Concurrent Session 1C
Tracks
Meeting Room 3
| Wednesday, October 4, 2023 |
| 3:30 PM - 4:30 PM |
| Meeting Room 3 |
Details
Session chair: Belinda Munroe
Speaker
Professor Kate Curtis
Director Research - Emergency
University of Sydney
Impact of a standardised emergency nursing framework (HIRAID™) on perceived quality of nursing clinical practice, handover and patient experience in rural Australia
3:30 PM - 3:50 PMAbstract
Background
The quality of emergency nursing assessment is crucial, particularly with current extended wait times for medical review. HIRAID™ is a clinical safety system for emergency nurse use with any patient presentation and known to reduce adverse patient events1. The impact of HIRAID™ on clinical practice, handover and patient experience is unknown.
Aim
To determine the impact of HIRAID™ on perceived quality of nursing practice, handover and patient experience.
Methods
In 2021/2 HIRAID™ was implemented in 23 Emergency Departments with 550+ nursing staff in rural Australia using a multimodal, behaviour change informed implementation strategy that included eMR modification, scaffolded training including face to face, executive sponsorship, audit and feedback. Permanently employed nursing staff participated in a pre-post survey assessing clinical practice. Patient experience was captured via telephone interview using Australian Hospital Patient Experience Question Set and Schmidt's Perceptions of Nursing Care Survey. Appropriate tests were conducted to determine any changes before and after HIRAID™ implementation using SPSS v26.0.
Results
There were 519 (300 pre, 219 post) nurse and 1283 (626 pre 657 post) patient responses. Nurses reported significant overall improvement in quality of nursing assessment (p=0.004), handover (p=0.002), recognition (p=0.023) and escalation (p=0.007) of patient deterioration. Overall reported patient experience significantly improved, particularly in pain management (p<0.0001) and communication (p<0.0001).
Conclusion
HIRAID™ resulted in improved clinical handover and patient experience. A larger study is underway to evaluate medical staff perceptions, sustainability, and health service outcomes.
The quality of emergency nursing assessment is crucial, particularly with current extended wait times for medical review. HIRAID™ is a clinical safety system for emergency nurse use with any patient presentation and known to reduce adverse patient events1. The impact of HIRAID™ on clinical practice, handover and patient experience is unknown.
Aim
To determine the impact of HIRAID™ on perceived quality of nursing practice, handover and patient experience.
Methods
In 2021/2 HIRAID™ was implemented in 23 Emergency Departments with 550+ nursing staff in rural Australia using a multimodal, behaviour change informed implementation strategy that included eMR modification, scaffolded training including face to face, executive sponsorship, audit and feedback. Permanently employed nursing staff participated in a pre-post survey assessing clinical practice. Patient experience was captured via telephone interview using Australian Hospital Patient Experience Question Set and Schmidt's Perceptions of Nursing Care Survey. Appropriate tests were conducted to determine any changes before and after HIRAID™ implementation using SPSS v26.0.
Results
There were 519 (300 pre, 219 post) nurse and 1283 (626 pre 657 post) patient responses. Nurses reported significant overall improvement in quality of nursing assessment (p=0.004), handover (p=0.002), recognition (p=0.023) and escalation (p=0.007) of patient deterioration. Overall reported patient experience significantly improved, particularly in pain management (p<0.0001) and communication (p<0.0001).
Conclusion
HIRAID™ resulted in improved clinical handover and patient experience. A larger study is underway to evaluate medical staff perceptions, sustainability, and health service outcomes.
Biography
Professor Kate Curtis has been an Emergency Nurse since 1994, is Director of Critical Care Research Illawarra Shoalhaven LHD, an RN at Wollongong ED, Professor of Emergency and Trauma Nursing at the University of Sydney and an honorary Professorial fellow at the George Institute for Global Health. Kate’s translational research program focuses on improving the way we deliver care to patients and their families and has attracted more than $18 million funding. Kate is the world’s most published author in the field of Trauma and Emergency nursing, has mentored more than 50 clinicians in research projects and was the 2019 Australian nurse of the year.
Ms Belinda Kennedy
Phd Candidate
The University of Sydney
Development of an evidence-based implementation plan for HIRAID™ Emergency Nursing Framework in rural emergency departments
3:50 PM - 4:10 PMAbstract
Background
Implementation science application enables identification of the organisational and individual changes required for effective, sustained practice change. This presentation describes the development of an implementation strategy for HIRAID™ (HIstory Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) - an emergency nursing framework known to improve patient and health service outcomes.
Methods
This mixed methods study was conducted in 11 rural regional EDs in Southern New South Wales in November 2020. An electronic survey was distributed to collect the Practice Environment Scale of Nursing Work Index and behavioural diagnostics. Potential barriers to implementation of HIRAID™ were mapped to the Theoretical Domains Framework (TDF) intervention functions. Intervention techniques were selected from the Behaviour Change Taxonomy and assessed for Acceptability, Practicability, Effectiveness/ cost-effectiveness, Affordability, Side-effects/safety and Equity.
Results
The survey was completed by 102 (55%, 11 sites) nurses. Barriers identified were mapped to 12/14 TDF domains. The largest barriers related to the environmental context / resources and knowledge domains. Key intervention functions included education, training, enablement and environmental restructure. These were operationalised through a tailored education package including instructor training, standardised documentation templates, video promotion, context specific resources such as posters, clinical champions, incentives and feedback.
Conclusion
Emergency nurses were integral to informing a strategy to implement HIRAID™ relevant to local context and individuals. This is crucial in the complex, fast paced ED environment. Measurement of the uptake and impact of the practice change is the next step to evaluating the effectiveness of the implementation design process.
Implementation science application enables identification of the organisational and individual changes required for effective, sustained practice change. This presentation describes the development of an implementation strategy for HIRAID™ (HIstory Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) - an emergency nursing framework known to improve patient and health service outcomes.
Methods
This mixed methods study was conducted in 11 rural regional EDs in Southern New South Wales in November 2020. An electronic survey was distributed to collect the Practice Environment Scale of Nursing Work Index and behavioural diagnostics. Potential barriers to implementation of HIRAID™ were mapped to the Theoretical Domains Framework (TDF) intervention functions. Intervention techniques were selected from the Behaviour Change Taxonomy and assessed for Acceptability, Practicability, Effectiveness/ cost-effectiveness, Affordability, Side-effects/safety and Equity.
Results
The survey was completed by 102 (55%, 11 sites) nurses. Barriers identified were mapped to 12/14 TDF domains. The largest barriers related to the environmental context / resources and knowledge domains. Key intervention functions included education, training, enablement and environmental restructure. These were operationalised through a tailored education package including instructor training, standardised documentation templates, video promotion, context specific resources such as posters, clinical champions, incentives and feedback.
Conclusion
Emergency nurses were integral to informing a strategy to implement HIRAID™ relevant to local context and individuals. This is crucial in the complex, fast paced ED environment. Measurement of the uptake and impact of the practice change is the next step to evaluating the effectiveness of the implementation design process.
Biography
Belinda is a registered nurse with over 25 years’ experience working in critical care areas, in both Australia and the United Kingdom. Currently working in research at The University of Sydney and completing a PhD, she has previously worked in emergency and trauma in Sydney in both clinical and education roles.
Dr Abdi Osman
Senior Lecturer & Researcher
Austin Health & Victoria University
Emergency Department routine blood test performance on stable adult patients. A retrospective study
4:10 PM - 4:30 PMAbstract
Background/Introduction:
Emergency Departments frequently perform routine blood tests on non-time critical patients as defined by allocated triage category. The utility of routine blood testing in acute healthcare settings has been questioned. This study aims to evaluate the bleeding habits in our department for patients allocated triage categories 3, 4 and 5.
Aim/Purpose:
The study’s primary aim was to assess whether an association existed between blood test results and patient diagnosis or treatment. The secondary aim was assessing whether there was a link between blood testing and how busy the ED was using the National Emergency Department Overcrowding Scale (NEDOCS) and relation with ED length of stay (EDLOS).
Methods/Intervention/Activity:
Quantitative method and retrospective design were used to review electronic medical records on data collected at a major metropolitan teaching hospital of 670 beds with annual ED census of around 90,000 patients situated in Metropolitan Melbourne, Australia.
Results/Outcome:
Of the 383 patients included, 51% were female, age ranges were 18-99 years (mean 51.6). Majority were triage category 3 (55%) and 62% had blood tests performed. Blood test performance was found to be associated with advancing age (p<0.001) but not with how busy the department was as determined by the National Emergency Department Overcrowding Scale (p=0.230).
Conclusion/Recommendations:
Blood test performance in the Emergency Department on non-time critical patients was found to be frequent and elderly patients were found to be more likely to have a blood test. There is a positive correlation between blood test performance and length of stay in the department.
Emergency Departments frequently perform routine blood tests on non-time critical patients as defined by allocated triage category. The utility of routine blood testing in acute healthcare settings has been questioned. This study aims to evaluate the bleeding habits in our department for patients allocated triage categories 3, 4 and 5.
Aim/Purpose:
The study’s primary aim was to assess whether an association existed between blood test results and patient diagnosis or treatment. The secondary aim was assessing whether there was a link between blood testing and how busy the ED was using the National Emergency Department Overcrowding Scale (NEDOCS) and relation with ED length of stay (EDLOS).
Methods/Intervention/Activity:
Quantitative method and retrospective design were used to review electronic medical records on data collected at a major metropolitan teaching hospital of 670 beds with annual ED census of around 90,000 patients situated in Metropolitan Melbourne, Australia.
Results/Outcome:
Of the 383 patients included, 51% were female, age ranges were 18-99 years (mean 51.6). Majority were triage category 3 (55%) and 62% had blood tests performed. Blood test performance was found to be associated with advancing age (p<0.001) but not with how busy the department was as determined by the National Emergency Department Overcrowding Scale (p=0.230).
Conclusion/Recommendations:
Blood test performance in the Emergency Department on non-time critical patients was found to be frequent and elderly patients were found to be more likely to have a blood test. There is a positive correlation between blood test performance and length of stay in the department.
Biography
Senior lecturer with over 5 years’ experience in higher education and research. Abdi also has more than 20 years’ experience in clinical settings mainly, Emergency Department. He currently has a dual appointment as a senior lecturer at Victoria University and a researcher at Austin Health Emergency Department. Abdi also has an honorary senior fellowship appointment with the Department of Critical Care, University of Melbourne.
