From HAS-BLED to SH-BRAT: Bridging the Bleeding Risk Gap with the First Universal Nurse-Led Tool | ||||
| Egyptian Journal of Health Care | ||||
| Volume 16, Issue 3, September 2025, Page 480-494 PDF (630.77 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejhc.2025.448342 | ||||
 View on SCiNiTO | ||||
| Author | ||||
| Selwan Hamza Elgazzar | ||||
| Nursing Education Administration, King Saud Medical City, Saudi Arabia | ||||
| Abstract | ||||
| Background: Despite the prevalence of bleeding complications among hospitalized patients, nursing-led risk assessment remains underdeveloped and unsupported by standardized tools. Existing models such as the Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/Alcohol (HAS-BLED) score and the Outcomes Registry for Better Informed Treatment (ORBIT) are physician-centric, complex, and often incompatible with routine nursing workflows. This gap underscores the urgent need for a simple, evidence-based instrument tailored for bedside nursing use. Aim: To examine the clinical applicability, structural features, and contextual advantages of the Selwan Hamza’s Bleeding Risk Assessment Tool (SH-BRAT) as the first universal nurse-led tool for early identification of bleeding risk in hospitalized patients. Design: A descriptive comparative review design was adopted, integrating theoretical matrix analysis and literature synthesis to evaluate SH-BRAT against commonly used bleeding risk tools (HAS-BLED, ORBIT, Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines [CRUSADE], and International Medical Prevention Registry on Venous Thromboembolism [IMPROVE]). Methods: Relevant studies were identified through electronic database searches (PubMed, Scopus, and Web of Science) supplemented by manual reference checking. Data extraction focused on tool structure, scoring systems, workflow integration, and nursing applicability. The methodological quality and potential risk of bias of included studies were assessed using the Cochrane Risk of Bias Tool. Comparative synthesis was performed using five structured analytical tables and one conceptual figure illustrating differences in scoring systems and clinical usability. Results: The review revealed a lack of standardized, nurse-specific tools for bleeding risk assessment. SH-BRAT emerged as the only workflow-compatible instrument, comprising 13 binary items across three domains (Medical History, Clinical Indicators, and Age). Its simple structure enables bedside application without laboratory input, supporting consistent risk stratification and early detection of high-risk patients. Conclusion: SH-BRAT bridges a critical gap in bleeding risk assessment by introducing the first validated, nursing-specific framework suitable for bedside use. Its simplicity, applicability, and alignment with accreditation standards position it as a strategic advancement in nursing-led patient safety. Recommendations: Integration of SH-BRAT into routine nursing admission assessments is recommended. Institutions should embed it within policy frameworks, electronic health record systems, and training curricula to ensure consistent use. Further multicenter validation studies are encouraged to confirm its predictive value across diverse clinical settings. | ||||
| Keywords | ||||
| Bleeding Risk; Nursing Assessment; SH-BRAT Tool; Patient Safety; Clinical Decision-Making | ||||
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