The implementation and usability of HIRAID, a structured approach to emergency nursing assessment

Curtis, Kate; Munroe, Belinda; Van, Connie; Elphick, Tiana-Lee

doi:10.1016/j.auec.2019.10.001

Cited by 21 publications

(42 citation statements)

References 24 publications

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“…Although all emergency nurses at the study sites were required to use HIRAID, they were also empowered with the capability, opportunity and motivation to do so. Most respondents in a multicentre survey believed their fundamental responsibility as an emergency nurse is to ensure patient safety and that HIRAID provided a mechanism to enable this (20).…”

Section: Discussionmentioning

confidence: 99%

“…HIRAID was introduced as a mandatory tool for all nurses working in all four emergency departments using a detailed implementation strategy reported elsewhere (20). The strategy was designed following a survey of the facilitators and barriers to implementation (21).…”

Section: The Intervention Implementationmentioning

confidence: 99%

“…Modes of delivery selected for the successful implementation of HIRAID included; a compulsory eLearning module; half day HIRAID workshop; integration of HIRAID into emergency department orientation; initial nursing documentation audits (10 per quarter); and mandatory use of a template for nursing documentation based on the HIRAID assessment framework (20). The uptake of HIRAID was successful.…”

Section: The Intervention Implementationmentioning

confidence: 99%

“…Most nurses in implementation evaluation believed HIRAID re ects their responsibilities as an emergency nurse and 96% indicated they were using HIRAID. Reasons cited most often were because it was a mandatory requirement, a useful assessment and documentation tool, was easy to use and provided clinical consistency (20). The modes of delivery for HIRAID implementation most useful were HIRAID documentation templates, formal workshop and bedside training.…”

Section: The Intervention Implementationmentioning

confidence: 99%

“…The use of HIRAID improved emergency nurse's detection of clinical indicators of urgency, prioritisation and initiation of treatment, and quality of clinical handover in a simulation study (19). Nursing and medical staff report HIRAID to be a useful tool to improve consistency of patient assessment, quality of documentation and clinical handover (20).…”

Section: Introductionmentioning

confidence: 99%

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Does the Implementation of an Emergency Nursing Framework (HIRAID) Reduce patient Deterioration? A Multi-Centre Quasi-Experimental Study

Curtis

Munroe

Fry

et al. 2020

Preprint

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Background: Recognition and response of deteriorating patients is fundamental to safe, high quality healthcare. Failure to recognise and respond to deteriorating patients is associated with serious adverse events, both during and after emergency department care. This study aims to determine if the implementation of HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment), an emergency nursing framework, improves patient safety.Methods: This quasi-experimental cohort study was conducted between November 2017 and February 2019 in two regional hospitals in [Anonymised], Australia. HIRAID was implemented using a multi-pronged behaviour change intervention. Data of 920 patients (374 pre-cohort and 546 post-cohort) who had an episode of deterioration within 72 hours of emergency department departure were collected. Statistical tests were conducted as two-sided, with a 95% confidence interval to determine pre/post cohort association. The StaRI checklist was used in reporting this study.Results: Patients in the post group were older with more comorbidities, but experienced fewer episodes of clinical deterioration associated with care delivered in the emergency department (27% to 13%). There was a reduction in treatment delays [pre n=28 (28.3%) versus post n=11 (15.1%), p=0.041, 95% CI (1.1%–25.3%)], and delay or failure to escalate care when abnormal vital signs were identified [pre n=20 (20.2%) versus post n=5 (6.9%), p=0.014, 95% CI (3.5%–23.1%)]. The proportion of isolated nursing-related causal factors decreased from 20 (21%) to 6 (8%). Conclusions: HIRAID is a standardised emergency nursing framework which provides a structured, evidence-based approach to emergency nursing assessment that could be adapted for a variety of clinical settings. Implementing HIRAID using the principles of behavior change is associated with a reduction in clinical deterioration related to emergency care.

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Section: Discussionmentioning

confidence: 99%

Section: The Intervention Implementationmentioning

confidence: 99%

Section: The Intervention Implementationmentioning

confidence: 99%

Section: The Intervention Implementationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Does the Implementation of an Emergency Nursing Framework (HIRAID) Reduce patient Deterioration? A Multi-Centre Quasi-Experimental Study

Curtis

Munroe

Fry

et al. 2020

Preprint

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Implementation evaluation of pre-hospital blood collection in regional Australia: a mixed methods study

Curtis

Ellwood

Walker

et al. 2021

Australasian Emergency Care

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Rapid development and implementation of a behaviour change strategy to improve COVID-19 personal protective equipment use in a regional Australian emergency department

Curtis¹,

Jansen²,

Mains³

et al. 2022

Australasian Emergency Care

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Objective To identify barriers to, describe the development of and evaluate the implementation of a behavioural theory informed strategy to improve staff personal protective equipment (PPE) compliance during COVID-19 in a regional Australian Emergency Department. Methods Barriers to PPE use were identified through staff consultation then categorised using the Theoretical Domains Framework. The Behaviour Change Wheel was used to develop a strategy to address the barriers to PPE compliance. The strategy was refined and endorsed by the site COVID taskforce. Data were collected through direct observation. Descriptive statistics were used to summarise PPE compliance and inductive content analysis for free text data of staff behaviours. Results 73 barriers were identified, mapped to 9 intervention functions and 42 behaviour change techniques. The predominant mechanisms were: 1) Executive communication reinforcing policy and consequences; 2) implementation of a PPE Marshal; 3) face to face reinforcement / modelling; 4) environmental restructuring including electronic medical record modifications. The PPE Marshal observed 281 PPE activities. PPE compliance varied between 47.9% (Buddy check) and 91.8% (Bare below elbow). The PPE Marshal intervened on 121 occasions, predominantly through buddying, explaining and demonstrating correct PPE use, most frequently with medical staff (72%). Conclusion We describe an evidence-based process to overcome barriers to PPE compliance that maximise safe work practice in a time critical situation. Staff require enabling, access to equipment and reinforcement to use PPE correctly.

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The implementation and usability of HIRAID, a structured approach to emergency nursing assessment

Cited by 21 publications

References 24 publications

Does the Implementation of an Emergency Nursing Framework (HIRAID) Reduce patient Deterioration? A Multi-Centre Quasi-Experimental Study

Does the Implementation of an Emergency Nursing Framework (HIRAID) Reduce patient Deterioration? A Multi-Centre Quasi-Experimental Study

Implementation evaluation of pre-hospital blood collection in regional Australia: a mixed methods study

Rapid development and implementation of a behaviour change strategy to improve COVID-19 personal protective equipment use in a regional Australian emergency department

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