• Roberto Forero, Mohammed Mohsin, Sally McCarthy, Lis Young, Sue Ieraci, Ken Hillman, Nancy Santiano, Adrian Bauman, and Hai Phung.
• Simpson Centre for Health Services Research, Liverpool Health Service, The University of New South Wales South-Western Sydney Clinical School, Sydney, New South Wales, Australia. r.forero@unsw.edu.au
• Emerg Med Australas. 2008 Apr 1;20(2):136-43.

ObjectiveTo explore the association of morphine use with factors influencing time to initial analgesia (T-A).MethodsA retrospective cohort review was conducted. Morphine data were collected from a register for restricted drugs located in the ED. T-A was the time interval between triage and signing out of morphine's first dose. Statistical analyses were performed to determine the association between morphine use and patient volume.ResultsIn total, 8% of ED attendees received at least one dose of morphine sulphate in the ED. Prevalence of morphine use significantly (P < 0.05) varied by patient's age, Australasian Triage Scale category, time of arrival and type of illness. The median time of T-A was 79 min (95% CI 71-85) with substantially longer (median 107 min) for those who arrived during the afternoon and triaged as less urgent (median 127 min). Patients who arrived late at night (median 47 min), triaged as immediately/imminently life-threatening (median 58 min) and diagnosed as renal colic (median 27 min) or fractures/injuries (median 67 min) were more likely to receive i.v. morphine faster than other patients. The findings confirmed that large volume of patients in ED was associated with longer T-A. Patient volume in the ED showed a significant positive association with T-A (r = 0.568, 32% variation explained, P < 0.01).ConclusionT-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.

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