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Implementing an emergency nursing framework improves the quality of clinical handover: A stepped-wedge cluster
Kate Curtis1, Julie Considine2, Belinda Kennedy3
1Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia.
Aim:
To examine the effect of the HIRAID® emergency nursing framework on clinical handover.
Background:
Clinical handover is very frequent in emergency departments and critical for patient safety. Inadequate handovers are associated with up to 80 % of adverse events.
Methods:
This modified stepped-wedge cluster randomised control trial was conducted across 29 Australian rural, regional and metropolitan emergency departments between 2020 and 2024. HIRAID® was implemented using a behaviour change theory-informed strategy. Surveys were distributed to eligible staff. Quantitative data were analysed using a multiple regression approach; qualitative data using inductive content analysis.
Results:
Surveys were completed by 1205 nurses (671 control, 534 intervention) and 328 medical staff (176 control, 152 intervention). Significant improvements were observed in satisfaction with nurse-to-nurse communication of patient history (t = 5.57, p < 0.001, 95 % C.I. = 0.33-0.69), physical assessment (t = 4.72, p < 0.001, 95 % C.I. = 0.28-0.68), recognition of clinical deterioration (t = 2.58, p = 0.01, 95 % C.I. = 0.06-0.43), information relevance (t = 3.29, p = 0.001, 95 % C.I. = 0.13-0.51) and completeness (t = 3.60, p < 0.001, 95 % C.I. = 0.17-0.56). Qualitative findings supported these results.
Conclusions:
Implementing a structured emergency nursing framework improved nurse-to-nurse clinical handover, supporting safer patient care.
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