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Trolleys as beds: how have we come to this?

Posted by:

23 April, 2012

You realise what trouble we are in when policy advice is being given on whether it is best to look after patients on a trolley in A&E or on a trolley in a ward corridor. We seem to have got past the point where either of these situations are unacceptable and are now being seen as inevitable.

The advice last week from the College of Emergency Medicine is that this is the safest way of dealing with current capacity problems in some hospitals.

Maybe so but we have to careful that we are not setting up a system that will become the norm ie that every 20-bedded ward will now become 20 patients plus the one unfortunate on the trolley.

Apparently there is substantial evidence patients are harmed waiting in overcrowded emergency departments or ambulances but there is no evidence of harm to patients through waiting on wards. It may be of course that once a significant number of patients do end up on trolleys in ward corridors that we will establish that that causes harm too.

Ward corridors can be frantic and frightening places. Any patient parked in a corridor will get a ringside view of what is happening throughout the ward, much of which will appear alarming. Ringing phones, harassed staff, ringing buzzers,  distressed relatives. It will all be on view and I can’t imagine it will be good for their health and recovery.

The college does specify that the patient stuck on the trolley must be “stable, orientated and not receiving active treatment or require monitoring”. However it won’t be long before that detail is lost and the trolley be treated like the 21st bed. The college may be giving useful advice  — the worry is how it will be used.

Readers' comments (12)

  • Nurses have been saying there are not enough beds or staff for years, no-one cares what we think and no-one takes any notice of our concerns.

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  • I feel it is highly dangerous to place patients as the "extra one" on ward areas. They are right to point out that having patients in A&E corridors is dangerous, however mitigating that danger and working in that type of stressful environment is what i went into A&E for. I have my own medical staff and instant access to senior help if the patient deteriorates. It is unfair to place that kind of responsibility and pressures on a ward area where the back up and senior input is not so readily available.

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  • anon 08.49 - that is a very good point you have made, A&E is vastly different to being on the wards isn't it.

    I wish those responsible take notice of comments such as yours but they won't because they don't care, they just need to be seen to be moving patients out of A&E.

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  • Guess it is OK for the wards not to say no to patients. But A & E are unable to say right we have 30 patients therfore we ar closing the doors and patients will have to wait in ambulances or transferred. Fire regulations may be breached due to excessive numbers of people in an area, as may other H & S issues along with dignity of patients. Most A & E have little food/ beverages for patients so will they be starved.

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  • I'm lost for words, any patient who is stable, orientated, not receiving active treatment or require monitoring would be far safer discharged home some would say.
    Where is the dignity and compassion for the patient on a trolley in a ward corridor, no curtains, no light, no buzzer, no table need I go on.
    I would not like to be the nurse responsible for this patient. The advice given by the College of Emergency Medicine should be debated at the RCN congress in a couple of weeks time. It will be the RCN who are called on to defend the nurse who was unable to care for the patient safely.

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  • it's a scandal that patients in A&E who attend in the evening and are kept waiting for hours for medical attention and then, because they do not require admission, have to find their way home late at night which is extremely unsafe. Many patients don't need trolleys or beds, just prompt attention.

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  • words fail me, but that goes for all care in the NHS these days. However, other stories suggest we forget the past and move forward, to what? Pay freezes, pension contributions increased, working longer before you can retire or get a decent pension payout (how many nurses will still be fit enough to work until they are 68?), a further reduction in beds, more care in the community that hasn't been thought out and isn't provided, discharges at any time day or night, an increase in elderly care (population) that doesn't seem to be accounted for, regional pay that will divide the profession even further, more targets, more intentional rounding (convince me this is not task orientated), more trolleys with elderly patients on, and I agree with Anonymous | 24-Apr-2012 9:14 pm, but hey ho, all nurses will have degrees, I think we have been blinded with the fact this notion will change everything. It won't, mainly because it has come too late - a carrot to make a disregard all the sticks.

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  • Hospitals shut wards then Patients nursed on trolleys on a ward corridor. You couldn't make it up!

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  • ...not forgetting the bathrooms, treatment rooms and any other available spaces!

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  • Don't forget " virtual wards" !!

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  • If trusts keep closing beds/wards then the majority of our patients will end up on trolleys. It would be interesting to know how many beds have been lost for us to end up in this situation.
    Could NT publish the figures from the different trusts on ward closures and the resulting loss of beds?

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  • shouldnt the college of emergency medicine look at the picture in SOME HOSPITAlS and speak to the managers re appropiate placing of patients into beds on ward not trolleys . ward staff have enough to do !!!!!!!
    Any way a and e would soon be crying out for thier trolleys back when they needed them in A and E but what if the there was no bed on the ward for the trolly patient ???????

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