Does emergency department workload adversely influence timely analgesia?

Mitchell, Rob, Kelly, Anne-Maree and Kerr, Debra 2009, Does emergency department workload adversely influence timely analgesia?, Emergency medicine Australasia, vol. 21, no. 1, pp. 52-58, doi: 10.1111/j.1742-6723.2008.01145.x.

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Title Does emergency department workload adversely influence timely analgesia?
Author(s) Mitchell, Rob
Kelly, Anne-Maree
Kerr, DebraORCID iD for Kerr, Debra orcid.org/0000-0002-2956-2432
Journal name Emergency medicine Australasia
Volume number 21
Issue number 1
Start page 52
End page 58
Total pages 7
Publisher Wiley-Blackwell
Place of publication Milton, Qld.
Publication date 2009-02
ISSN 1742-6731
1742-6723
Keyword(s) analgesia
overcrowding
workload
Summary OBJECTIVE: The impact of ED overcrowding on delay to analgesia has not been well studied. Our objective was to determine if ED workload influenced time to analgesia (TTA).

METHODS: An observational, retrospective study (May 2006 to March 2007) was conducted. Adult patients with diagnoses of acute biliary pain, renal colic, wrist and femoral neck fractures were identified and assigned to an ED workload group based on total patient care time--a validated measure of ED workload. The groups were defined by low, middle and high quartiles of total patient care time. The high quartile was defined as overcrowded--equating to average ED occupancy/24 h of 85-140%. Data collected included demographics, pain score and analgesia data. The primary outcome was comparison of TTA between workload groups. Data were analysed using Cox regression and multivariate analyses. Sample size required was 50 per group.

RESULTS: A total of 254 patients were studied (52% male; median age 57 years). Demographics were similar between groups. Ninety-three per cent received analgesia with median TTA of 53 min (interquartile range 30.5-114.5). No significant association was found between workload and TTA (hazard ratio [HR] 1.02, 95% CI 0.99-1.02). On multivariate analysis, factors associated with delay to analgesia included advanced age (HR 0.35, P= 0.006), language other than English (HR 0.55, P= 0.010), lower triage acuity (HR 0.20, P= 0.000) and delay to pain assessment (HR 0.16, P= 0.000). Those with higher pain scores received analgesia more quickly (HR 1.12, P= 0.003).

CONCLUSION: No relationship between workload and TTA was observed; however, there were delays to analgesia associated with age, non-English-speaking background and delay to pain assessment.
Language eng
DOI 10.1111/j.1742-6723.2008.01145.x
Field of Research 110399 Clinical Sciences not elsewhere classified
1103 Clinical Sciences
1117 Public Health And Health Services
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2009, The Authors
Persistent URL http://hdl.handle.net/10536/DRO/DU:30089875

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