Emergency Care LibGuide

PLoS One. 2025 Jun 6;20(6):e0323115. doi: 10.1371/journal.pone.0323115. eCollection 2025.

ABSTRACT

BACKGROUND: HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) is an evidence-based framework that supports emergency nurses to optimise safety, quality, and patient experience of care. HIRAID® was the intervention in a modified stepped-wedge cluster randomised controlled trial (SW-cRCT) in a convenience sample of 29 Australian emergency departments (Australian New Zealand Clinical Trials Registry: ACTRN12621001456842). The aim of this paper is to describe the methods and processes used to develop and deliver a theory-informed education program to support behaviour change during HIRAID® implementation.

METHODS: The HIRAID® education program was developed using: i) existing HIRAID® research using the Behaviour Change Wheel and Theoretical Domains Framework to identify enablers and barriers to HIRAID® use; ii) application of educational pedagogical theoretical frameworks (constructive alignment, backwards design, scaffolded learning); Bloom's taxonomy of educational objectives, and active and collaborative learning; iii) Australian standards related to safety, quality, clinical governance, and emergency nursing; and iv) behavioural diagnostic data from study sites (n = 670 nurses).

RESULTS: HIRAID® education program consisted of HIRAID® Provider and Instructor Courses and was delivered using a 'train-the-trainer' model. Fifteen HIRAID® Instructor Courses were held from February 2021 to March 2023 with 162 participants, and at November 2023 over 1300 emergency nurses had completed the HIRAID® Provider Course.

CONCLUSIONS: The theory-informed approach to the HIRAID® education program enabled development of a structured program and delivery in the dynamic and complex emergency department environment. The approach reported in this paper provides a blueprint for other researchers aiming to change behaviours in complex settings.

PMID:40478825 | DOI:10.1371/journal.pone.0323115

Rural Remote Health. 2025 Jun;25(2):9260. doi: 10.22605/RRH9260. Epub 2025 Jun 4.

ABSTRACT

INTRODUCTION: The centralisation of birthing care, driven by the closure of 225 of Australia's rural birthing centres over the past 20 years, has resulted in a 47% increase in births before arrivals at hospitals. This shift positions paramedics as critical primary health providers for out-of-hospital births and obstetric emergencies. Despite the infrequency of such emergencies for paramedics, they demand proficient clinical management due to their severity and potential complications. Confidence is vital for paramedics in managing high-risk obstetric emergencies effectively. However, there is limited research on paramedics' confidence levels and the factors influencing them, particularly in Australia following the introduction of paramedic registration and mandatory obstetric training in 2018. This scoping review seeks to explore paramedics' confidence in managing prehospital obstetric emergencies, identify influencing factors and examine the implications of confidence on both patient and paramedic welfare.

METHODS: Following Joanna Briggs Institute methodology, a comprehensive literature search across three databases yielded 125 results. Screening of titles and abstracts by two authors, followed by full-text screening of 18 remaining articles, was conducted. Conflicts were resolved by the primary author, and three additional relevant articles were retrieved manually. Thirteen studies met the inclusion criteria and were analysed to inform the review.

RESULTS: The findings consistently highlighted feelings of low confidence, insecurity, vulnerability and heightened stress among paramedics when confronted with prehospital obstetric emergencies. These were largely attributed to infrequent and inadequate education and training, leading to skills decay and difficulties in distinguishing normal from complicated obstetric events. Rurality due to various logistical, geographical and resourcing factors was found to exacerbate paramedic insecurity attending and managing obstetric emergencies. The decline in confidence not only affects clinical proficiency but also poses risks to patient safety and contributes to paramedic stress and poor mental health outcomes.

CONCLUSION: Proportional confidence emerges as a crucial factor in medical education, facilitating enhanced clinical competence and better mental health outcomes for patients, clinicians and teams. This is of increased importance in rural areas where logistical barriers to ensuring appropriate care are prevalent. Further research is needed to ascertain the optimal frequency and type of training/education required to bolster paramedic confidence in managing obstetric emergencies effectively.

PMID:40467529 | DOI:10.22605/RRH9260

Emerg Med Australas. 2025 Jun;37(3):e70081. doi: 10.1111/1742-6723.70081.

ABSTRACT

INTRODUCTION: Emergency departments (ED) in Australia have experienced an increase in patient presentations. To address this demand, we introduced phlebotomists at ED triage seeking to reduce ED waiting and disposition times. We report the impact of this intervention.

METHOD: Using a quantitative retrospective comparative study design guided by the STROBE checklist, we investigated the impact on ED performance before and after the introduction of phlebotomists (the intervention). Data from two periods-T1 (January-June 2021) and T2 (January-June 2023) were obtained and analysed for all ED presentations.

RESULTS: A total of 90,020 patients were included (T1: 46,639; T2: 43,381). Post-intervention improvements included an increase in short stay unit-admissions from triage (3.1% vs. 5.9%, p < 0.001) and a decrease in the proportion of patients transferred to a cubicle from the waiting room (T1: 78.8%; T2: 76.4%). However, patients who left the ED before treatment was completed (known as 'Did not Wait') rose significantly (9.8% vs. 11.5%) as did waiting room times (80.02 vs. 112.91 min). Overall, ED length of stay (EDLOS) increased significantly (mean T1: 305.1 to T2: 319.4 min; p < 0.001). There were significant increases in blood tests (T1: 52.0% vs. T2: 59.9%) and ECGs (16.5% vs. 19.1%) performed.

CONCLUSION: The introduction of phlebotomists at triage failed to reduce waiting, treatment and disposition times and increased the number of investigations performed with an overall increase in EDLOS. We observed an increase in the number of patients directed from the waiting room to the short stay unit and fewer patients transferred from the waiting room to an ED cubicle.

PMID:40464127 | PMC:PMC12135029 | DOI:10.1111/1742-6723.70081

Emerg Med Australas. 2025 Jun;37(3):e70063. doi: 10.1111/1742-6723.70063.

ABSTRACT

Emergency and critical care services are essential to universal health coverage. World Health Assembly (WHA) Resolution 76.2, adopted in 2023, outlined the importance of integrated emergency, critical and operative care systems in strengthening primary healthcare capabilities. Recent research has determined that system strengthening and partnership-based approaches to healthcare capacity development have the potential to achieve greater equity and sustainability. The Regional Emergency and Critical Care Systems Strengthening Initiative (RECSI) is an Australian Government funded programme under the Partnerships for a Healthy Region (PHR) initiative. It aims to enhance acute care capacity and healthcare system resilience across the Pacific and Timor Leste. RECSI is led by a consortium of acute care organisations and provides a vehicle for progressing WHA 76.2. The programme focuses on four thematic areas: workforce capacity and training, systems and processes, data and research, and leadership and governance. As part of RECSI's inception, a structured programme logic was developed, which describes programme activities and outputs, and how they contribute to defined intermediate and end-of-programme outcomes. RECSI's monitoring, evaluation and learning (MEL) plan, which supplements the programme logic, incorporates sustainability indicators that are focused on monitoring the impact of mechanisms designed to enable ongoing benefits from programme outcomes. Utilising a partner-led and context-specific programme design, RECSI represents a rigorous approach to acute care system strengthening. This strategy aims to build genuine partnerships to leverage skills, knowledge and opportunity across the Pacific and Timor-Leste.

PMID:40462693 | PMC:PMC12134838 | DOI:10.1111/1742-6723.70063