A groundbreaking emergency nursing system, co-developed by a national team led by the University of Sydney and including Deakin Distinguished Professor Julie Considine AO, has been transforming emergency care since its rollout in 2020—saving lives and setting a new benchmark for nursing standards nationwide.
Trialled in 29 emergency departments across NSW and Victoria over three years and involving more than 100,000 patients and 1,300 nurses, the system is estimated to prevent deterioration in more than 5,400 patients if scaled across all emergency departments nationally.
Known as HIRAID® – which stands for History, including Infection risk, Red Flags, Assessment, Interventions, Diagnostics, reassessment and communication – the seven-step nursing framework for emergency department patients provides nurses with a structured approach to assess and manage patients after triage.
The trial demonstrated:
- a 7.4 percent drop in rapid response calls – meaning fewer patients’ condition deteriorated;
- a more than 8 percent improvement in early intervention for complex cases, and;
- ongoing use across all participating hospitals, three years after the trial ended.
The results come amid increasing global demand for emergency services, with patient safety incidents in emergency departments often due to failures in recognising and responding to patient deterioration, inadequate clinical handover, poor patient assessment, and treatment delays.
Lead researcher Professor Kate Curtis AO from the Susan Wakil School of Nursing and Midwifery said the framework’s impact had already been profound: ““We estimate the framework will help prevent deterioration in more than 5400 patients when upscaled to all emergency departments nationally.”
Chief Investigator Professor Considine from the Institute’s Centre for Quality and Patient Safety Research and Eastern Health, said “HIRAID® is a gamechanger for emergency nursing. By providing emergency nurses with an evidence-based structure, it supports safety-oriented decision making, reduces their cognitive load which is important in an unpredictable environment like the ED. We’ve managed to show that when emergency nurses use HIRAID®, patients are safer with less deterioration in the ED and also on the wards, emergency nurses’ documentation of care is better, patients and carers have a better experience and feel more engaged despite the many challenges in emergency care. HIRAID® also increases nurses’ confidence in patient care and communication, especially handover and reporting deteriorating patients to senior nurses or doctors – all really important for patient safety.”
The team now has plans to take the system globally, with a recent rollout in Thailand and further implementation planned in Sweden, South Africa, and Denmark. “When we think of medical innovation, we often imagine new medicines or cutting-edge medical technology,” said Professor Curtis. “But history shows us that emergency processes and safe nursing care can have just as profound an impact. Since the advent of triage, Australia has played a leading role in setting global standards. HIRAID® represents the next chapter: putting patients first and investing in nursing quality.”
Deakin is playing a key role in a collaboration with Mae Fah Luang University, Chiang Rai Hospital (a strategic partner of Deakin’s School of Nursing and Midwifery), and the University of Sydney to implement HIRAID® in Thailand. Professor Considine was instrumental in supporting Thai colleagues secure government funding to implement HIRAID® at Chiang Rai Hospital – with HIRAID® results expected in 2026.
HIRAID® was piloted in the Illawarra, and this recent trial running in Southern NSW, Northern NSW, Western Sydney, and Eastern Health (Victoria) in partnership with Australian Commission on Safety and Quality in Health Care, Commonwealth Chief Nurse, Australian College Nursing, College Emergency Nursing Australasia, and the NSW Agency for Clinical Innovation. HIRAID® has now been deployed across 160 emergency departments across NSW, Victoria, South Australia and Tasmania
Transforming Practice: HIRAID® Education Program
Professor Considine led the development of the HIRAID® Education Program, a cornerstone of the implementation strategy. This evidence-based program provides structure to many practices emergency nurses already use, drawing on the best available research in patient assessment, risk factors for adverse outcomes, recognition and response to clinical deterioration, and educational principles that foster deep learning and advanced critical thinking.
Since its launch, the HIRAID® Education Program has reached more than 6,000 emergency nurses across Australia. Trial results confirm its effectiveness in supporting high-level adoption of HIRAID® in clinical practice.
How HIRAID® improves patient care and nurses’ decision-making
Rapid response calls are triggered when a patient’s condition suddenly worsens. By improving nurses’ ability to recognise early warning signs and intervene sooner, HIRAID® prevents patients from deteriorating in the first place thereby reducing the need for these calls, ultimately saving lives and easing pressure on hospital resources.
Emergency nurses are responsible for vital sign assessment, interpretation, and care escalation, playing a key role in patient safety, making effective communication, timely escalation and clear handovers between emergency department staff essential to safe patient care.
More than 2,500 patients and carers also reported clearer communication and a better understanding of their care.
Recognised as a potential national standard in emergency nursing, HIRAID® is now being trialled in aged care and other hospital settings, with the potential to become a global model for patient safety.
Read the latest research paper: Reducing inpatient deterioration and improving patient safety in emergency departments with a standardised nursing framework: A stepped-wedge cluster randomised controlled trial
Read more about Deakin Distinguished Professor Julie Considine’s research
Read the University of Sydney HIRAID press release.
Read more about HIRAID: https://www.sydney.edu.au/medicine-health/our-research/research-centres/project-hiraid.html
