Use of the structured emergency nursing framework HIRAID® improves patient experience: A stepped-wedge cluster randomised control trial in rural, regional and metropolitan Australia

Background: Emergency departments have high levels of uncertainty, long wait times, resource shortages, overcrowding and a constantly changing environment. Patient experience and patient safety are directly linked, yet levels of patient experience are stagnant. To improve emergency nursing care and patient experience, an emergency nursing framework HIRAID (R) (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) was implemented in 29 Australian emergency departments. Objectives: To evaluate HIRAID (R) on patient experience in the emergency department. Methods: This modified stepped-wedge cluster randomised control trial was conducted in 29 Australian rural, regional and metropolitan emergency departments and involved over 1300 emergency nurses. A total 2704 (1456 control, 1248 intervention) surveys were completed. We hypothesised implementation of HIRAID (R) would result in an at least 5% increase in patient experience per Schmidt's Perceptions of Nursing Care Survey and Australian Hospital Patient Experience Question Set. Patients (of all ages) and/or their carers completed a phone interview. Data were analysed using descriptive statistics and Generalized Estimating Equations approaches. Results: Median (IQR) participant age was 54 (31-67) years. The most common presenting problems were abdominal, chest and respiratory issues. Greater than 5% improvement in all categories of the Schmidt's Perceptions of Nursing Care Survey, and 10 out of 12 Australian Hospital Patient Experience Question Set was achieved. Conclusions: The implementation of the HIRAID (R) emergency nursing framework in Australian emergency departments significantly improved patient experience with emergency care. Implications: Demand for emergency care is increasing. Evaluating what methods work to effectively translate evidence to emergency practice, improve patient experience in the complex emergency setting is crucial. We present how a behaviour change informed implementation strategy enabled maximum, sustained uptake of an intervention that improved patient experience in a variety of emergency settings despite the COVID-19 pandemic and catastrophic flooding.