A&E waiting times: Diary of a doctor on a night shift

With A&E waiting times at their worst for a decade, doctors in emergency units are under intense pressure to provide a safe, effective service.

One doctor in a busy A&E department, who used the pseudonym Dr Ali, recorded an audio diary of his night shift for Radio 5 Live.

His account, set out below, indicates the delicate balancing act emergency doctors face in trying to care for patients when facing challenges such as overcrowding and patients with very different needs.

8pm:

"It's eight o'clock at night, 6 January 2015, I've just parked my car outside the accident and emergency to start my night shift, in the on-call car park. I can see that the waiting room is already overcrowded, and I think I counted seven ambulances in the ambulance bay, and there are two or three police vehicles as well. So, it promises to be another busy night."

12am:

"It's midnight now, and things are getting worse than what they were before. The numbers of patients have increased. More than 15 in the department right now. A young girl, fallen off a horse, abdominal injuries. The book in the training says that she should be in the critical care area, seen by a team of doctors.

"The practical reality is that I had to put her in a room where I look at the eye injury patients, because that's the only room available right now, and I'm somehow trying to manage a scan and try and figure out what kind of injuries she has sustained."

2am:

"The department situation has taken a turn after a drunken brawl in the town. These are difficult patients to treat. They have cuts and bruises, injuries to the head or chest area. But they are under the influence of alcohol.

"They normally don't tend to cooperate, and you somehow have to see beyond the torrent of abuse that you get from these patients, to ensure their safety.

"I'm pretty sure once they sober up they will apologise for their conduct, as they usually do, and thank us for our services, but the last two hours have been very difficult with that situation.

"Don't have much time though, I have to get back. We've just been informed that a young lady has tried to hang herself, so we'll have to somehow create some space to see her, because she might take priority over others. And I'm just hoping that most of my intoxicated injured patients haven't sustained any major injuries tonight."

3am:

"In the last hour or so a gentleman who had symptoms of stroke earlier in the day - and he's one of those nice people who don't want to come to A&E to waste our time. I wish he had, because now we have missed the window to treat him.

"And that emphasises the point that we can't tell people, we can't turn people around from A&E. We can't tell people not to come to A&E because we're busy, because we don't want to miss out on these particular patients, who we can treat.

"I've got three more hours left in the shift, but I think I'll have to hang on a bit longer because it's a very busy shift today."