The ACCELERATE Plus (assessment and communication excellence for safe patient outcomes) Trial Protocol: a stepped-wedge cluster randomised trial, cost-benefit analysis, and process evaluation
Authors: Liu Mark , Whittam Susan , Thornton Anna , Goncharov Liza , Slade Diana , McElduff Benjamin , Kelly Patrick , Law Chi Kin , Walsh Sarah , Pollnow Vivien , Cuffe Jayde , McMahon Jake , Aggar Christina , Bilo Jacqueline , Bowen Karen , Chow Josephine S. F. , Duffy Katharine , Everett Bronwyn , Ferguson Caleb , Frost Steven A. , Gleeson Narelle , Hackett Kate , Komusanac Ivanka , Marshall Sonia , May Sharon , McErlean Gemma , Melbourne Gregory , Murphy Jade , Newbury Joanne , Newman Deb , Rihari-Thomas John , Sciuriaga Hayley , Sturgess Lauren , Taylor Joanne , Tuqiri Karen , McInnes Elizabeth , Middleton Sandy ,   on behalf of the ACCELERATE Plus Project Team, Alsop Caitlin , Cahill Ainslie , Delaney Geoffrey , Mackie James , Riddell Kathryn , Ryan Mary , White Christopher , Rafferty Rae , Brown Travis , Chappelow Joanne , Curtis Sharon , Faulds Sarah , George Jessica , Lagat Sheena , Lee Leanne , McEwin Rebecca , Richmond Laura , Steadward Yvonne , Doyle Tara , Parker Carmel , Zenonos Patty 
Published: August 2023

Abstract
Background
Nurses play an essential role in patient safety. Inadequate nursing physical assessment and communication in handover practices are associated with increased patient deterioration, falls and pressure injuries. Despite internationally implemented rapid response systems, falls and pressure injury reduction strategies, and recommendations to conduct clinical handovers at patients’ bedside, adverse events persist. This trial aims to evaluate the effectiveness, implementation, and cost–benefit of an externally facilitated, nurse-led intervention delivered at the ward level for core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication. We hypothesise the trial will reduce medical emergency team calls, unplanned intensive care unit admissions, falls and pressure injuries.

Methods
A stepped-wedge cluster randomised trial will be conducted over 52 weeks. The intervention consists of a nursing core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication and will be implemented in 24 wards across eight hospitals. The intervention will use theoretically informed implementation strategies for changing clinician behaviour, consisting of: nursing executive site engagement; a train-the-trainer model for cascading facilitation; embedded site leads; nursing unit manager leadership training; nursing and medical ward-level clinical champions; ward nurses’ education workshops; intervention tailoring; and reminders. The primary outcome will be a composite measure of medical emergency team calls (rapid response calls and ‘Code Blue’ calls), unplanned intensive care unit admissions, in-hospital falls and hospital-acquired pressure injuries; these measures individually will also form secondary outcomes. Other secondary outcomes are: i) patient-reported experience measures of receiving safe and patient-centred care, ii) nurses’ perceptions of barriers to physical assessment, readiness to change, and staff engagement, and iii) nurses’ and medical officers’ perceptions of safety culture and interprofessional collaboration. Primary outcome data will be collected for the trial duration, and secondary outcome surveys will be collected prior to each step and at trial conclusion. A cost–benefit analysis and post-trial process evaluation will also be undertaken.

Discussion
If effective, this intervention has the potential to improve nursing care, reduce patient harm and improve patient outcomes. The evidence-based implementation strategy has been designed to be embedded within existing hospital workforces; if cost-effective, it will be readily translatable to other hospitals nationally.

Trial registration
Australian New Zealand Clinical Trials Registry ID: ACTRN12622000155796. Date registered: 31/01/2022.