Emergency Protocols Initiating Care (EPIC) – standardising nurse-initiated care across NSW

Prof. Kate Curtis1, Rachael Allen2, Wayne Varndell3, Michael Golding2

1Emergency Services, Illawarra Shoalhaven Local Health District, 2Emergency Care Institute, NSW Agency for Clinical Innovation, NSW Ministry of Health, 3Emergency Department, Prince of Wales Hospital, South East Sydney Local Health District


Nurse-initiated care drives early, evidenced based treatment that is known to improve patient care, outcomes and health service delivery. EDs in NSW provided care for 2,880,287 patients in 2017-18. However there is variation in how nurse-initiated care is developed, endorsed and delivered in NSW Emergency Departments (ED), which can result in unwarranted variations in care. To address this gap in care delivery, in January 2018 the NSW Emergency Care Institute, with the Emergency Clinical Nurse Consultants and Educators from across NSW have agreed on a standardised approach to managing common ED presentations and developed an evidenced based state-wide nurse-initiated care framework to meet national and NSW Health State based objectives.


To describe the development of, need and framework for Emergency Protocols Initiating Care (EPIC).


A repository of existing emergency nurse training and protocols was compiled, including the Rural Adult Emergency Clinical Guidelines and the First Line Emergency Care Course (FLECC).  Through a series of teleconferences with senior nurse clinicians around NSW, a protocol template was developed. The template is informed by HIRAID, the only known evidence based emergency nursing assessment framework. The protocol includes history taking and clinical assessment prompts, clinical indicators of urgency and interventions including medication indications and doses. The protocols will be published as a Policy Directive with ECI as the authoring agency and the Ministry of Health the custodian. An education working party was formed to inform the education tools and processes, and an implementation group to develop the strategy with key stakeholders.


The EPIC template has been populated with more than 50 of the most common types of adult and paediatric emergency presentations.  Alongside the protocols, a state-wide framework for the education and professional development of emergency nurses is under development. This framework identifies the core knowledge and skills required by ED nurses to deliver the assessment and management outlined in the clinical guidelines, and, to progress from a transitional emergency nurse to an EPIC trained nurse.  A NSW wide credentialing program, adapting and building on existing education will be housed at a State level, and allow for a more transferable emergency workforce across NSW.


The EPIC project has provided the opportunity to incorporate translational research into the standardisation and structured assessment and management of common presenting conditions to ED’s across NSW. EPIC will enable standardised, best-practice nurse-initiated care in all NSW EDs


Bio to come