Does emergency department workload adversely influence timely analgesia?

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.