A protocol to improve analgesia use in the accident and emergency department.

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To assess the use of analgesia in an accident and emergency (A&E) department and identify shortcomings. University teaching hospital. An audit of patients referred from the A&E department to orthopaedic fracture clinic (n = 100) or for orthopaedic admission (n = 100) was carried out to document analgesia use. An analgesia protocol was introduced and analgesia use was reassessed on the same numbers of patients. Prescribing of analgesia was initially poor: 91% of fracture clinic referrals and 39% of admissions received no analgesia while in the A&E department; when given, it was often by inappropriate routes. Introduction of an analgesia protocol significantly improved analgesia use: fracture clinic referrals receiving unsatisfactory analgesia were reduced from 91% to 69% (P < 0.001). There was a marked increase in the use of intravenous analgesia, from 9% to 37% (P < 0.001). Large numbers of patients still receive no analgesia while in the A&E department. This seems to be a common problem requiring intervention at a national level. The absence of a coordinated approach to improving analgesia provision for acute trauma in the United Kingdom should be addressed urgently.