Successful and sustained implementation of a behaviour-change informed strategy for emergency nurses: a multicentre...

Area of Science:

• Nursing Practice
• Healthcare Implementation Science
• Quality Improvement

Background:

• Implementing evidence-based practice in emergency departments (EDs) faces significant barriers like uncertainty, resource shortages, and high staff turnover.
• A behavior-change informed strategy was developed to overcome these challenges for implementing the HIRAID® (History, Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, reassessment) nursing framework.

Purpose of the Study:

• To evaluate the effectiveness of a behavior-change strategy in implementing the HIRAID® framework.
• Assess the strategy's impact on reach, effectiveness, adoption, quality (dose, fidelity), and maintenance (sustainability) in Australian EDs.

Main Methods:

• An effectiveness-implementation hybrid design utilizing a step-wedge cluster randomized control trial (SW-cRCT).
• Implementation involved over 1300 emergency nurses across 29 Australian EDs.
• Evaluation used the RE-AIM framework, incorporating surveys, audits, and qualitative analysis.

Main Results:

• HIRAID® was implemented in all 29 EDs, with 1123 nurses (82%) completing training.
• The strategy showed high fidelity (100% dose, very high fidelity) and minimal modifications.
• Sustainment was high, with 95% individual and 100% setting sustainability at 6 months and 3 years, respectively.

Conclusions:

• The behavior-change informed strategy for HIRAID® implementation was highly successful across diverse Australian ED settings.
• Achieved excellent reach, adoption, quality, and sustainability, demonstrating its effectiveness in reducing clinical variation and enhancing nursing care.