• Marlene D Melzer-Lange, Christine M Walsh-Kelly, Gwen Lea, Cheryl A Hillery, and J Paul Scott.
• Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA. mmelzer@mail.mcw.edu
• Pediatr Emerg Care. 2004 Jan 1;20(1):2-4.

ObjectiveTo determine whether a protocol to start patient-controlled analgesia (PCA) in the emergency department (ED-PCA) would shorten the length of time between narcotic bolus doses and PCA initiation as compared with standard inpatient initiation of PCA (IP-PCA). Also, to compare patient satisfaction and inpatient length of stay for the 2 groups.MethodsTo improve care, we developed a protocol to institute ED-PCA after an initial bolus dose of narcotics. This was a nonrandomized pilot study. Patient records were reviewed for location of PCA initiation, time from narcotic bolus to initiation of PCA, and length of stay. A brief patient/parent satisfaction survey was collected.ResultsSixty-nine records were reviewed. Patients treated using the protocol had initiation of PCA therapy within 35 +/- 7 minutes from the last bolus narcotic dose in the emergency department versus 211 +/- 17 minutes for nonprotocol patients. Forty-eight of 50 patient surveys indicated preference for starting ED-PCA; 2 did not have a preference. No complications were identified in either group.ConclusionsA protocol to initiate PCA for sickle cell patients in a pediatric emergency department shortened the time of its initiation and was preferred by patients.

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