Reducing inpatient deterioration and improving patient safety in emergency departments with a standardised nursing framework: A stepped-wedge cluster randomised controlled trial
Abstract
BACKGROUND: Patients admitted via Emergency Departments (EDs) sustain twice as many in-hospital adverse events than non-emergency admissions. Unwarranted variation in care, that is, differences not explained by patient illness, care needs, or patient preferences, contributes to adverse patient outcomes. The HIRAID® framework [History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, reassessment, and communication], standardises nursing assessment and management of patients in the ED. The aim of this study was to test the effect of HIRAID® on the quality and safety of emergency care.
METHODS: A modified (staircase) stepped-wedge, cluster randomised controlled trial was conducted in 29 Australian metropolitan, regional, rural Emergency Departments involving 1377 nurses from June 2020 to February 2024. The 29 Emergency Departments were allocated to four clusters and randomised to one of four sequences, with three-six month intervention periods. HIRAID® was implemented with a multifaceted strategy comprising 21 behaviour change techniques including an education program, and modifications to nursing documentation. The primary outcome was inpatient deterioration as evidenced by a rapid response team call within 72 h of admission via ED. Secondary outcomes were the proportion of rapid response team calls where emergency nursing care was a contributor; time to first dose analgesia; patient/carer experience with emergency nursing care; and staff…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 106,047 participants or records.
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