The Assessment and CommuniCation ExcelLEnce foR sAfe paTient outcomEs (ACCELERATE) PLUS Trial - The effect of improving patient assessment and clinical communication among clinicians on patient adverse events in acute general settings through external remote facilitation.

The ACCELERATE Plus Intervention consists of three components (refined from the ACCELERATE Trial ACTRN12621000265875). Intervention Nurses will be required to: 1) Complete a core physical assessment for all allocated patients at the start of each nursing shift. 2) Perform a structured nurse-to-nurse and multidisciplinary team, patient and family centred bedside nursing handover using: ISBAR (Introduction, Identify, Situation, Background, Assessment / Actions, Recommendations / Readback); and CARE (Connect, Ask, Respond, Empathise). 3) ‘Speak up’ by communicating and escalating assessment finding concerns early to the multidisciplinary team using ISBAR. Our implementation strategy consists of: i) Education A) Train-the-Trainer Education delivered by external facilitators from the research team The ACCELERATE Plus intervention will be delivered by external experienced facilitators from the researcher team using ‘train-the-trainer’ ‘cascading facilitation’ whereby researchers mentor site leads advising on implementation and behaviour change strategies who in turn then will deliver education at the ward level to nurses to aid embedding of the intervention. The site leads will undertake site lead specific training in a two-day face-to-face session, to: 1) develop their capability and capacity in leading evidence-based change; 2) understand trial milestones; 3) understand data collection timepoints and methods; 4) understand minimum clinical trial elements; and 5) deliver the ward clinician education package. Site leads will receive a ‘train-the-trainer’ education package consisting of: 1) ward clinician education package, 2) resources consisting of audit tools and action plans and, 3) flowchart with project milestones. B) Ward Clinician Education delivered by the site leads Site leads will be responsible for educating ward nurses on the intervention wards. All registered and enrolled nurses on the ward nursing roster will attend one (2-hour duration) on-site face-to-face education sessions consisting of: 1) Training in core physical assessment and clinical handover for nurses using resources provided by the researchers (i.e., short videos, PowerPoint presentations); 2) trial details (i.e., aims, outcome measures and data collection); and 3) Barrier and enabler identification to the conduct of core physical assessments and clinical handover with nurses; 4) development of ward-specific action plans which will be refined over the duration of the Trial with involvement of the site lead and the research team. The education sessions will be delivered once per day for five consecutive days. To reach all nurses, (i.e., nurses on leave when workshops will be scheduled) the education sessions will be run multiple times with the number of additional education sessions determined by demand from the ward to enable all nurses to attend. Ward nurse education workshop attendance rates will be recorded. Attendance certificates will be provided to ward nurses and will contribute to continuing education hours. The written material used in this intervention will be designed specifically for this study and based on previous work produced by the research team (https://doi.org/10.1111/jan.15110; https://doi.org/10.1111/jocn.13201; https://doi.org/10.7748/ns.2017.e11030). ii) External facilitation Site leads also will be provided with ongoing external remote facilitation by the research team for the duration of the Trial. This will consist of a minimum of four one-hour videoconference sessions held at key project milestones, specifically: study commencement, pre-intervention data collection commencement, ward education, and intervention commencement. The number of site leads in a session will depend on their availability to attend a scheduled session. Sessions will be repeated as many times as necessary to ensure all site leads receive the same dose of external remote facilitation. Any additional sessions beyond the four planned sessions and their timing will be determined by demand from the site leads. Ongoing support for site leads and clinicians will be provided by Nurse leadership (at executive, middle management, and ward level) to support, drive, and monitor change. iii) Multidisciplinary Ward Clinical Champions Nursing and medical clinical champions will be identified from each ward to assist the site lead. The site leads, ward Nurse Unit Managers, Nurse Managers and nursing ward clinical champions will liaise with medical colleagues to explain the aim of the trial, and the medical doctors’ role in supporting the intervention. iv) Reminders The research team will provide site leads with proactive and responsive email and telephone call remote support as follows: - Proactive emails from the research team at key milestones (study commencement, pre-intervention data collection commencement, ward education, and ACCELERATE Plus intervention commencement.) - Responsive emails/ telephone calls from site leads to the research team when required. The researchers will provide site leads with email reminders to prompt them to progress with implementation and data collection according to the anticipated project timelines as follows: - Identification of site clinical nursing and medical champions (within two weeks of receiving site specific ethics approval) - Randomisation of hospitals (within two weeks of receiving site specific ethics approval) - Pre-intervention surveys completion (for six weeks at the start of each step) - Nurse education sessions (one week at the start of each step) - Preparation period (two weeks post ward nurse education sessions) - Initial action plan (two weeks post education sessions) - ACCELERATE Plus ‘go-live’ date (three weeks post nurse education sessions) - ACCELERATE Plus implementation (total duration of four months after the 'go-live' date - two months implementation and two months ‘bedding down’ of the intervention for it to become routine practice) - post intervention surveys collection (at trial conclusion) - process evaluation interviews/focus groups (at trial conclusion). Process evaluation: All data collection will be conducted by researchers who were not involved in the delivery of the intervention. Participants across all organisational levels will be invited to participate, including site leads, nursing executives, medical heads of department, nursing direct line managers, medical officers, nurse unit managers and ward nurses. To maximise variation of contexts, we will purposively sample to ensure participants from sites are included according to the following criteria: large (Principal Referral) and small (Group A/B) AIHW hospital classification; state (NSW and VIC); setting (metropolitan and regional); prior involvement in the ACCELERATE (2021) feasibility study.