Original research
other people when, you know, there’s someone beside them raising their voice. Person B Due to their health problems, People F and G could not wait on chairs and required trolleys. They were being accommodated in a temporary structure. This caused surprise and disappointment: We were hoping it was in the main hospital with the sliding doors where it’s quieter and they can shut it off a bit. Person F When you’re coming into hospital and you’ve been put in a tent, you’re thinking what’s going on. You’re already not well and going through anxiety and stress, and then you’re put somewhere which is unfamiliar. Person G These expectations being unmet led to participants being reluctant to attend in the future: Person C I don’t want to come back to A&E. I’d rather wait for the GP, unless I feel like it’s life and death. Person E We were at the point where we looked at treatment even if we have to pay … because it saves the time and effort of everybody coming
Table 2 Potential interventions to mitigate unpleasant crowding experiences
Loss of autonomy
Unmet expectations
Intervention
Vulnerability
Screens detailing ED processes Screens identifying staff professions and roles Signs directing to toilets, water and food Process updates from staff during interactions
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•
•
•
•
•
•
•
•
Distractions (eg, television)
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ED, emergency department .
Hopefully there’s support for the staff as well so that everybody feels that they can make the best of a bad situation. I think they must be under a lot of pressure. Person B I’m sure it’s stressful, a lot, because there’s so many people that they have to tend to and help. Person E Participants in the waiting area felt that they were invisible or even forgotten. This led to missed treatments, as Person E had been prescribed analgesia that was not given: People who came in after us were being seen and that makes me feel that I’m not a priority when I know jolly well I am. Person A They are busy and you do get forgotten … So when the four hour mark came when I was in pain I did go up to them and ask. I just wish it was something that they were doing it more often rather than just leaving you. Person E Person G likened their experience in ambulance overflow to being on a conveyer belt, perhaps referencing depersonalisation while proceeding through processes: Basically it’s a conveyer belt, that’s what you’re running right now, the NHS is running a conveyer belt, a sandwich factory. Person G Potential alleviating interventions Participants suggested interventions to mitigate their situation in the crowded setting. Summarised by themes (table 2), these focused on the provision of accessible information and orienta- tion to available facilities for personal needs. Loss of autonomy Lessening uncertainty was a priority. Participants suggested improved information provision, both from staff and with signage: They could say a rough estimate of how long you’ll be waiting. Instead of just saying ‘the doctor will come’, maybe they could say ‘we can’t guarantee but it could be up to an hour wait’. Person B
to A&E. Person G
Vulnerability Participants worried for their safety. Person A explained that security personnel were not visible in the waiting area, while for Person F this was caused by feelings of powerlessness due to uncertain processes and timing. Person F feared their condition deteriorating, unnoticed by staff: I didn’t feel safe at all. There were too many people, there were alcoholics, drug addicts and people just literally shouting. Person A How do you feel about calling for help? Respondent: They’ve not been rude, but they don’t seem to have
the time. Person F
Participants in the waiting area worried about other patients, as well as family members who were alone at home. Here, people were exposed to higher numbers of other patients and staff members. There was a girl there who didn’t look well at all, but she went up to the counter a few times and they were putting things on her finger, checking pressure and everything. Person A If someone’s on their own, it will be so hard for them. Person C I’m breastfeeding. My husband does not cope very well when it comes to – he can’t offer – you know, so there’s a lot of stress hap- pening. So I do want to go home as soon as possible. Person E They were also concerned for the well-being of staff and reflected on working in a crowded department:
Craston AIP, et al . Emerg Med J 2024; 0 :1–6. doi:10.1136/emermed-2023-213751
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