***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Pain is the most common reason due to which patients come to the emergency department ( ED ) . Aim : The purpose of this study was to measure the correlation , if any , between pain reduction and the level of satisfaction in patients who presented to the ED with pain as their chief complaint . Material s and Methods : This study used a r and omly selected group of patients who presented to the ED with pain of 4 or more on the Visual Analogue Pain Scale ( VAS ) as their chief complaint to a level one adult and pediatric trauma center . Instruments that were used in this study were the  VAS , Brief Pain Inventory ( BPI ) , and the Medical Interview Satisfaction Scale ( MISS ) . They were administered to patients by research fellows in the treatment rooms . Statistical analysis included frequencies , descriptive , and linear regression . This study was approved by the Internal Review Board . Results : A total of 159 patients were enrolled in the study . All patients were given some type of treatment for their pain upon arrival to the ED . A logistic regression showed a significant relationship to reduction in pain by 40 % or more and customer service questions . Conclusions : A reduction in perceived pain levels does directly relate to several indicators of customer service . Patients who experienced pain relief during their stay in the ED had significant increases in distress relief , rapport with their doctor , and intent to comply with given instructions OBJECTIVES The objectives of this study were : ( i ) to measure the analgesic efficacy and frequency of adverse events following autonomous nurse-initiated intravenous morphine in patients presenting with acute pain , awaiting medical assessment ; and ( ii ) to determine whether such a process would improve the time to analgesia . METHODS A prospect i ve convenience sample of patients presenting in acute pain received titrated intravenous morphine by experienced emergency nurses . Pain scores on a 10.0 cm visual analogue scale and predetermined adverse events defined by physiological parameters were measured at regular intervals over the following 60 min . Demographic , diagnostic and waiting time data were also recorded . RESULTS Three hundred and forty nine patients were enrolled over a 12-month period . The median initial pain score was 8.5 cm , with a reduction to 4.0 cm at 1 h. Respiratory rate , oxygen saturation , heart rate and blood pressure all showed small but statistically significant reductions over 60 min . There were 15 predefined adverse events , 10 episodes of hypotension and five episodes of oxygen desaturation . No intervention other than supplemental oxygen was required . There were no episodes of bradycardia , bradypnoea or reduced level of consciousness . The median time to narcotic was 18 min and the median time to be seen by a doctor was 52 min . CONCLUSION Experienced emergency nurses can initiate effective intravenous narcotic analgesia for patients in acute pain awaiting medical assessment , with minimal change in physiological parameters . This process can improve the time to analgesia for patients in acute pain INTRODUCTION Timely and appropriate pain management is an important quality indicator of ED performance . Emergency health care workers are well positioned to become active leaders and innovatively responsive in reducing human suffering . A pain management audit was conducted to determine Australia practice patterns . METHODS A 12-month retrospective descriptive cohort audit was undertaken . Through the r and omization process a medical record audit tool was completed for each record identified . Ethical approval for the study was obtained . RESULTS Seventy-four hospitals agreed to conduct the audit , 36 ( 48 % ) provided data . The total number of patient notes review ed was 2,066 . Ninety-five percent ( 1,966 ) of patients arrived by ambulance . Of the patients ( n=547 ; 56.4 % ) with a documented triage pain score the majority arrived in severe pain ( n=300 ; 41.3 % ) . Of the total number of patients ( 1,966 ) documented arriving in pain 1,473 ( 74.9 % ) received an analgesic . Six hundred and forty-four ( 32.7 % ) patients received an opioid . From time of emergency department arrival , the median time for analgesic administration was 70 minutes ( IQR 58 minutes to 92 minutes ) . Twenty-five emergency departments ( 69.4 % ) had pain management policies that enabled nurses to initiate a pharmacological analgesia without medical consultation . DISCUSSION The Australian pain management audit highlighted current practice s and potential areas for further research . While the audit demonstrated that nurse initiated pain management interventions promoted better analgesic response , greater consistency of triage pain assessment , code allocation , and documentation of pain scores may go some way to improving the timeliness of analgesia STUDY OBJECTIVE Emergency department ( ED ) crowding is a common and complicated problem challenging EDs worldwide . Nurse-initiated protocol s , diagnostics , or treatments implemented by nurses before patients are treated by a physician or nurse practitioner have been suggested as a potential strategy to improve patient flow . METHODS This is a computer-r and omized , pragmatic , controlled evaluation of  6 nurse-initiated protocol s in a busy , crowded , inner-city ED . The primary outcomes included time to diagnostic test , time to treatment , time to consultation , or ED length of stay . RESULTS Protocol s decreased the median time to acetaminophen for patients presenting with pain or fever by 186 minutes ( 95 % confidence interval [ CI ] 76 to 296 minutes ) and the median time to troponin for patients presenting with suspected ischemic chest pain by 79 minutes ( 95 % CI 21 to 179 minutes ) . Median ED length of stay was reduced by 224 minutes ( 95 % CI -19 to 467 minutes ) by implementing a suspected fractured hip protocol . A vaginal bleeding during pregnancy protocol reduced median ED length of stay by 232 minutes ( 95 % CI 26 to 438 minutes ) . CONCLUSION Targeting specific patient groups with carefully written protocol s can result in improved time to test or medication and , in some cases , reduce ED length of stay . A cooperative and collaborative interdisciplinary group is essential to success AIM The purpose of this prospect i ve observational study was to characterise patients occupying the ambulance bay and to determine the ensuing nursing workload . BACKGROUND The number of patients presenting to ED by ambulance is increasing . During periods of peak dem and and access block in the ED , patients with ongoing care needs , requiring continual assessment and symptom management by emergency nurses can remain in the ambulance bay for extended periods of time . The profile of these patients and on the related nursing workload is not well known . METHODS A prospect i ve observational study design based upon a convenience sample of patients was conducted over a r and omly selected four-week period .  Nursing workload  was assessing using the Jones Dependency Tool .  A modified Work Observation Method By Activity Timing technique was used to estimate direct nursing care time . RESULTS Of 4068 presentations to ED , 640 ( 16 % ) occupied the ambulance bay following triage , of which the majority ( n=408 ; 64 % ) had arrived by ambulance . Of those occupying the ambulance bay 205 ( 32 % ) were evaluated using the JDT . The majority of patients had potentially life-threatening symptoms ( ATS 3 , n=424 ; 66 % ) , were moderately dependent ( n=134 ; 65 % ) , and consumed approximately 152.1h of direct nursing care time . A large proportion of direct nursing care time was spent on patient re assessment ( 60.4h ) and pain management ( 29.6h ) . Patients occupying the ambulance bay had an average ED length of stay of 5.6h ( 4.6h ) , of which 1.8h ( SD 1.8h ) was spent delayed in the ambulance bay . CONCLUSION Early detailed assessment and symptom management of patients occupying the ambulance bay is extensively undertaken by emergency nurses . The frequency and number of patients off-loaded into non- clinical areas is not currently monitored or reported upon . This study has demonstrated that patients managed in the ambulance bay consume large amounts of nursing re sources , commonly require acute level care and hospital admission OBJECTIVES The aims of this study were to 1 ) estimate differences in pain management process and patient-reported outcomes , pre- and postimplementation of analgesic protocol s for adults with sickle cell disease ( SCD ) , and 2 ) examine the effects of site and visit frequency on changes in pain scores and time to analgesic . METHODS A multicenter , prospect i ve , longitudinal study enrolled patients from three academic medical centers between October 2007 and September 2009 . All ED patients 18 years or older with a chief complaint of a sickle cell pain episode were enrolled . Sites formed a SCD quality improvement ( QI ) team and implemented st and ard nurse-initiated emergency department ( ED ) analgesic protocol s ; outcomes were compared between study periods defined as pre- and postimplementation of protocol s. Medical record review was conducted to measure time to administration of initial analgesic , opioids used , route of opioid administration , the change in pain scores from arrival to discharge ( negative numbers reflect a decrease in pain scores ) , and the number of ED visits per individual patient during the study period at each site . On day 7 after the ED visit , a follow-up phone interview was conducted . Patients were queried about their ED pain management using a scale from 1 to 10 ( 1 = outst and ing , 10 = worst ) . Descriptive statistics are used to report the results . Ordinary least-squares regression models were constructed to measure the effect of time period , site , and number of visits per patient on change in pain score . RESULTS During the study period , 342 unique patients ( 57 % female , mean ± SD age = 32 ± 11 years ) were enrolled and had a total of 2,934 visits . There was no difference in time to administration of the initial analgesic between study periods . Overall , there was a significant decrease in pain scores from arrival to discharge between the pre- and postintervention study periods : the average difference in arrival to discharge pain scores ( cm ) was greater during the postimplementation period than during the preintervention period ( -4.1 vs. -3.6 , t = 2.6 , p < 0.01 ) . Site 1 had significant improvement between study periods ( mean difference = -0.87 , t = 2.63 , p < 0.01 ; F = 14.3 , p < 0.01 ) . Patients with few ED visits ( one to six annual visits , mean difference = -1.55 , t = 2.1 , p = 0.04 ) and those with frequent ED visits ( 7 to 19 annual visits , mean difference = -1.65 , t = 3.52 , p < 0.01 ) had a significant decrease in pain scores compared to patients with very frequent ED visits ( > 19 visits ) . There was an overall decrease in the use of morphine sulfate ( MS ) and increase in the use of hydromorphone  ( χ(2 ) = 105.67 , p < 0.001 ) between study periods and a significant increase in the use of oral ( PO ) and subcutaneous ( SC ) routes , with a corresponding decrease in the intravenous ( IV ) route ( χ(2 ) = 13.67 , p < 0.001 ) . There were no statistically significant differences in patient-reported satisfaction with the attempt to manage pain in the ED between study periods ( p = 0.54 ) . CONCLUSIONS While the use of a learning collaborative and implementation of nurse-initiated analgesic protocol s was not associated with improvement in time to administration of the initial analgesic , improvements in the decrease in the arrival to discharge pain score and increased use of hydromorphone and the SC route were noted in adults with SCD in the ED PURPOSE S This study was design ed to evaluate the ability of a triage pain protocol to improve frequency and time to delivery of analgesia for musculoskeletal injuries in the emergency department ( ED ) . BASIC PROCEDURES Frequency and time to analgesic administration were measured before and after use of a triage pain protocol . The protocol allowed analgesic medications to be given at the time of triage . MAIN FINDINGS Time to medication administration was 76 minutes ( 95 % confidence interval [ CI ] , 68 - 84 minutes ) before and 40 minutes ( 95 % CI , 32 - 47 minutes ) after the protocol . Five hundred fifty-nine ( 70 % ) of 800 patients  received analgesics  using the protocol compared with 212 of 471 ( 45 % ) patients prior . PRINCIPAL CONCLUSIONS Use of a triage pain protocol increased the number of patients with musculoskeletal injury who received pain medication in the ED . Use of the protocol also result ed in a decrease in the time to analgesic medication administration INTRODUCTION This study describes an innovative pain management strategy that aim ed to improve the efficiency and effectiveness of timely analgesia for those patients in moderate pain and who experienced significant delay prior to medical assessment . METHOD A 12-week prospect i ve exploratory study was conducted to evaluate the introduction of a triage nurse initiated schedule 4 drug . A panadeine forte policy was developed and a data tool formulated to evaluate the effectiveness and frequency of nurse initiated panadeine forte . RESULTS The average pre-pain score reported by patients was 68 mm and the median was 70 mm . The average post-pain score was 37 mm and the median was 35 mm . The average post-pain score reduced by 31 mm demonstrating a clinical ly significant change . A statistically significant ( Wilcoxon signed rank test < 0.001 ) reduction in post-pain scores was also identified . CONCLUSION We identified a statistically and clinical ly significant reduction in post-analgesic pain scores for patients . Improving pain management can have a positive impact on patients in moderate pain who experience extended waiting times prior 
    Output:
    
CONCLUSION Nurse-initiated analgesia was associated with safe , timely and effective pain relief