Separating A&E drunks and children 'like spinning plates'

The Lead Clinician for A&E at Altnagelvin told the Sentinel the safety of child patients is a key concern in A&E but it was simply impossible to accommodate them separately from adults particularly during the out-of-hours period.

He spoke after members of Strabane District Council raised concerns in relation to Altnagelvin, stating that not only did the abuse of staff need to be addressed, the abuse of patients, particularly children, also needed to be considered. It also emerged that around 60% of problems dealt with at the 'casualty' department were directly or indirectly related to alcohol.

Dr McKinney said the safety of children was paramount and where possible they would be placed in separate waiting areas.

Such areas include a special children's waiting area accommodating four or five children with eight or nine chairs for relatives; a sub wait area accommodating six people beyond the main adult waiting area; and a relatives room.

But as the children's waiting area is not subject to 24 hour monitoring and as the sub wait area is also used to accommodate patients who have been placed under arrest neither are always suitable for children. It results in a fine balancing act for staff.

Dr McKinney explained: "There are a number of groups of our patients with special needs, children, patients with learning disabilities, elderly and also relatives of the critically injured and the bereaved.

"You also then have general patients including adults; included with that you would have drunks who can become aggressive.

"The staff do their best to juggle it as best they can. It has to be done on an ad hoc basis. We don't have so many children after 9pm and we have more of the drunken, aggressive fighters after 9pm."

The casualty boss said a triage nurse will initially assess a patient's suitability for a particular waiting area as well as assessing their medical needs

Small children are normally placed in a special children's area during the day but this area is closed during out-of-hours because it is not monitored nor is it visible from the security desk.

During out-of-hours children will either be placed in the main waiting area, the sub wait area or the relatives room.

Dr McKinney said the department head will decide on the deployment of staff and where suitable the sub wait area beyond the doors of the main waiting area can be used to accommodate kids when necessary.

This area is also used for patients coming back for an x-ray, for people under arrest, and for people in wheelchairs.

"It is a matter of spinning plates," he commented. "I don't want small children to be frightened by drunks and adults. Sometimes we could have someone under arrest in the sub wait area and adults in the main room and it's not always possible to keep children separate from them. It isn't satisfactory by any means."

The A&E manager said the problem is that the department is not big enough to accommodate comfortably the 50,000 patients attending it every year.

"The department is not big enough. That's the problem. If it was bigger you would have more space between the various areas. It was hoped to build a new A&E with separate children, GP out-of-hours, adult and special needs areas," he said.

Plans for a modern casualty department were prepared over a year ago but Dr McKinney said it was unlikely it would be built any time in the immediate future due to current budget restraints though he believes one could be opened within three years if funds were forthcoming.

"The reality of the A&E department is that it was built slightly over 20 years ago for a capacity of 25,000 to 30,000 patients per year. Given that we now have 50,000 patients per year you are going to have pressure on space," he explained.

"There was less pressure on beds when it was created as well. I can understand why councillors are asking why children are sometimes waiting in the same room as adults but we have to live with the space we have until the Trust can make funds available to us," he said.

Ultimately there would be no issue if there were no drunks clogging A&E. But Dr McKinney said alcoholism is a factor staff take account of in the day-to-day running of the department.

"Alcohol is a major factor in A&E in terms of injuries, falls, road accidents. It causes us problems. It makes it difficult to assess people. Some people come in with head injuries and we don't know whether their symptoms are caused by the injury or alcohol," he said.

"You also have people who may be slightly disinhibited by alcohol and are frustrated at having to wait for a few hours. So it is a potent mix that staff have to cope with. Everyone's needs are slightly different," he concluded.