Data-Driven Implementation Strategy to Optimise Clinician Behaviour Change at Scale in Complex Clinical Environments:...

Area of Science:

• Emergency Medicine
• Nursing Practice
• Health Services Research

Background:

• The HIRAID (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) framework has shown promise in pilot studies for improving emergency care outcomes.
• Implementing new interventions in busy emergency departments is challenging due to unpredictable workloads, patient complexity, and high staff turnover.

Purpose of the Study:

• To develop an evidence-driven, behavior change-focused strategy to maximize the implementation and uptake of HIRAID.
• To address barriers and enablers for HIRAID implementation across 30 diverse Australian emergency departments.

Main Methods:

• A mixed-methods study, forming the first phase of a cluster randomized control trial involving over 1300 emergency nurses.
• Quantitative and qualitative data were collected via electronic surveys informed by the Theoretical Domains Framework.
• Data analysis integrated descriptive statistics, inductive content analysis, and stakeholder consultation using APEASE criteria.

Main Results:

• Six key barriers to HIRAID implementation were identified, including lack of knowledge, high workload, and insufficient support for education.
• Three enablers were noted: willingness to learn, recognition of need, and commitment to patient care.
• The developed strategy incorporated a scaffolded education program, clinical support, and environmental modifications.

Conclusions:

• A systematic, behavior change-focused process generated a multifaceted strategy for HIRAID implementation in emergency departments.
• Further evaluation is required to assess the implementation fidelity, reach, and impact of the strategy.