Time to Analgesia in the Emergency Department: A Retrospective Audit of Pain Assessment and Management Practices at a Sydney Metropolitan Hospital Emergency Department

Background: Pain is one of the most common presenting complaints in Australian emergency departments (EDs). National guidelines recommend that patients with pain should receive analgesia within 30 minutes of presentation. However, inconsistent pain score documentation and underutilisation of nurse-initiated analgesia (NIA) protocols remain barriers to timely pain management. Aims: This audit aimed to assess the time taken for analgesia (TTA) to be initiated in patients presenting with pain to this hospital’s ED. Secondary aims included assessing pain score documentation, evaluating NIA use and identifying factors associated with delays in analgesia. Methods: A retrospective clinical audit was conducted over a consecutive 7-day period in April 2025. Data from 280 eligible patients were extracted from electronic medical records. Variables included demographics, presenting complaint, triage category, documented pain score, TTA, prescriber of first analgesia and analgesia type. Descriptive, comparative and subgroup analyses were performed. Results: Of 280 patients, 146 (52%) received analgesia, with a median TTA of 61.5 minutes. Only 24% (n = 67) of patients had a documented pain score. Patients with a documented pain score had a shorter median TTA (49 minutes) compared to those without (70 minutes). NIA was utilised in 31.5% of patients who received analgesia and was associated with a shorter median TTA (40 minutes) compared to doctor-prescribed analgesia (83.5 minutes). Conclusion: This audit highlights significant variability in pain assessment and management at this ED. Pain score documentation and NIA use were associated with reduced TTA. Future quality improvement initiatives should include staff education, mandatory pain scoring, NIA implementation and optimising analgesia regimens.