HIRAID® Emergency Nursing Framework improves documentation for common emergency department presentations: A stepped-wedge cluster randomised control trial

BACKGROUND: The HIRAID® emergency nursing framework (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) decreases patient deterioration; improves patient and carer experience; and improves nurses' confidence in patient assessment and communication. In this paper, the effect of HIRAID® on emergency nurses' documentation is reported. METHODS: Patients presented with chest, abdominal, hip or limb pain, fever or shortness of breath; were triaged to categories 2, 3 or 4, and had emergency department stay > 60 min (n = 884: 441 control and 443 intervention). Data were collected via record audit using the modified D-catch tool and HIRAID® framework. RESULTS: There were significant increases a structured approach to documentation (77.1% vs 93.5%, p < 0.001), and median accuracy of nursing record structure scores (2.0 vs 3.0, p < 0.001). HIRAID® increased overall quantity (median=2.3 vs 3.0, p < 0.001) and quality (median=2.0 vs 2.5, p < 0.001) scores for initial nursing assessment documentation, and quantity and quality scores for documentation of all HIRAID® elements. The time to documentation from arrival did not change (median=74.5 vs 79.5 min, p = 0.475). CONCLUSION: HIRAID® improves emergency nurses' documentation of: i) initial patient assessment and management; ii) communication with colleagues, patients and families; and iii) plan of care without increasing time to documentation.