Implementation evaluation of an evidence-based emergency nursing framework (HIRAID): study protocol for a step-wedge...

Area of Science:

• Emergency Nursing
• Clinical Assessment Frameworks
• Patient Safety

Background:

• Poor patient assessment in emergency departments (EDs) can lead to undetected clinical deterioration.
• A lack of standardized assessment frameworks for Australian emergency nurses contributes to clinical variation.
• The HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) framework was developed to address these issues.

Purpose of the Study:

• To present the rationale and protocol for a multicentre clinical trial of the HIRAID framework.
• To evaluate the effectiveness of HIRAID in improving emergency nursing care.
• To assess implementation strategies for optimizing HIRAID uptake and fidelity.

Main Methods:

• A stepped-wedge cluster randomised controlled trial design will be used across 31 EDs in NSW, Victoria, and Queensland.
• The study employs an effectiveness-implementation hybrid design.
• Primary outcomes include inpatient deterioration incidence, time to analgesia, patient satisfaction, and medical satisfaction with nursing handover.

Main Results:

• The study is designed to determine the effectiveness of HIRAID in reducing clinical variation and improving patient safety.
• Implementation strategies for optimizing HIRAID uptake and fidelity will be identified.
• Data on primary outcomes will be collected to assess the framework's impact on care quality.

Conclusions:

• The findings will inform the national rollout of the HIRAID framework.
• A toolkit will be developed to integrate HIRAID into nursing education and practice.
• The study aims to enhance the safety and quality of initial emergency nursing care across Australia.