Reducing inpatient deterioration and improving patient safety in emergency departments with a standardised nursing framework: A stepped-wedge cluster randomised controlled trial (20 October 2025)

Summary

Patients admitted via Emergency Departments (EDs) sustain twice as many in-hospital adverse events than non-emergency admissions. Unwarranted variation in care, that is, differences not explained by patient illness, care needs, or patient preferences, contributes to adverse patient outcomes. The HIRAID® framework [History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, reassessment, and communication], standardises nursing assessment and management of patients in the ED. The aim of this study was to test the effect of HIRAID® on the quality and safety of emergency care. It found that emergency nurses' use of HIRAID® significantly reduced inpatient deterioration requiring a rapid response team call and improved patient experience and perceived quality of clinical handover.