Some wag (not me) changed a screen saver on the works pc to: 'A&E Breeches before safety'. Just about sums up the culture at present.
Had a patient who became unwell just prior to transfer. 10 minutes before her 4 hour time was up. Vitals were ok, repeat ecg not too bad, but the sister in charge was almost losing it trying to move this patient out before she breached. This was the same sister who earlier tried to place a highly clinically unstable patient with a PE into a low dependency bed on the clinical decisions unit. One look at this patient tells you they are sick, however add that to her poor vital signs leads to the fact this person needs a higher dependency bed. I made sure she got one, and was castigated by this sister for doing this.
Therefore, the wag who typed 'breaches before saftey' is right on the ball when it comes to summing up the current climate in my A&E Deopartment. It is not helped when some of our seniors lack clinical acumen.