Abstract Objective To explore the clinical education programs that support new graduate nurses and their impact on confidence, competence, job satisfaction and workforce retention. Background Nursing workforce turnover is a key issue for healthcare organisations, impacting efficiency, cost-effectiveness, quality of care and patient safety. New graduate nurses are an at-risk cohort who face distinct challenges transitioning into practice, requiring structured and supportive clinical education programs. Methods The JBI methodology for scoping review approach was used. The review was registered and made publicly available in Open Science Framework: https://osf.io/ke5hd . Included studies involved clinical education programs that support new graduate nurses within their first 12 months of employment after completing a bachelor-level degree and their impact on confidence, competence, job satisfaction and retention. The literature search was conducted in March 2025 using CINAHL, Medline and Scopus, with no restrictions on geography or language, and included grey literature across the selected databases. Results 31 studies met the inclusion criteria of the review, with the majority (n = 27) conducted in a hospital setting. Various terminologies were adopted for clinical education programs in the included studies, such as transition or residency programs, preceptorship programs and critical reflection programs. The duration of these programs was between six weeks to 18 months, with the majority delivered over 12 months (n = 18). Clinical education modalities included education sessions, support strategies, facility orientation, leadership involvement in structured programs, shift pattern rules, reflection, structured feedback and participation in quality improvement projects. This review highlighted the positive impact of providing clinical and social support to this at-risk cohort, and identified that structured clinical education programs resulted in improved confidence, competence, retention and job satisfaction of new graduate nurses. Additionally, the review of these studies revealed organisational challenges, including staffing issues and competing demands between sustaining clinical services, and releasing new graduate nurses for scheduled educational activities required to meet clinical education objectives. Conclusion The review identified that structured clinical education programs positively impact the transition of new graduate nurses into professional practice. These findings will inform healthcare educators, policymakers and leaders in planning and prioritising responsive strategies to strengthen new graduate clinical education programs and sustain a future-ready nursing workforce.

BACKGROUND:Nurse-led clinics (NLCs) are structured models of care in which nurses assume primary responsibility for patient care, often practising autonomously within multidisciplinary teams across all healthcare settings. Developed to address rising clinical demands, workforce shortages, and the growing chronic disease burden, NLCs play a key role in delivering accessible, holistic, patient-centred care led by advanced practice nurses. Although a qualitative systematic review of patient experiences with NLCs was conducted in 2012, evolving models of care and research designs highlight the need for updated evidence. Accordingly, this mixed-methods systematic review employs a narrative synthesis approach to examine and synthesise the perceptions, perspectives, and experiences of adult patients attending NLCs, including factors that influence these perceptions. METHODS:Published research from 2012 to April 2025 was retrieved using the electronic databases MEDLINE, CINAHL, Embase, Scopus, and PsycINFO using a comprehensive search strategy. All articles were collated in EndNote and screened via COVIDENCE by two independent reviewers. Data were extracted from the articles that met the inclusion criteria using a standardised form. Quality appraisal was undertaken using JBI critical appraisal tools. RESULTS:A total of 3185 articles were identified of which 23 studies met the inclusion criteria were included in the final synthesis. A mix of quantitative and qualitative methodologies were applied in these articles, with 12 using a cross-sectional design with a structured patient satisfaction survey, seven of these studies employed a qualitative approach while four studies used a mixed method approach. Key findings identified include patient satisfaction with the length of consultation time, the confidence in the care provided by the APN, decreased waiting times, improved confidence in managing disease, continuity of care, person centred approach and the feeling of being involved in the decision making. NLCs generally met patient expectations, with patients reporting satisfaction, accessibility, increased knowledge, timely access, service acceptability, and holistic care. CONCLUSION:This review demonstrated that patients highly value nurse-led clinics across diverse healthcare settings for their accessibility, continuity, timeliness, and the holistic care provided by APNs. These insights can guide future service improvements and enhance patient experiences. CLINICAL TRIAL NUMBER:Not applicable.

OBJECTIVES:Timely recognition and management of sepsis in emergency departments (ED) is critical to improving patient outcomes. We conducted a systematic review and meta-analysis to evaluate the impact of targeted interventions on sepsis care in ED. METHODS:Studies published between 2001 and 2024 were included if they assessed interventions to improve sepsis recognition and/or management. Risk of bias was assessed using the ROBINS-I quality appraisal tools by Cochrane. Our primary outcome was the posterior probability of any intervention effect, using a Bayesian approach. Outcomes of interest included rates of compliance with sepsis guidelines, patient mortality, and time to administration of intravenous antibiotics and fluids. Both frequentist and Bayesian meta-analyses were performed, and heterogeneity was assessed using the I2 statistic. RESULTS:Fifty-six studies were included; all were before-and-after designs, except a single randomised controlled trial. Bayesian analyses estimated a posterior probability >99% of any improvement in compliance, and a posterior probability of 97% of any mortality reduction, in the context of sceptical priors, for targeted sepsis interventions. Pooled random-effects showed higher compliance during intervention periods (Risk Ratios(RR) =1.71, 95% Confidence Intervals(CI) 1.39-2.15; I2 = 93%) and lower mortality (RR =0.80, 95% CI 0.73-0.86; I2 = 46%), when compared to non-intervention periods. Time to treatment was also estimated to be reduced for antibiotics administration (Mean Difference (MD) = -32.5 min, 95% CI -44.7 to -20.2) and fluid administration (MD = -20.4 min, 95% CI -37.6 to -3.1). Posterior probabilities suggested a 90% likelihood of any time reduction, though estimates of reduced antibiotic times were sensitive to analysis that accounted for risk-of-bias assumptions. CONCLUSIONS AND IMPLICATIONS TO CLINICAL PRACTICE:Targeted ED interventions improve compliance with sepsis guidelines and reduce mortality. While gains in treatment timeliness were modest, likely reflecting prioritisation of sicker patients, evidence supports multimodal, context-specific strategies strengthening early sepsis management. Given heterogeneity of studies, future research should evaluate specific intervention components in well-designed, adequately powered randomised controlled trials. REGISTRATION:PROSPERO ID: CRD42024560232.

PURPOSE:Triage is a critical process for patient prioritisation in emergency departments (EDs) that aims to rapidly allocate patients to the appropriate level of emergency care commensurate with clinical urgency. Triage completion is expected within two to five minutes while ensuring patient safety. The purpose of this review is to identify the facilitators and barriers to triage efficiency in EDs and provide an overview of how these factors impact the triage process. PROCEDURES:An integrative literature review was conducted with a structured search across six databases, including CINAHL, Embase, Medline, Scopus, ProQuest, and PubMed. Twenty studies met the inclusion criteria and were narratively synthesised. FINDINGS:Factors affecting triage efficiency were grouped under four themes. Process-related factors such as workflow designs, electronic triage support decision tools, "quick look" triage approaches, and system inefficiencies; nurse-related factors like experience, educational attainment, cognitive approach, and fatigue; environmental and system-related pressures such as interruptions, high patient volume, overcrowding, and availability of adequate triage spaces and equipment; and patient factors, including patient complexity, all shaped triage efficiency. CONCLUSION:Triage efficiency is a dynamic and context-sensitive outcome shaped by multiple factors. Some factors are modifiable, and further studies are needed to explore targeted interventions and their impact on triage efficiency in emergency care.

Recognising sepsis in fast-paced Emergency Department (ED) environments is challenging. The Sepsis risk AI algorithm For Emergency department WAITing room (SAFE WAIT) model was developed to detect sepsis in the ED waiting room. We aimed to evaluate the performance and clinical utility of the SAFE-WAIT model across different patient subgroups in a silent trial. We reported standard evaluation metrics for model's performance and calculated the model's expected utility to complement the evaluation. SAFE-WAIT demonstrates an earlier prediction, better subgroup performance compared to the existing Sepsis Alert. Its expected utility highlighted a potential value in the future decision-making process. This silent trial is a first step of our multistage approach for a safe introduction and implementation of AI systems into clinical practice.

This paper presents a scalable, serverless machine learning operations (ML Ops) architecture for near real-time sepsis detection in Emergency Department (ED) waiting rooms. Built on Amazon Web Services (AWS) cloud environment, the system processes HL7 messages via MuleSoft, using Lambda for data handling, and SageMaker for model deployment. Data is stored in Aurora PostgreSQL and visualized in on-premise Tableau™. With 99.7% of HL7 messages successfully processed, the system shows strong performance, though occasional downtime, code set mismatches, and peak execution times reveal areas for optimization.

Background: Sepsis is a medical emergency requiring prompt recognition, and early administration of intravenous fluids and antibiotics. While compliance with appropriate and timely administration of intravenous fluids has been found to be poor, the reasons are not well understood. Therefore, we have explored the experiences and perceptions of emergency nurses and medical officers from four hospitals to identify the associated facilitators and barriers.Methods: Qualitative design incorporating six focus group discussions and thematic analysis of data. A hybrid approach using both inductive and deductive reasoning was used.Findings: Four key themes were developed: 1. Overcrowding and understaffing threaten appropriate fluid man-agement in sepsis; 2. Variations in clinical practice results in suboptimal fluid management; 3. Challenges with clinical recognition of sepsis impedes timely fluid administration; 4. Top-down approach is necessary to improve fluid management.Conclusion: Themes highlighted the specific challenges associated with fluid administration in sepsis in the emergency department setting providing potential strategies to be implemented to improve practice and ulti-mately patient outcomes.

Background Sepsis is a life-threatening medical emergency in which appropriate and timely administration of intravenous fluids to patients with features of hypotension is critical to prevent multi-organ failure and subsequent death. However, compliance with recommended fluid administration is reported to be poor. There is a lack of consensus among emergency clinicians on some of the determinant factors influencing fluid administration in sepsis. Thus, the aim of this study was to identify the level of consensus among key stakeholders in emergency departments regarding the facilitators, barriers, and strategies to improve fluid administration. Methods The modified Delphi questionnaire with 23 statements exploring barriers, facilitators, and strategies to improve fluid administration was developed from the integration of findings from previous phases of the study involving emergency department clinicians. A two-round modified Delphi survey was conducted among key stakeholders with managerial, educational, supervision and leadership responsibilities using a “Reactive Delphi technique” from March 2023 to June 2023. The statements were rated for importance on a 9-point Likert scale. The RAND/UCLA Appropriateness Method (RAM) was used to identify the level of consensus (agreement/disagreement). Results Of the 21 panellists who completed Round 1 survey, 18 (86%) also completed Round 2. The panellists rated 9 out of 10 (90%) barriers, 3 out of 4 (75%) facilitators and all 9 (100%) improvement strategies as important. Out of the total 23 statements, 18 (78%) had agreement among the panellists. Incomplete vital signs at triage (Median = 9, IQR 7.25 to 9.00) as a barrier, awareness of importance of fluid administration in sepsis (Median = 9, IQR 8.00 to 9.00) as facilitator and provision of nurse-initiated intravenous fluids (Median = 9, IQR 8.00 to 9.00) as an improvement strategy were the highest rated statements. Conclusion This is the first Delphi study identifying consensus on facilitators, barriers, and strategies to specifically improve intravenous fluid administration in sepsis in Australia. We identified 18 consensus-based factors associated with appropriate and timely administration of intravenous fluids in sepsis. This study offers empirical evidence to support the implementation of the identified strategies to improve patient outcomes.

Abstract Background Appropriate and timely administration of intravenous fluids to patients with sepsis-induced hypotension is one of the mainstays of sepsis management in the emergency department (ED), however, fluid resuscitation remains an ongoing challenge in ED. Our study has been undertaken with two specific aims: firstly, for patients with sepsis, to identify factors associated with receiving intravenous fluids while in the ED; and, secondly to identify determinants associated with the actual time to fluid administration. Methods We conducted a retrospective multicentre cohort study of adult ED presentations between October 2018 and May 2019 in four metropolitan hospitals in Western Sydney, Australia. Patients meeting pre-specified criteria for sepsis and septic shock and treated with antibiotics within the first 24 h of presentation were included. Multivariable models were used to identify factors associated with fluid administration in sepsis. Results Four thousand one hundred forty-six patients met the inclusion criteria, among these 2,300 (55.5%) patients with sepsis received intravenous fluids in ED. The median time to fluid administration from the time of diagnosis of sepsis was 1.6 h (Interquartile Range (IQR) 0.5 to 3.8), and the median volume of fluids administered was 1,100 mL (IQR 750 to 2058). Factors associated with patients receiving fluids were younger age (Odds Ratio (OR) 1.05, 95% Confidence Interval (CI (1.03 to 1.07), p < 0.001); lower systolic blood pressure (OR 1.11, 95% CI (1.08 to 1.13), p < 0.001); presenting to smaller hospital (OR 1.48, 95% CI (1.25 to 1.75, p < 0.001) and a Clinical Rapid Response alert activated (OR 1.64, 95% CI (1.28 to 2.11), p < 0.001). Patients with Triage Category 1 received fluids 101.22 min earlier (95% CI (59.3 to131.2), p < 0.001) and those with Category 2 received fluids 43.58 min earlier (95% CI (9.6 to 63.1), p < 0.001) compared to patients with Triage Category 3–5. Other factors associated with receiving fluids earlier included septic shock (-49.37 min (95% CI (-86.4 to -12.4), p < 0.001)); each mmol/L increase in serum lactate levels (-9.0 min, 95% CI (-15.7 to -2.3), p < 0.001) and presenting to smaller hospitals (-74.61 min, 95% CI (-94.0 to -55.3), p < 0.001). Conclusions Younger age, greater severity of sepsis, and presenting to a smaller hospital increased the probability of receiving fluids and receiving it earlier. Recognition of these factors may assist in effective implementation of sepsis management guidelines which should translate into better patient outcomes. Future studies are needed to identify other associated factors that we have not explored.

Objective To investigate the association between timing and volume of intravenous fluids administered to ED patients with suspected infection and all-cause in-hospital mortality. Methods Retrospective cohort study of ED presentations at four metropolitan hospitals in Sydney, Australia, between October 2018 and May 2019. Patients over 16 years of age with suspected infection who received intravenous fluids within 24 h of presentation were included. Results During the study period, 7533 patients with suspected infection received intravenous fluids. Of these, 1996 (26.5%) and 231 (3.1%) had suspected sepsis and septic shock, respectively. Each 1000 mL increase in intravenous fluids administered was associated with a reduction in risk of in-hospital mortality (adjusted odds ratio [AOR] 0.87, 95% confidence interval [CI] 0.76-0.99). This association was stronger in patients with septic shock (AOR 0.66, 95% CI 0.49-0.89), and those admitted to intensive care unit (ICU) (AOR 0.74, 95% CI 0.56-0.96). Patients with suspected sepsis and septic shock who received a total volume of >3600 mL had lower in-hospital mortality (AOR 0.44, 95% CI 0.22-0.91; AOR 0.16, 95% CI 0.05-0.57) compared to those administered <3600 mL within the first 24 h of presenting to the ED. There was no association between the time of initiation of fluids and in-hospital mortality among survivors and non-survivors (2.3 vs 2.5 h, P = 0.50). Conclusion We observed a reduction in risk of in-hospital mortality for each 1000 mL increase in intravenous fluids administered in patients with septic shock or admitted to ICU suggesting illness severity to be a likely effect modifier.

This chapter will offer the reader an outline of the current medical and surgical setting in Australia, and a description of contemporary key practice challenges that medical and surgical nurses face. It will also offer a description of pathways to practice in medical and surgical nursing and an overview of future challenges to nursing and nurses who practice in this area.

Background: Severe sepsis can lead to organ failure and death if immediate treatment, such as intravenous fluids and antibiotics, are not commenced within the first hour. Time - critical initiation of intravenous fluids which in other words is early goal directed fluid resuscitation has not always been given its clinical priority. This qualitative study aimed at exploring the experiences of emergency nurses initiating early goal directed fluid resuscitation in patients with sepsis. Methods: Using an exploratory approach, face - to - face semi - structured interviews were conducted with ten registered nurses working in emergency departments across New South Wales, Australia. Thematic analysis was used for data analysis. Findings: Participants described various factors that inhibited the timely initiation of early goal directed fluid resuscitation, some clinical practice challenges, and strategies to improve nursing practice. Most participants, particularly those practicing as Clinical Initiatives Nurses suggested the incorporation of nurse initiated early goal directed fluid resuscitation for patients with sepsis as part of their scope of practice. Conclusion: Our findings identified several barriers that inhibit effective nurse - initiated early goal directed fluid resuscitation. It is anticipated that these findings will provide validation for the re-evaluation of the existing protocols and practice guidelines to increase the scope of practice of emergency nurses initiating early goal directed fluid resuscitation. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia.