ACCELERATE Trial- The effect of improving patient assessment and clinical communication among healthcare staff on patient adverse events in acute general wards.

The ACCELERATE Intervention consists of: 1) Training in comprehensive nursing assessments incorporating risk assessment and mitigation strategies for clinical deterioration, pressure injury and falls; 2) Training in effective clinical handover following observation and analysis of interactions with patients and multidisciplinary team; 3) Ward-specific tailored strategies to enhance assessment and handover practices amongst the multidisciplinary team developed at the workshop (see below) and reviewed fortnightly at dedicated team meetings by hospital leads; 4) Implementation of comprehensive assessment and clinical handover at ward level. Evidence-based implementation strategies will be conducted at each enrolled hospital and will be run out over a 6 month period and comprises: i) One 3-hour hospital-based workshop for training in comprehensive assessment and clinical handover for nurses delivered by clinical experts, external facilitator for ACCELERATE for each hospital, researchers and implementation experts using multi-media approach (ie videos, educational, engagement and ownership strategies). Workshops will focus on uplifting and enhancing current assessment and communication practices which currently do not meet evidence-based guidelines. There will be 3 3-hour workshops per ward to enable all nurses to attend. Nurses are only required to attend one workshop. ii) Collaborative barrier and facilitator identification to improved assessment and handover with clinicians which will inform the ward based action change management plan. This plan will be developed at the workshop and refined over time with involvement of the external facilitator.; iii) Nurse and medical leadership (at executive, middle management and ward level) and external facilitator (senior nurse not connected to participating wards) to support, drive and monitor change, iv) Audit and feedback of data on ward level pressure injury, falls and MET call rates every 6 weeks post-workshop presented at progress ward based meetings facilitated by the external facilitator. The intervention will be delivered in 3 steps at 4-month intervals. The intervention will be sequentially introduced into 9 wards (three clusters with each cluster containing three wards) across three hospitals over 12 months. Wards from each hospital will be randomised into clusters which will determine the commencement date of the intervention, with the condition that each step contains at least one ward from each hospital.