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HiRAID: Evaluation of an emergency nursing assessment framework

Sydney Nursing School, University of Sydney
Project Added:
30 October 2014
Last updated:
30 October 2014

Summary

The objective of the study was to evaluate HiRAID: an innovated evidence-based assessment framework designed to structure the initial patient assessment of patients presenting to the Emergency Department (ED) once triaged.

The HiRAID components are:

  • collecting a patient History
  • identifying Red flags
  • performing a physical Assessment
  • Interventions
  • Diagnostics
  • reassessment and communication. 

The study employs a pre-test and post-test design, using immersive simulated scenarios, questionnaires and focus groups to evaluate participants’ satisfaction and self-efficiency levels, documentation and assessment performance before and after undertaking training in how to apply the HiRAID assessment framework. Follow-up surveys 4-6 months after the initial HiRAID training plan to evaluate knowledge retention and uptake of the HiRAID framework in the clinical setting.

HiRAID assessment framework

HiRAID assessment framework diagram has an "patient presents" arrow at the bottom pointing to five concentric circles labelled:  history, red flags, assessment, interventions, diganostics. An arrow at the top labelled "despatch from ED". An arrow on each side from the top to the bottom labelled "Reassess Communicate".

Aim

This study aims to determine: the feasibility and effectiveness of a novel emergency nursing assessment framework on: 

  • the completeness, structure and time taken to complete the seven components of nursing assessment
  • the detection of clinical indicators of urgency
  • escalation and communication of indicators or urgency 
  • content and quality of clinical assessment and documentation
  • nurse satisfaction on the application of the assessment framework being tested
  • anxiety, perceptions of control and self-efficacy levels related to assessment performance.

Expected outcome benefits

  • Improved service delivery  with validation of an innovative, evidence based model of care
  • Increased efficiency with early initiation of appropriate investigations and decreased length of stay in the Emergency Department (ED)
  • Improved patient safety through the early detection of clinical indicators of urgency “red flags”
  • Improved communication using structured approach.

Project status

Status: Pre-Implementation.

Key dates 

Project started:  February 2013.

December 2013-June 2014 – Data collection completed.

July 2014 - Data analysis is underway. Results will be used to develop the implementation strategy in conjunction with the NSW Emergency Care Institute

Background

When reviewing the curriculum of an emergency nursing post graduate course a team of academics at Sydney Nursing School, University of Sydney were unable to locate an evidenced based systematic approach to emergency nursing assessment1. A theoretical model was considered necessary to guide nursing patient assessment in the ED, based on existing knowledge surrounding emergency nursing practice and the demands of the clinical environment. An integrative review of the literature confirmed the paucity of evidence surrounding the emergency nursing assessment process and the benefits of a structured approach to patient assessment on clinical performance and care delivery2. HiRAID assessment framework and education workshop was subsequently devised founded on current evidence relating to emergency nursing practice. It is anticipated that training in the application of the HiRAID assessment framework will assist emergency nurses to perform systematic patient assessments of patients presenting to the ED (post triage) and improve emergency care delivery.

Partnerships 

  • NSW Emergency Care Institute, Agency for Clinical Innovation
  • The Emergency Departments of: 
    • Wollongong Hospital
    • Westmead Hospital
    • Blacktown Hospital
    • Shoalhaven Hospital
    • Shellharbour Hospitals
    • Sydney Nursing School, University of Sydney.

Implementation sites

Data collection was undertaken at Westmead Hospital Simulation Laboratory and the Illawarra Shoalhaven Health Education Centre. 

Nursing participants were recruited for the study from Emergency Departments across the Western Sydney and Illawarra Shoalhaven Local Health Districts.

Results

Preliminary findings demonstrate that training in the HiRAID assessment framework reduced nurse’s anxiety and increased their confidence when performing an initial patient assessment. The majority of nurses who participated in the study reported that the HIRAID assessment framework helped their understanding of the initial patient assessment process in the ED and suggested it be implemented within three months of commencing work in the ED.

Lessons learnt 

Key lessons learnt to date:

  • Prior to HiRAID there was no systematic evidence-based approach to teaching emergency nurses how to perform a structured patient assessment of patients presenting to the ED after triage
  • HiRAID offers an evidence-based framework to structure the initial assessment of patients presenting to the ED 
  • HiRAID decreases anxiety and increases confidence in nurses when performing an initial patient assessment
  • Nurses new to the ED should participate in HiRAID training prior to or within three months of commencing work in the ED.

References

  1. Curtis K, Murphy M, Hoy S, Lewis MJ. The emergency nursing assessment process-A structured framework for a systematic approach. Australasian Emergency Nursing Journal. 2009;12(4):130-136.
  2. Munroe B, Curtis K, Considine J, Buckley T. The impact structured patient assessment frameworks have on patient care: An integrative review. J Clin Nurs. 2013;22(21-22):2991-3005.

Contacts

Kate Curtis
Associate Professor / Research Supervisor
Sydney Nursing School, University of Sydney
Phone: 02 9351 0604
kate.curtis@sydney.edu.au

Belinda Munroe
PhD Candidate / Project lead
Sydney Nursing School, University of Sydney
Phone: 0421 577 796
bmun1400@uni.sydney.edu.au

Margaret Murphy
Westmead Hospital ED CNC / Investigator
Sydney Nursing School, University of Sydney
Phone: 02 9945 5555 page 08828
Margaret.Murphy@health.nsw.gov.au

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