title: Time to analgesia for care delivered by nurse practitioners in the emergency department – a retrospective chart audit.
abstract: OBJECTIVE
  To evaluate quality of care delivered to patients presenting to the emergency department (ED) with pain and managed by emergency nurse practitioners by: 1 Evaluating time to analgesia from initial presentation 2 Evaluating time from being seen to next analgesia 3 Measuring pain score documentation
  
  
  BACKGROUND
  The delivery of quality care in the emergency department (ED) is emerging as one of the most important service indicators being measured by health services. Emergency nurse practitioner services are designed to improve timely, quality care for patients. One of the goals of quality emergency care is the timely and effective delivery of analgesia for patients. Timely analgesia is an important indicator of ED service performance.
  
  
  METHODS
  A retrospective explicit chart review of 128 consecutive patients with pain and managed by emergency nurse practitioners was conducted. Data collected included demographics, presenting complaint, pain scores, and time to first dose of analgesia. Patients were identified from the ED patient information system (Cerner log) and data were extracted from electronic medical records.
  
  
  RESULTS
  Pain scores were documented in 67 (52.3%; 95% CI: 43.3-61.2) patients. The median time to analgesia from presentation was 60.5 (IQR 30-87) minutes, with 34 (26.6%; 95% CI: 19.1-35.1) patients receiving analgesia within 30 minutes of presentation to hospital. There were 22 (17.2%; 95% CI: 11.1-24.9) patients who received analgesia prior to assessment by a nurse practitioner. Among patients who received analgesia after assessment by a nurse practitioner, the median time to analgesia after assessment was 25 (IQR 12-50) minutes, with 65 (61.3%; 95% CI: 51.4-70.6) patients receiving analgesia within 30 minutes of assessment.
  
  
  CONCLUSIONS
  The majority of patients assessed by nurse practitioners received analgesia within 30 minutes after assessment. However, opportunities for substantial improvement in such times along with documentation of pain scores were identified and will be targeted in future research.
authors.affiliation: School of Nursing & Institute for Health & Biomedical Innovation, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Qld 4059, Australia; Emergency and Trauma Centre, The Alfred Hospital, Commercial Road, Prahran, Victoria 3004, Australia. Electronic address: N.Jennings@alfred.org.au.
authors.forename: Natasha
authors.initials: N
authors.lastname: Jennings
authors.affiliation: University of Adelaide, Adelaide, Australia.
authors.forename: Arushi
authors.initials: A
authors.lastname: Kansal
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Gerard
authors.initials: G
authors.lastname: O'Reilly
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
authors.affiliation: School of Nursing & Institute for Health & Biomedical Innovation, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Qld 4059, Australia.
authors.forename: Glenn
authors.initials: G
authors.lastname: Gardner
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods / Q000592:standards*; D001315:Australia; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000592:standards* / Q000706:statistics & numerical data; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors
keywords: Analgesics; Clinical audit; Emergency service; Nurse practitioners; Pain