Implementation evaluation of the Emergency nurse Protocol Initiating Care—Sydney Triage to Admission Risk Tool (EPIC-START) model of care

INTERVENTION: EPIC‐START model of care, with three components. Implementation of EPIC‐START will use a detailed strategy supported with behaviour change and implementation science theory. Emergency nurse Protocols Initiating Care (EPIC): A clinical framework to support the earlier delivery of standardised evidence‐based nurse‐initiated treatment by emergency nurses for 74 EPICs (41 Adult + 33 Paediatric) for the most common emergency department (ED) presentations, for example, there are protocols for abdominal pain, chest pain, mild head injury, asthma, bites and stings, limb fractures, shortness of breath, headache, wound care, and burns. The EPIC protocols were developed by the NSW Agency for Clinical Innovation (NSW ACI) with clinicians and policy stakeholders across NSW with metropolitan, regional and rural input. Emergency nurses at sites will be trained in the epic protocol use with online and in person training. There will be recognition of prior learning for experienced staff for some of the skills. It is anticipated the training will occur in the months leading up to the implementation date. There will be support with the implementation clinical nurse consultants for each Local Health District (LHD). There will continue to be support post‐implementation. The EPIC protocols will be stored on the NSW ACI website and the staff will be able to enter information relating to the EPIC into the patient medical record. The EPIC protocols will support the standard care of the patients in ED. It will mean nurses can commence some treatments earlier prior to doctor review. Use of the EPIC protocols should not increase the time it takes to care for a patient. It may take extra time to read the protocols until the staff are more familiar with the protocol use. CONDITION: Emergency medicine ‐ Other emergency care Nurse‐initiated emergency care ; ; Nurse‐initiated emergency care Public Health ‐ Health service research PRIMARY OUTCOME: 1. Change in patient length of stay in the ED; ; Data collected from medical record data (routinely collected) [On discharge from ED ] Change in time to analgesia; ; Data collected from medical record data (routinely collected) [Time of analgesia first receive in ED; ; ] Change in time to treatment ; ; Data collected from medical record data (routinely collected) [Time receives first treatment in ED] SECONDARY OUTCOME: Change in patient / carer experience in ED. ; Composite ‐ Either the patient or their carer (eg for patients <18 years, cognitively incapable) will complete the survey ; The patient or carer will either complete a survey independantly or will be assisted via telephone call by one of the site research nurses to complete the survey. ; To assess patient experience two instruments will be used, the Australian Hospital Patient Experience Question Set (AHPEQS) and Schmidt's Perceptions of Nursing Care Survey (SPNCS)[Within 2 weeks of discharge from the ED ; ] Change to costs in ED. ; ; Data collected from medical record data (routinely collected) [Cumulative data will be assessed at the conclusion of the study using admission information. ] INCLUSION CRITERIA: Emergency patient presentations Data will be collected via medical records and other routinely collected data including patient presentation information and costing data. Inclusions: ‐ All patients presenting to the emergency department during the collection period for each cluster ‐ Adult and paediatric patients are included