Accident and emergency departments must pay more attention to variations in the quality of care after reducing waiting times, the NHS watchdog says.
Some 98% of A&E patients are seen within four hours
The Healthcare Commission, in a study of data from 170 A&E units in England, found many hospitals were not administering pain relief quick enough.
It found only 53% were giving relief within an hour to children who were in moderate or severe pain.
The government said it was looking to start to measure the quality of care.
The study of data from 170 of the country's 202 A&E units found 42% of patients with hip fractures were given pain relief within 60 minutes of arrival.
A&E consultants recommend pain relief is given within 20 minutes for those in severe pain, but hardly any units managed this target.
But the watchdog found hospitals were doing much better at treating people who had taken overdoses of paracetamol, with just seven hospitals struggling to meet guidelines.
And it said 71% of patients were rating their A&E services as good or excellent.
Hospitals have spent the last few years ensuring most patients wait no longer than four hours for treatment.
Healthcare Commission chief executive Anna Walker said A&E had made great strides at reducing waiting times - 98% of patients are seen within four hours - but it was time to address variations in the quality of care.
"A&E departments now have to go the extra mile if they are to deliver the care that patients need and that means focussing on quality as well as waiting."
Martin Shalley, president of the British Association for Emergency Medicine, which represents A&E consultants, said: "We have concentrated on waiting times, but I think it is right now we turn our attention to variations.
"As we can see, there are issues with pain relief. An organisation the size of the NHS is bound to have variations, but we must do more to deal with them."
And Nigel Edwards, director of policy at the NHS Confederation, which represents health service managers, said regular monitoring of the quality of care was needed.
Lord Warner said the government was looking to turn its attention to quality of care by developing new measures to assess performance.
But he said the NHS was "working hard to deliver consistently high standards of clinical care in A&E".
The quality of care delivered in A&E should not be judged just by how quickly analgesia is offered to the patients. An A&E department will also see the 'sickest' of patients, trauma and medical. They should be judged by how accurately these patients are being assessed and how promptly resuscitation and treatment is initiated. A&E departments can deliver high quality care only if they have experienced clinicians on the floor 24/7. This does not happen in most departments. The Healthcare Commission should concentrate on the real issues of quality emergency care and not just giving patients pain relief.
A Bhattacharyya, Bognor Regis, UK
I am a doctor who has worked in A&E for many years. Make no mistake it is good that people are seen quicker but there is definitely at times poorer care in order for this to happen. Doctors and nurses work extremely hard. Patients don't always appreciate this. Thank God I am leaving the NHS very soon. I am 36 years old.
Leadership and management in Emergency departments are better than in almost any other field in medicine currently. And the evidence for this is in the meeting of targets, albeit artificial ones. The emphasis on this has led to eyes being taken off the ball elsewhere and this is a direct result of the government's current agenda.
(A&E Dr) Chris FitzSimmons, Sheffield, UK
The government has continued to focus all attention on 'targets' rather than ensuring that all accident and emergency departments are properly staffed to give the level of care patients need in the first few hours after arrival in hospital which is what the priority ought to be.
Cllr Geoffrey Heathcock, Cambridge
I agree. The waiting times are mad. I was in there one time with my fiancée. We were waiting about an hour and a woman came in with bad eyes, she had had an accident at work and had cleaning fluid in them. She was told to wait. We waited another hour and then we were seen to. She was seen at the same time as us. She never received any pain relief while waiting though and she was in agony.
Steven, Hartlepool, England
The state of the patients should be the first thing on the minds of the emergency staff so it is important that the NHS should make it necessary for pain relief to be available for patients minutes after being admitted into the A&E room.
Chike, Anambra State, Nigeria
The main problem as I see it is that leadership and adequate management is lacking in A&E departments where pain relief is delayed and patients are kept waiting. The flexibility needs to exercised rather than ticking the boxes.
Mahendra Kothari, Leyland, Preston, Lancashire