title: Association between access block and time to parenteral opioid analgesia in renal colic: a pilot study.
abstract: OBJECTIVE
  To seek an association between access block and time to parenteral opioid analgesia (POA) in ED patients presenting with renal colic.
  
  
  METHODS
  Renal colic patients given POA were retrospectively identified over 3 months. Time of administration of POA was abstracted from patients' charts. Access block data, time of arrival and demographics were retrieved electronically. A logistic regression was used to seek an association between time to POA (dichotomized into <1 h and >1 h of arrival) with daily access block (proportion of patients requiring hospital admission in a 24 h period who have a total ED time >8 h, dichotomized at its median), time of administration of POA (00.00-07.59 hours [T1], 08.00-15.59 hours [T2], 16.00-23.59 hours [T3] ), age and sex.
  
  
  RESULTS
  Of 69 patients, 42 (60.1%, 95% CI 51-70%) received POA within 1 h. Access block occurred daily (median 28.8%, range 6.8-53.1%). Mean hourly ED attendance rates for all patients during T1, T2 and T3 were 4.0, 11.7 and 7.8 patients/h respectively. As predictors of time to POA (>1 h vs<or=1 h), the adjusted OR for access block (>or=29% vs <29%) was 1.0 (95% CI 0.4-2.9), T3 versus T2 was 5.0 (95% CI 1.4-17.7), T1 versus T2 was 1.0 (95% CI 0.3-23.8), age (>or=47 years vs <47 years) was 0.8 (95% CI 0.3-2.3) and for sex (female vs male) was 0.4 (95% CI 0.1-1.6).
  
  
  CONCLUSIONS
  Time to POA was related to time of administration, but not to access block. Access block might be too crude a measure to quantify ED overcrowding, and so its influence on time to POA may not be exhibited.
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. kevin_chu@health.qld.gov.au
authors.forename: Kevin
authors.initials: K
authors.lastname: Chu
authors.forename: Anthony
authors.initials: A
authors.lastname: Brown
mesh_terms: D000328:Adult; D000698:Analgesia / Q000295:instrumentation / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D003085:Colic / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007263:Infusions, Parenteral; D007674:Kidney Diseases / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011785:Quality Assurance, Health Care / Q000379:methods*; D011793:Queensland; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid