Standardising Initial Emergency Nursing Care: A Multicentre Implementation Evaluation

Abstract

Background

Emergency nurses are crucial for safe, high-quality care and are the first clinicians to assess and treat patients who present to the emergency department (ED), especially in rural settings. The HIRAID emergency nursing framework provides a standardised approach to post-triage patient assessment and management.

Methods

A multimethod implementation study evaluated HIRAID in 11 rural Australian EDs. A mixed-methods survey of emergency nurses identified enablers and barriers to implementation, using the Theoretical Domains Framework (TDF). Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Results were integrated and mapped to Behaviour Change Techniques (BCTs).

HIRAID implementation was evaluated through a multimethod approach using the RE-AIM (reach, effectiveness, adoption, implementation quality, maintenance) framework. Evaluation included nurse surveys and interviews, audits of site implementation records, and medical records. Quantitative data were analysed with descriptive and inferential statistics, while inductive content analysis was used to analyse qualitative interview data.

Results

Enablers and barriers mapped to 10 TDF domains, and 20 BCTs, operationalised through 12 delivery modes, such clinical champions, and medical record modifications. HIRAID was implemented in 11 EDs, achieving high reach. Over 90% of nurses engaged in HIRAID education. Nurses (83%) reported using HIRAID documentation templates. Fidelity to strategies was low to moderate, but use was sustained at over 6 months. Improved accuracy of nursing documentation was demonstrated through medical record review (n=222), with audit scores increasing significantly across all areas of nursing documentation audited.

Conclusion

An evidence-based implementation strategy was effective for the sustained uptake of HIRAID in rural EDs. The intervention supported nursing practice and demonstrated clinical effectiveness.