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Assessment and communication excellence for safe patient outcomes (ACCELERATE): A stepped-wedge cluster randomised trial protocol

  • John Rihari-Thomas
    Affiliations
    Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010 Australia

    St Vincent's Health Network, Sydney, Australia

    The University of Wollongong, Wollongong, Australia
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  • Susan Whittam
    Affiliations
    Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010 Australia

    St Vincent's Health Network, Sydney, Australia
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  • Liza Goncharov
    Affiliations
    Institute for Communication in Health Care, Australian National University (ANU), Canberra, Australia
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  • Diana Slade
    Affiliations
    Institute for Communication in Health Care, Australian National University (ANU), Canberra, Australia
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  • Benjamin McElduff
    Affiliations
    Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010 Australia

    School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia
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  • Tanya Pritchard
    Affiliations
    Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010 Australia

    School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia
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  • Jake McMahon
    Affiliations
    Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010 Australia

    St. Vincent's Hospital, Melbourne, Australia
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  • Alysia Coventry
    Affiliations
    Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010 Australia

    School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia
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  • Kelly Coughlan
    Affiliations
    Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010 Australia

    School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia
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  • Yvonne Steadward
    Affiliations
    The Prince of Wales Hospital, Randwick, Australia
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  • Joanne Taylor
    Affiliations
    Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010 Australia

    St Vincent's Health Network, Sydney, Australia
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  • Anna Thornton
    Affiliations
    St Vincent's Health Network, Sydney, Australia
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  • Kathryn Riddell
    Affiliations
    St. Vincent's Hospital, Melbourne, Australia
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  • Karen Tuqiri
    Affiliations
    The Prince of Wales Hospital, Randwick, Australia
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  • Kim Olesen
    Affiliations
    District Executive Unit, South Eastern Sydney Local Health District, Caringbah, Australia
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  • Maria R Dahm
    Affiliations
    Institute for Communication in Health Care, Australian National University (ANU), Canberra, Australia
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  • Laura Chien
    Affiliations
    Institute for Communication in Health Care, Australian National University (ANU), Canberra, Australia
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  • Patrick Kelly
    Affiliations
    School of Public Health, The University of Sydney, Camperdown, Australia
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  • Author Footnotes
    # Joint senior authors.
    Elizabeth McInnes
    Footnotes
    # Joint senior authors.
    Affiliations
    Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010 Australia

    School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia
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  • Author Footnotes
    # Joint senior authors.
    Sandy Middleton
    Correspondence
    Corresponding author.
    Footnotes
    # Joint senior authors.
    Affiliations
    Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Level 5, deLacy Building, 390 Victoria Street, Darlinghurst, NSW 2010 Australia

    School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia
    Search for articles by this author
  • Author Footnotes
    # Joint senior authors.

      Abstract

      Background

      Nurses play a major role in patient safety. Poor nursing assessment and communication practices are associated with higher incidence of the adverse events of undetected deterioration, falls, and pressure injuries. Despite widespread adoption of patient safety systems, occurrence of these events continues.

      Aim

      To implement and evaluate the feasibility and effectiveness of an organisational ward-level intervention to facilitate comprehensive systematic assessment and improved communication in clinical handover to reduce medical emergency team calls; unplanned Intensive Care Unit admissions; falls; and pressure injuries.

      Design

      A stepped-wedge cluster randomised trial sequentially implemented over 12 months.

      Methods

      Evidence-based implementation strategies will be employed to support implementation of an intervention focusing on comprehensive systematic patient assessment and improved nurse bedside clinical handover and multidisciplinary communication involving the patient. These are – intervention tailoring to individual wards through barrier and enabler identification; action plans; education; clinical champions; outreach visits; facilitation; clinician engagement; and reminders. Primary outcome measures will be a composite of Medical Emergency Team calls and unplanned intensive care unit admissions for deterioration. Secondary outcomes will be all categories of inpatient falls; stage 2–4 pressure injuries; nurse-reported perceptions of: teamwork; safety culture, and engagement; and patient-reported experience measures of receiving safe and patient-centred care. An a priori process evaluation will determine factors influencing intervention uptake and inform strategies for future upscale and spread.

      Discussion

      This feasibility trial will provide evidence regarding the use of systematic comprehensive patient assessment, combined with clinical handover re-design involving patients, to reduce clinical deterioration, falls and pressure injuries.

      Keywords

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