A good deal of thought has gone into the physical design of new emergency departments, and quite right too. Good patient flow, space and a calming environment can do wonders for a unit’s performance and atmosphere. There’s one thing, though, they often haven’t thought of. At St Elsewhere’s, the staff break room is opposite one of the waiting areas. As you walk past, especially if you’re rash enough to be carrying a coffee cup or a lunchbox, you can feel the hostile gaze of a row of uncomfortable, frustrated patients boring into you. Occasionally, if the wait’s longer or the patients are rowdier than usual, there’s even heckling: ‘Oi, we’ve been waiting hours!’, or ‘That’s right, you enjoy your sandwich while we’re suffering out here!' Needless to say, it doesn’t contribute much to anyone’s enjoyment of their limited breaktime. The trouble is that, for the patient, attending the emergency department is always a ‘special occasion’ – a time of heightened emotion and anxiety – but for the staff it’s a regular day’s work. And if it’s a day’s work lasting 10 or 12 hours, then that half-hour break away from the coalface is absolutely vital. In 2014, Leicester hospitals became briefly notorious when they banned staff from drinking tea or coffee anywhere they might be seen by patients. The idea was to cultivate the impression that doctors were hard at work at all times, not slacking off by having breaks or consuming refreshment. Apparently, this wasn’t just the deranged stratagem of an incompetent management consultant: people had actually complained. Not many departments went far as Leicester – possibly noting the universal mockery they attracted – but I’ve worked in several places where eating or drinking at a desk in A&E was banned for ‘infection control reasons’. Given we provide drinks to patients in the same space, either we don’t mind poisoning them or this is a spurious cover story to avoid the unacceptable spectacle of a doctor drinking coffee in public. So perhaps the solution is to conceal all evidence of medical staff eating, drinking or performing any other non-work-related function. Meals could be served in windowless cubicles, coffee provided in a secret cubby-hole behind the sluice and the staff loos labelled ‘Biohazard’ to discourage prying eyes. No, seriously, maybe that is a solution. People who are frightened or in pain can’t be expected to think completely rationally, and it’s naturally galling to see someone going on their lunchbreak when you’re waiting for a cast on your broken arm. Hospital design really could take this into account. But on the other hand, is it unreasonable to ask our patients to pause and remember that the people serving them, even in their urgent need, have needs of their own? Source
