Patient isolation impacts on time to analgesia in the emergency department: a cohort study

Abstract Pain is one of the most common causes for presentation to the emergency department (ED). Although previous research has identified factors influencing time to analgesia (TTA), impact of isolation, an infection control measure for selected communicable diseases, has not been investigated. Aim To determine the association between isolation precautions and TTA for patients presenting to the ED with pain. Method A retrospective cohort study included adult patients with pain requiring analgesia and a Australasian Triage Scale category of 2 or 3 that presented to two metropolitan EDs, located in Melbourne, Australia, between 1 January 2021–31 March 2021. Patients were identified using a Health Registry for Emergency Care. The primary outcome was the proportion of eligible patients that received analgesia within 30 min of their ED arrival. Secondary outcomes included TTA and ED disposition. The primary exposure variable was placement in isolation precautions in the ED. Ethical approval was granted by the Alfred Health Ethics Committee (Reference no: 783/20) and the study conforms with the Australian National statement on ethical conduct in human research . Results During the study period, 2786 eligible patients were identified. There were no differences in baseline characteristics between exposure groups. Among 541 isolated patients, 3.3% ( n = 18) received analgesia within 30 min of ED arrival, compared with 8.0% ( n = 180) of the 2245 patients who did not require isolation precautions (odds ratio 0.39, 95% confidence interval 0.24–0.65, p < 0.001). The median TTA was 164 min for patients requiring isolation and 106 min for those that did not (p < 0.001). Conclusion Among patients presenting to the ED with acute pain, placement in isolation precautions was associated with prolonged TTA. Further research is required to determine specific factors to mitigate delays to analgesia, including for isolated patients.