ORIGINAL RESEARCH Prevalence of morphine use and time to initial analgesia in an Australian emergency department Roberto Forero, 1,2 Mohammed Mohsin, 3,4 Sally McCarthy, 5 Lis Young, 1,2 Sue Ieraci, 6 Ken Hillman, 1,2 Nancy Santiano, 1 Adrian Bauman 7 and Hai Phung 1,2 1 Simpson Centre for Health Services Research, Liverpool Health Service, 2 The University of New South Wales South-Western Sydney Clinical School, 3 Centre for Research, Evidence Management & Surveillance (REMS), Population Health, Sydney South-West Area Health Service, 4 School of Public Health and Community Medicine, University of New South Wales, 5 Department of Emergency Medicine, Prince of Wales Hospital, 6 Department of Emergency Medicine, Bankstown Hospital, and 7 Department of Public Health and Community Medicine, University of Sydney, Sydney, New South Wales, Australia Abstract Objective: To explore the association of morphine use with factors influencing time to initial analgesia (T-A). Methods: A retrospective cohort review was conducted. Morphine data were collected from a register for restricted drugs located in the ED. T-A was the time interval between triage and signing out of morphine’s first dose. Statistical analyses were performed to determine the association between morphine use and patient volume. Results: In total, 8% of ED attendees received at least one dose of morphine sulphate in the ED. Prevalence of morphine use significantly (P < 0.05) varied by patient’s age, Australasian Triage Scale category, time of arrival and type of illness. The median time of T-A was 79 min (95% CI 71–85) with substantially longer (median 107 min) for those who arrived during the afternoon and triaged as less urgent (median 127 min). Patients who arrived late at night (median 47 min), triaged as immediately/imminently life-threatening (median 58 min) and diagnosed as renal colic (median 27 min) or fractures/injuries (median 67 min) were more likely to receive i.v. morphine faster than other patients. The findings confirmed that large volume of patients in ED was associated with longer T-A. Patient volume in the ED showed a significant positive association with T-A (r = 0.568, 32% variation explained, P < 0.01). Correspondence: Dr Roberto Forero, Simpson Centre for Health Services Research, University of New South Wales, Locked Bag 7103, Liverpool Hospital, Liverpool BC, NSW 1871, Australia. Email: r.forero@unsw.edu.au Roberto Forero, PhD, MPH, MA, Senior Research Fellow; Mohammed Mohsin, PhD, MSc (Stats), MSc (Demography), Statistician; Sally McCarthy, MB BS, FACEM, MBA, Director of Emergency Medicine; Lis Young, FAFPHM, Clinical Coordinator; Sue Ieraci, MB BS, FACEM, Area Advisor Emergency Medicine; Ken Hillman, MB BS, FRCAnes, FFICANZCA, Professor of Intensive Care and Director Simpson Centre for Health Services Research; Nancy Santiano, RN, BSN (Phil), PGDip ED, Mclin Nsg, Project Director; Adrian E Bauman, PhD, MPH, FAFPHM, Professor of Public Health; Hai N Phung, PhD, MD, MPH, Former Principal Research fellow. doi: 10.1111/j.1742-6723.2008.01068.x Emergency Medicine Australasia (2008) 20, 136–143 © 2008 The Authors Journal compilation © 2008 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine Copyright Agency Limited (CAL) licenced copy