The contribution of time to first analgesic medication in Emergency Department length of stay

Dr. James Hughes1,2, Dr. Nathan Brown1,3, Ms Jacqui Chiu3, Mr Brandon  Allwood1, A/Prof Kevin Chu1,3

1Royal Brisbane And Women’s Hospital , Herston, Australia, 2Queensland Univerity of Technology, Kelvin Grove, Australia, 3University of Queensland, St Lucia, Australia

Background:  Pain is the most common presenting symptom in emergency department (ED) patients. Many factors such as workload and age, are known to affect the time taken to deliver analgesic medications (TTA), which in turn can impact on the patient’s ED length of stay (ED LOS).

Objective: To determine the independent contribution of TTA to ED LOS.

Methods:  A retrospective cohort study was conducted in a tertiary-referral, inner-city ED. The sample included adult patients who presented with pain and received analgesic medication(s).  Study participants were identified from a random selection of 2,000 adult patients who presented between August and October 2018. The relationship between ED LOS and TTA was described using bivariable and multivariable linear regression models with the latter adjusting for sex, triage category, ED location where patient was first seen by a clinician, departure destination, and workload metrics (average daily time to be seen, and daily access block).

Results:  Of the 2,000 randomly selected patients, 727 (36.4%) had pain as a symptom on arrival, 423 (21.2%) had analgesic medication administered. Median (IQR) age was 35 (25-52) years and 53.3% were female. Median (IQR) TTA was 62 (36–105) minutes and median (IQR) ED LOS was 218 (160–318) minutes.  TTA was found to be an independent predictor of ED LOS, contributing to 7.0% of the variance in ED LOS in the multivariable model.

Conclusion:  Providing analgesic medication faster to patients presenting in pain, in addition to previously demonstrated positive patient outcomes, may decrease their ED LOS.


Dr. Hughes is an early career researcher who specialises in emergency care research. He has an extensive background as an emergency nurse and leader, working in some of Queensland’s busiest ED’s. Dr. Hughes completed his PhD in November 2018 on factors that influence pain care in the ED.  He is currently employed as a Nurse Researcher in the Emergency and Trauma Centre at the RBWH and Conjoint Senior Research Fellow in the School of Nursing at QUT, a position partially funded by the Emergency Medicine Foundation. His research interests include pain care, infection detection and care of the vulnerable patient.