Implementing an emergency nursing framework improves the quality of clinical handover: A stepped-wedge cluster randomised control trial.

AIM: To examine the effect of the HIRAID® emergency nursing framework on clinical handover.

BACKGROUND

Clinical handover is very frequent in emergency departments and critical for patient safety. Inadequate handovers are associated with up to 80 % of adverse events.

METHODS

This modified stepped-wedge cluster randomised control trial was conducted across 29 Australian rural, regional and metropolitan emergency departments between 2020 and 2024. HIRAID® was implemented using a behaviour change theory-informed strategy. Surveys were distributed to eligible staff. Quantitative data were analysed using a multiple regression approach; qualitative data using inductive content analysis.

RESULTS

Surveys were completed by 1205 nurses (671 control, 534 intervention) and 328 medical staff (176 control, 152 intervention). Significant improvements were observed in satisfaction with nurse-to-nurse communication of patient history (t = 5.57, p < 0.001, 95 % C.I. = 0.33-0.69), physical assessment (t = 4.72, p < 0.001, 95 % C.I. = 0.28-0.68), recognition of clinical deterioration (t = 2.58, p = 0.01, 95 % C.I. = 0.06-0.43), information relevance (t = 3.29, p = 0.001, 95 % C.I. = 0.13-0.51) and completeness (t = 3.60, p < 0.001, 95 % C.I. = 0.17-0.56). Qualitative findings supported these results.

CONCLUSIONS

Implementing a structured emergency nursing framework improved nurse-to-nurse clinical handover, supporting safer patient care.