Prevalence of morphine use and time to initial analgesia in an Australian emergency department

Abstract

T-A is an important indicator of the quality of ED services. Severity of illness and patient volume were significant factors associated with extended T-A. Strategies for improving pain management in the complex ED environment are discussed.

A Comparison of Analgesic Management for Emergency Department Patients With Sickle Cell Disease and Renal Colic

“…Our data are similar to findings from several recent studies that found patients who received a low priority triage score experienced longer delays to administration of analgesics 2, 3, 5 . In the context of crowding, assignment of a lower priority triage level has a great impact on delays to care for all patients.…”

“…Previous studies have also found patients with RC experience more rapid treatment when compared with all ED patients who received morphine sulfate for treatment of acute pain. 5 Delays associated with arrival shift may reflect crowding, however, regardless of arrival time, we found delays were still consistently longer for patients with SCD. Patients arriving during the night shift experienced the shortest time to receiving an initial analgesic; this is a variable that cannot be controlled.…”

“…Patients arriving on the evening shift experienced the longest delays, with the shortest delays for patients arriving on the night shift. 4, 5 …”

“…Recent studies have identified oligoanalgesia and delay to analgesia as two specific areas that continue to pose significant challenges to emergency clinicians in the era of overcrowding. 1 Timely, adequate analgesia has been shown to vary based on a number of factors, including degree of hospital and ED crowding, 2-4 age, 2, 4 gender, 2, 4 triage level, 2, 3 arrival shift, 5 and disease state. 3, 6 Two disease states commonly studied with regard to adequate analgesia are sickle cell disease (SCD) and renal colic (RC).…”

“…Two recent Australian studies have noted that pain secondary to renal colic is an independent predictor of quicker analgesic administration compared with pain secondary to orthopedic injuries, abdominal pain, and chest pain. 3, 5 Meanwhile, recent data demonstrate lengthy delays to administration of the initial analgesic for patients with acute painful episodes secondary to SCD. 6 The following factors have been described as being associated with inadequate analgesia for patients with SCD: assumptions of health care practitioners about possible drug seeking behaviors, frequent emergency department visits by some patients, often secondary to access issues; and the predominance of African American race among patients with SCD in the United States.…”