“This assessment is vital”: $3.6m grant to improve emergency care through nurse training

WSLHD infection prevention and control expert Professor Ramon Shaban and emergency department clinical nurse consultant Margaret Murphy are behind a nurse training system that has been awarded a $3.6 million grant.

Emergency nurses are receiving more training to prevent deterioration and improve patient care thanks to a program created by Western Sydney Local Health District (WSLHD) and its partners.

The project research titled Improving the safety and quality of emergency nursing care has been funded to the tune of $3,621,356 by the National Health and Medical Research Council’s Partnership Project scheme.

Westmead Hospital clinical nurse consultant Dr Margaret Murphy said she is hoping the randomised, controlled study will see a 20 per cent reduction in patient deterioration in the program developed by WSLHD, Illawarra-Shoalhaven Local Health District and the University of Sydney.

She hopes for an improvement in how many patients rate their emergency care as ‘very good’.

Prof Shaban and Margaret Murphy chat with emergency department patient Timothy Elsegood and his mother Raewyn Elsegood.

The funding will allow a new framework – known as HIRAID – to be assessed at the highest level across 31 NSW, Victoria and Queensland hospitals over five years.

HIRAID stands for:

  • History
  • Identify
  • Red flags
  • Assessment
  • Interventions
  • Diagnostics, communication and reassessment

The HIRAID framework promotes critical analysis by requiring nurses get crucial background information early, which allows treatment and further investigation to begin sooner.

“We realised there was no standardised way that Australia’s 29,000 emergency nurses are taught to initially assess and manage their patients,” Dr Murphy said.

Margaret started on the research journey seven years ago with Professor Kate Curtis from the University of Sydney. The pair were consulting on the Masters of Emergency Nursing when they realised there was no standard emergency nurse triage training in Australia.

“Emergency nurses are responsible for the initial assessment, management and safety of critically ill and injured patients, most of whom have undiagnosed conditions.

“They are often the first clinicians that patients see, so the quality of this initial assessment is vital.

“It underpins clinical decisions made by all members of the emergency care team and promotes safe care by detecting, preventing and acting on deterioration,” Dr Murphy explained.

After a successful pilot across emergency departments in western Sydney and Illawarra-Shoalhaven hospitals, the research team – including Dr Murphy and WSLHD infection prevention and control expert Professor Ramon Shaban – is now joining forces with many partners to generate the ultimate evidence for the embedding of HIRAID into policy and practice.

“Out of little things, big things grow,” she said.

“I’m passionate about this because emergency nurses have such an impact on the level of care given to patients.

“They need to be able to pick a sick patient, and they can. This is about putting their knowledge and experience into a framework and teaching new nurses to think that way.

“I’m really chuffed that the idea came from Westmead emergency department and can now be rigorously investigated at the highest level. This is very exciting for nursing,” added Dr Murphy.

Partners for the randomised control trial (RCT) include Eastern Health, Northern NSW LHD, Southern NSW LHD, the Royal Brisbane Hospital, Thyne Reid Foundation, the NSW Emergency Care Institute, College of Emergency Nursing Australasia, the Australian College of Nursing, The Office of the Commonwealth Chief Nurse and the Australian Commission on Safety and Quality in Health Care.