The ACCELERATE Plus (assessment and communication excellence for safe patient outcomes) Trial Protocol: a stepped-wedge cluster randomised trial, cost-benefit analysis, and process evaluation

BMC Nursing

Study Protocol

Sharon May¹  Liza Goncharov²  Diana Slade²  Deb Newman³  Narelle Gleeson³  Chi Kin Law⁴  Karen Bowen⁵  Katharine Duffy⁵  Sandy Middleton⁶  Benjamin McElduff⁶  Mark Liu⁶  Elizabeth McInnes⁶  Sarah Walsh⁷  Susan Whittam⁷  Jayde Cuffe⁸  Jake McMahon⁸  Karen Tuqiri⁹  Hayley Sciuriaga^1,10  Patrick Kelly^1,11  Kate Hackett^1,12  Sonia Marshall^1,13  Gregory Melbourne^1,13  Josephine S. F. Chow^1,14  Steven A. Frost^1,15  Christina Aggar^1,16  Lauren Sturgess^1,17  Joanne Taylor^1,18  Anna Thornton^1,18  Vivien Pollnow^1,18  Jade Murphy^1,19  Jacqueline Bilo^1,19  Ivanka Komusanac^2,20  Joanne Newbury^2,21  Bronwyn Everett^2,22  John Rihari-Thomas^2,22  Gemma McErlean^2,22  Caleb Ferguson^2,22 

[1] Fairfield Hospital, Polding Street and Prairie Vale Road, 2176, Prairiewood, NSW, Australia;Institute for Communication in Healthcare, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, 2601, Acton, ACT, Australia;Lismore Base Hospital, 60 Uralba Street, 2480, Lismore, NSW, Australia;National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Medical Foundation Building, 92-94 Parramatta Road, 2050, Camperdown, NSW, Australia;Northern NSW Local Health District, Crawford House, Hunter Street, 2480, Lismore, NSW, Australia;Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, 2010, Darlinghurst, NSW, Australia;School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 40 Edward Street, 2060, North Sydney, NSW, Australia;Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, 2010, Darlinghurst, NSW, Australia;St Vincent’s Health Network Sydney, 390 Victoria Street, 2010, Darlinghurst, NSW, Australia;Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, 2010, Darlinghurst, NSW, Australia;St Vincent’s Hospital Melbourne, 41 Victoria Parade, 3065, Fitzroy, VIC, Australia;Prince of Wales Hospital, 320-346 Barker Street, 2031, Randwick, NSW, Australia;Royal Prince Alfred Hospital, 50 Missenden Road, 2050, Camperdown, NSW, Australia;School of Public Health, University of Sydney, Edward Ford Building, A27 Fisher Road, 2006, Camperdown, NSW, Australia;South Eastern Sydney Local Health District, The Sutherland Hospital and Community Health Service, Corner The Kingsway and Kareena Road, 2229, Caringbah, NSW, Australia;South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, 2170, Liverpool, NSW, Australia;South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, 2170, Liverpool, NSW, Australia;Ingham Institute for Applied Medical Research, 1 Campbell Street, 2170, Liverpool, NSW, Australia;South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, 2170, Liverpool, NSW, Australia;University of Wollongong, Northfields Avenue, 2522, Wollongong, NSW, Australia;Southern Cross University, Military Road, 2480, East Lismore, NSW, Australia;Northern NSW Local Health District, Crawford House, Hunter Street, 2480, Lismore, NSW, Australia;St George Hospital, Gray Street, 2217, Kogarah, NSW, Australia;St Vincent’s Health Network Sydney, 390 Victoria Street, 2010, Darlinghurst, NSW, Australia;St Vincent’s Hospital Melbourne, 41 Victoria Parade, 3065, Fitzroy, VIC, Australia;Sydney Local Health District, King George V Building, Missenden Road, 2050, Camperdown, NSW, Australia;The Sutherland Hospital, Corner The Kingsway and Kareena Road, 2229, Caringbah, NSW, Australia;University of Wollongong, Northfields Avenue, 2522, Wollongong, NSW, Australia;

关键词: Evidence-based nursing;    Implementation science;    Patient safety;    Nursing assessment;    Clinical handover;    Multidisciplinary handover communication;    Randomised controlled trial;    Cost–benefit analysis;    Process evaluation;    Learning health system.;   

DOI  :  10.1186/s12912-023-01439-x

 received in 2023-06-08, accepted in 2023-08-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundNurses play an essential role in patient safety. Inadequate nursing physical assessment and communication in handover practices are associated with increased patient deterioration, falls and pressure injuries. Despite internationally implemented rapid response systems, falls and pressure injury reduction strategies, and recommendations to conduct clinical handovers at patients’ bedside, adverse events persist. This trial aims to evaluate the effectiveness, implementation, and cost–benefit of an externally facilitated, nurse-led intervention delivered at the ward level for core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication. We hypothesise the trial will reduce medical emergency team calls, unplanned intensive care unit admissions, falls and pressure injuries.MethodsA stepped-wedge cluster randomised trial will be conducted over 52 weeks. The intervention consists of a nursing core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication and will be implemented in 24 wards across eight hospitals. The intervention will use theoretically informed implementation strategies for changing clinician behaviour, consisting of: nursing executive site engagement; a train-the-trainer model for cascading facilitation; embedded site leads; nursing unit manager leadership training; nursing and medical ward-level clinical champions; ward nurses’ education workshops; intervention tailoring; and reminders. The primary outcome will be a composite measure of medical emergency team calls (rapid response calls and ‘Code Blue’ calls), unplanned intensive care unit admissions, in-hospital falls and hospital-acquired pressure injuries; these measures individually will also form secondary outcomes. Other secondary outcomes are: i) patient-reported experience measures of receiving safe and patient-centred care, ii) nurses’ perceptions of barriers to physical assessment, readiness to change, and staff engagement, and iii) nurses’ and medical officers’ perceptions of safety culture and interprofessional collaboration. Primary outcome data will be collected for the trial duration, and secondary outcome surveys will be collected prior to each step and at trial conclusion. A cost–benefit analysis and post-trial process evaluation will also be undertaken.DiscussionIf effective, this intervention has the potential to improve nursing care, reduce patient harm and improve patient outcomes. The evidence-based implementation strategy has been designed to be embedded within existing hospital workforces; if cost-effective, it will be readily translatable to other hospitals nationally.Trial registrationAustralian New Zealand Clinical Trials Registry ID: ACTRN12622000155796. Date registered: 31/01/2022.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 1

Fig. 1

40517_2023_267_Article_IEq8.gif

Fig. 1