Evidence map›Paper›PMID 42443990›Full record

ArticleImplementation science : IS2026

Implementation evaluation of nurse-initiated care in 29 Australian emergency departments: a RE-AIM multi-method evaluation.

Sarah Kourouche, Julie Considine, Ling Li, Margaret Murphy, Saartje Berendsen Russell, Louise Casey, Rebecca Richardson, Ramon Z Shaban, Christina Aggar, Michael M Dinh and 5 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Implementation science : IS, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Sarah KouroucheSusan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia. Sarah.Kourouche@sydney.edu.au.ORCID http://orcid.org/0000-0001-6210-6191
Julie ConsidineSchool of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Eastern Health, Box Hill, Geelong, VIC, Australia.ORCID http://orcid.org/0000-0003-3801-2456
Ling LiMacquarie University, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0002-1642-142X
Margaret MurphyWestern Sydney Local Health District, North Parramatta, NSW, 2145, Australia.ORCID http://orcid.org/0000-0002-8937-8418
Saartje Berendsen RussellRPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0002-1380-8469
Louise CaseySouthern NSW Local Health District, Queanbeyan, NSW, Australia.
Rebecca RichardsonRPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, NSW, Australia.
Ramon Z ShabanSusan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia.ORCID http://orcid.org/0000-0002-5203-0557
Christina AggarNorthern NSW Local Health District Southern Cross University, Lismore, NSW, Australia.
Michael M DinhRPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0002-4034-1059
Amith ShettySystem Sustainability and Performance, NSW Ministry of Health, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0001-7349-1128
Timothy ShawFaculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0003-0783-1918
Radhika V SeimonRPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0002-3903-4801
Nanda R AryalAustralian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0003-3118-2006
Kate CurtisSusan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia.ORCID http://orcid.org/0000-0002-3746-0348

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNurse-initiated care improves timely treatment access, but adoption varies. The Ministry of Health introduced 73 Emergency Care Assessment and Treatment (ECAT) protocols for public emergency departments (EDs) to standardise nurse-initiated care. A behaviour change strategy was used to implement ECAT in 29 EDs as part of a trial, using implementation strategies like education, clinical champions, videos, and audit and feedback. The aim of this study was to evaluate the implementation of the ECAT protocol and the strategies used for reach, effectiveness, adoption, quality, and maintenance (REAIM).

methodsThis multi-method implementation evaluation used the RE-AIM framework. Methods comprised: i) emergency nurse surveys (Intervention and Control groups); ii) scoring by site implementation nurses of fidelity, adaptation and effectiveness of implementation strategies out of 5; iii) audits determining appropriateness of ECAT protocol use at 6-12 weeks and iv) implementation tracking logs during all study periods. Descriptive statistics were used for quantitative data, and content analysis for qualitative data (surveys/logs).

resultsData from surveys (n = 787), audits (1375 audits, 509 nurses), fidelity scores (n = 11), and implementation tracking logs (>600 entries) were used to evaluate implementation of ECAT protocols in the 29 EDs. Emergency nurses reported high use of ECAT protocols in their daily practice (median (IQR) 9.0 (8.0, 10.0), and audits demonstrated 92.9% of eligible nurses used at least one ECAT protocol in their shift (509/548). High effectiveness was demonstrated through 93.7% selection of the fully appropriate ECAT protocol (1288/1375). Implementation strategy fidelity was high (4.6/5) and effective (3.9/5), particularly the Education program (885 nurses, 97 courses), Audit and Feedback (1375 audits, 509 nurses), stakeholder engagement (>450 meetings) and electronic medical record update (all sites). The strategy with the lowest fidelity and effectiveness was Clinical Champions. Maintenance was demonstrated by training, use and monitoring embedded in practice at 12 months.

conclusionBehaviour-change informed implementation strategies successfully enabled large-scale successful adoption of nurse-initiated care at 12 months. Relying on clinical champions already operating at full capacity in an overcrowded ED to assist with implementation was impractical. Ongoing investment in facilitation, education, and adaptive support structures is essential to maintain gains and realise the full potential of nurse-initiated emergency care.

trial registrationAustralian and New Zealand Clinical Trial, ACTRN12622001480774p. Registered prospectively on 27 October 2022. Link: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384899%26isClinicalTrial=False.

Indexed as

Emergency NursingEmergency Service, HospitalNurse's RoleAustraliaClinical ProtocolsHumansImplementation ScienceBarriersBehaviour changeChange managementEmergencyEmergency medicineEmergency nursingEmergency room visits; evaluation study [publication type]Emergency service hospitalEnablersEvidence-based nursingHealth services researchImplementation scienceImplementation strategiesNot MESH - implementation evaluationNurse-initiated careNurse-ledNursingPatient outcome assessmentProcess evaluationProgram evaluationRE-AIM

Identifiers

PMID42443990
PMCPMC13440231

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.