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

In 30 seconds

This modified stepped-wedge cluster randomised controlled trial evaluated implementation of the HIRAID® emergency nursing framework across 29 Australian rural, regional and metropolitan emergency departments between 2020 and 2024. Surveys from 1205 nurses and 328 medical staff were analysed. After implementation, nurses reported significantly greater satisfaction with nurse-to-nurse handover of patient history, physical assessment, recognition of deterioration, information relevance and completeness. The largest reported confidence interval was for patient-history communication (95% CI 0.33–0.69); all five outcomes were statistically significant. Qualitative findings supported the quantitative results.

Key findings

• Satisfaction with handover of patient history improved significantly (t = 5.57, p < 0.001, 95% CI = 0.33-0.69).
• Satisfaction improved for physical assessment (t = 4.72, p < 0.001, 95% CI = 0.28-0.68) and recognition of deterioration (t = 2.58, p = 0.01, 95% CI = 0.06-0.43).
• Information relevance and completeness improved significantly (t = 3.29, p = 0.001, 95% CI = 0.13-0.51; t = 3.60, p < 0.001, 95% CI = 0.17-0.56, respectively).

Why it matters

Emergency department handovers occur frequently and are important to patient safety. These findings suggest that a structured nursing framework, implemented with a behaviour change-informed strategy, can improve staff-reported quality across several key elements of nurse-to-nurse communication. Better handover processes may support safer care, although the reported outcomes are satisfaction measures rather than direct patient safety events.

What to keep in mind

Outcomes were based on staff surveys and satisfaction; the abstract does not report direct measures of adverse events or patient outcomes.