The person, environment, health and illness factors influencing time to first analgesic medication in the adult Emergency Department

Mr James Hughes1, Prof Patsy Yates2, A/Prof Kim  Alexander2, Dr Lyndall Spencer3

1Royal Brisbane & Women’s Hospital / Queensland University Of Technology, Herston, Australia, 2School of Nursing, Queensland University of Technology, Kelvin Grove, Australia, 3Princess Alexandra Hospital, Woolloongabba, Australia

Background: Up to 65% of patients presenting to the emergency department (ED) have pain. The ED’s treatment of pain is often inadequate and patients wait a long time for analgesic medication.

Symptom Management Theory (SMT) is a mid-range theory that has been applied to many symptoms in different settings. It is based on the three dimensions of care influenced by the three domains of nursing science. The SMT has been used to guide this inquiry into factors influencing time to first analgesic medication in the ED.

Aim: To build a model of the person, environment, health and illness factors that influence the TTA for patients presenting with pain to the ED.

Methods:  Retrospective cohort study for presentations to the ED over a twelve-month period. Modelling the associations between the person, environment, health, and illness on TTA in patients presenting with moderate to severe pain. The study used a Cox Proportional Hazards (CPH) regression to model the influences on TTA guided by the SMT.

Results: 383 patients were identified for inclusion in the study, 290 (75.92%) of these patients received an analgesic medication in a median time of 45 minutes (IQR, 70minutes). A significant model containing nine explanatory variables was identified. These nine variables (employment status, discharge location, triage score, Charlson score, arrival pain score, socioeconomic status, first location, daily total treatment time and patient time to be seen) represent all of the domains of nursing science as represented in SMT.

Conclusions: This study has identified factors from the person, environment, health and illness domains of the model that influence the time taken to deliver analgesic medication to those in pain in the ED. This study demonstrates the complexity of influences of pain care in the ED and the applicability of mid-range theory to pain in the ED.


Mr Hughes is the Nurse Research Manager at the Emergency and Trauma Centre, Royal Brisbane and Women’s Hospital. The is a jointly appointed position with Queensland University of Technology and partly funded through the Emergency Medicine Foundation. His research interests include pain management in the ED, patient flow and capacity building in emergency research. He is currently finishing off his PhD in pain care at QUT.