where we’ll be going … we’ve just got to hang on and wait haven’t we. Person F You can’t regulate what’s going on, yourself as a patient. It feels very restrictive than what you would in a ward. Person G People waiting in the adult ambulatory and ambulance over- flow areas could see department thoroughfares. Participants here felt unable to approach healthcare professionals for assistance, considering them to be too busy: I don’t want to take the trouble to ask them [for medication] … I think that would just take longer so I’d rather just wait here. Person C They are just too busy. You see them all the time on the go and there’s too much to fit in. I sometimes think don’t even go and ask them because they’re too busy to ask anything. Person G Uncertainty around processes and timing made participants feel unable to understand the setting or update important contacts. This affected not only people queuing for clinicians, but also those who had been seen and were receiving treatments. People B and C wanted to be able to plan how they would travel and needed to anticipate their discharge time, while Person E was concerned about her baby at home: I don’t drive so I have to rely on taxis or people to come and pick me up so it would be nice to be able to give them a bit of an indica- tion about when they could come. Person B I don’t know how long it’s going to take me today. I asked one of the nurses. He’s like he’s not sure either so I have no expectation of the time. Person C The first nurse said about eight hours, nine hours. So you are catch- ing on that you’re going to be here for a considerable amount of
time, but it’s a very long time. And I have a baby that I’m breast- feeding at home. Person E Person G’s long-term condition had caused them to require care in several hospitals. While they were familiar with health- care processes, uncertainty around temporary reconfigurations disrupted understanding of their current situation, causing dissatisfaction: Nobody explains to you why you’re in the tent. If you’re told that we’re sorry this is the situation and that’s why we’re putting you here, it’s the assessment thing. Person G Unmet expectations The UK was no longer under pandemic restrictions at the time of these interviews. Still, participants felt that the crowded envi- ronment posed danger. Person E, who had spent the full night waiting, was conscious of risk: Obviously because of Covid, you kind of want to spread out a bit … It’s such a small space and there’s so many people coming, I don’t know what more they could do. Person E People C and E felt uncomfortable in the waiting room due to the lack of facilities for nutrition and personal hygiene: I haven’t seen a water supply anywhere … I think they provide food but I’m not sure. Person C It’s very grubby. There was tissue on the floor, there was urine on
the floor. Person E
Despite the crowd, participants attending alone could still feel lonely. Person B had become unwell at university, far from family. They sought distraction by contacting relatives: I’ve been texting family to give them updates … just so I don’t feel so alone because I’m here by myself. Person B Other people were also distracting themselves by conversing or making calls. This inevitably led to feeling disturbed or even frightened by the level of noise: I found it quite difficult, people having telephone calls when they’re obviously very frustrated. I think it can be quite hard on
Craston AIP, et al . Emerg Med J 2024; 0 :1–6. doi:10.1136/emermed-2023-213751
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