Research - HIRAID: The Emergency Nursing Framework
The complexity, uncertainty and sometimes urgency surrounding Emergency nursing practice requires a structured approach. When a patient first presents to the emergency department (ED), the triage nurse performs a brief assessment and allocates a triage category indicating how long the patient can wait for emergency care. Following triage, the allocated nurse must perform a more comprehensive assessment and commence nursing care. Previously there was no standardised validated structure to guide emergency nursing assessment and care post triage.
The emergency nursing framework ‘HIRAID’ (History, Identify Red flags, Assessment, Interventions, Diagnostics, (HIRAID) reassessment and communication) (Figure 1) was designed to provide emergency nurses with an evidence-based structured approach to emergency nursing care post triage. HIRAID was developed with experts, designed on research evidence and validated in both the simulated and clinical settings with 302 Emergency nurses in regional NSW.
There are three significant outcomes associated with HIRAID determined using robust data collection and analyses.
1. 50% reduction in patient deterioration associated with care delivered in the ED [27% to 13%]. This is despite 12,000 more ED presentations, a 6.3% higher admission rate and sicker patients in the HIRAID intervention period. Per the well validated Human Factors Classification Framework for patient safety the use of HIRAID resulted in fewer treatment delays (28.28% vs 15.07%) and failure to escalate (20.20% vs 6.85%).
2. HIRAID equivalent savings exceed the costs of implementation. The estimated preliminary savings to ISLHD (through less deterioration) was $1,914,252 with a payback period of 75 days. Conservative projections estimated a net benefit of $1,813,760 pa by 2022-23, even when controlling for LOS, diagnosis and age.
3. Nursing documentation describing all essential assessment components increased from 5% to 80% in a random audit of 120 random paediatric and adult medical records for all presentation types. In particular the quantity (completeness) and quality (completeness and linguistic correctness) of patient history and physical assessment per the validated D-Catch instrument.