July 26, 2021
A recent audit completed in SHED looking at time to analgesia delivery in paediatric fractures revealed some excellent work, and some areas for improvement.
To evaluate the time taken to deliver analgesia in paediatric patients presenting to SHED with fractures.
Three months of data was obtained to determine the median time from arrival of patient to the ED to delivery of analgesia, in paediatric patients presenting with fractures.
- 234 paediatric patients presented with fractures
- 81.6% of paediatric patient with fracture were triaged as a category 4 or 5
- The median time to analgesia was 104 minutes for patients with a category 4
- The median time to analgesia was 27.5 minutes for patients with a category 2
- Almost half (48.7%) of paediatric patients with fracture received no analgesia whilst in SHED
- Of the patients who received analgesia, 49.2% received paracetamol, 36.7% received ibuprofen, 10.8% received fentanyl, and 3.3% received oxycodone
- The median time from presentation to an X-Ray being ordered was 52 minutes in category 4 patients, and 34 minutes in category 2 patients
- The median time from X-Ray order to X-Ray being performed was 20 minutes for category 4 patients, and 23 minutes for category 2 patient
- Patients presenting with high acuity (triage category 2) were receiving analgesia quickly (median time 27.5 minutes)
- Excellent work by the SHED patient transport and radiography teams in getting patients to X-Ray promptly. The median time from X-Ray order to X-Ray being performed was 20 minutes in category 4 patients
Areas of improvement identified
Ongoing need for improvement to decrease the time to delivering analgesia in paediatric patients.
Areas to continue to work on include:
- Improved communication pathways between consultants, triage and wait room staff with resulting front loading of care
- Documentation of patient weight and allergies directly onto EMR to facilitate prompt prescription of analgesia
- Education on paediatric fracture management, for example early assessment of pain and need for analgesia, analgesia administration, splint application, neurovascular assessment to exclude limb threatening injuries and assessment of need for imaging
Following the audit, the information collected has been used to inform staff of best practice for paediatric fracture management, and drive ongoing education in this area.