The implementation of an emergency nursing framework (HIRAID) reduces patient deterioration: A multi-centre quasi-experimental study

Group, HIRAIDR; Curtis, K; Munroe, B; Fry, M; Considine, J; Tuala, E; Watts, M; Alkhouri, H; Elphick, T; Ruperto, K; Barrass, J; Balzer, S; Chisholm, B; Van, C; Shaban, RZ

The implementation of an emergency nursing framework (HIRAID) reduces patient deterioration: A multi-centre quasi-experimental study

Group, HIRAIDR Curtis, K Munroe, B Fry, M

Considine, J Tuala, E Watts, M Alkhouri, H Elphick, T Ruperto, K Barrass, J Balzer, S Chisholm, B Van, C Shaban, RZ

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: International Emergency Nursing, 2021, 56
Issue Date:: 2021-04-18

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Field	Value	Language
dc.contributor.author	Group, HIRAIDR
dc.contributor.author	Curtis, K
dc.contributor.author	Munroe, B
dc.contributor.author	Fry, M https://orcid.org/0000-0003-1265-7096
dc.contributor.author	Considine, J
dc.contributor.author	Tuala, E
dc.contributor.author	Watts, M
dc.contributor.author	Alkhouri, H
dc.contributor.author	Elphick, T
dc.contributor.author	Ruperto, K
dc.contributor.author	Barrass, J
dc.contributor.author	Balzer, S
dc.contributor.author	Chisholm, B
dc.contributor.author	Van, C
dc.contributor.author	Shaban, RZ
dc.date.accessioned	2021-11-18T04:55:39Z
dc.date.available	2021-02-02
dc.date.available	2021-11-18T04:55:39Z
dc.date.issued	2021-04-18
dc.identifier.citation	International Emergency Nursing, 2021, 56
dc.identifier.issn	0965-2302
dc.identifier.issn	1532-9267
dc.identifier.uri	http://hdl.handle.net/10453/151707
dc.description.abstract	Introduction Timely recognition and treatment of acutely ill patients at appropriate levels of the health system are fundamental to the quality and safety of healthcare. This study determines if the implementation of an emergency nursing framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) improves patient safety. Methods A quasi-experimental cohort study was conducted in two emergency departments in [Anonymised], Australia. HIRAID was implemented using a multi-pronged behaviour change intervention. Data of 920 patients (374 pre and 546 post) who deteriorated within 72-hours of ED departure were collected. Statistical tests were conducted as two-sided, with a 95% confidence interval to determine pre/post cohort association. Results Patients in the post group had more comorbidities, but experienced less deterioration associated with care delivered in the ED (27% to 13%). There was a reduction in treatment delays [ 28.3% to 15.1%, p = 0.041, 95% CI (1.1%–25.3%)], and delay or failure to escalate care when abnormal vital signs were identified [20.2% to6.9%, p = 0.014, 95% CI (3.5%–23.1%)]. Isolated nursing-related causal factors decreased from 20 (21%) to 6 (8%). Conclusions Implementing a standardised emergency nursing framework is associated with a reduction in clinical deterioration related to emergency care.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation.ispartof	International Emergency Nursing
dc.relation.isbasedon	10.1016/j.ienj.2021.100976
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1110 Nursing
dc.subject.classification	Nursing
dc.subject.mesh	Clinical Deterioration
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Emergency Nursing
dc.subject.mesh	Emergency Service, Hospital
dc.subject.mesh	Humans
dc.subject.mesh	Vital Signs
dc.title	The implementation of an emergency nursing framework (HIRAID) reduces patient deterioration: A multi-centre quasi-experimental study
dc.type	Journal Article
utslib.citation.volume	56
utslib.location.activity	England
utslib.for	1110 Nursing
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
dc.date.updated	2021-11-18T04:55:37Z
pubs.publication-status	Published
pubs.volume	56

Abstract:

Introduction Timely recognition and treatment of acutely ill patients at appropriate levels of the health system are fundamental to the quality and safety of healthcare. This study determines if the implementation of an emergency nursing framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) improves patient safety. Methods A quasi-experimental cohort study was conducted in two emergency departments in [Anonymised], Australia. HIRAID was implemented using a multi-pronged behaviour change intervention. Data of 920 patients (374 pre and 546 post) who deteriorated within 72-hours of ED departure were collected. Statistical tests were conducted as two-sided, with a 95% confidence interval to determine pre/post cohort association. Results Patients in the post group had more comorbidities, but experienced less deterioration associated with care delivered in the ED (27% to 13%). There was a reduction in treatment delays [ 28.3% to 15.1%, p = 0.041, 95% CI (1.1%–25.3%)], and delay or failure to escalate care when abnormal vital signs were identified [20.2% to6.9%, p = 0.014, 95% CI (3.5%–23.1%)]. Isolated nursing-related causal factors decreased from 20 (21%) to 6 (8%). Conclusions Implementing a standardised emergency nursing framework is associated with a reduction in clinical deterioration related to emergency care.

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http://hdl.handle.net/10453/151707