A nursing system developed at the University of Sydney is helping to save lives in emergency departments, setting a new national standard for nursing care since its rollout in 2020.
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 per cent drop in rapid response calls – meaning fewer patients’ conditions deteriorated – a more than 8 per cent 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 5,400 patients when upscaled to all emergency departments nationally,” she said.
“Emergency departments are chaotic and unpredictable. HIRAID® gives nurses a lifeline – a clear, evidence-based process to act fast when every second counts. We’re seeing improved assessment skills, earlier recognition of patient deterioration, and the confidence to escalate concerns immediately and effectively – all of which help prevent catastrophic events.”
The team now has plans to take the system globally, with a recent rollout in Thailand and further implementation planned in Sweden, South Africa, Saudi Arabia 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.”
HIRAID® was piloted in the Illawarra, with this study focusing on Southern NSW, Northern NSW, Western Sydney and Eastern Health in Victoria.
It has now been deployed across 160 emergency departments in NSW, Victoria, South Australia and Tasmania, and works in partnership with the Australian Commission on Safety and Quality in Health Care, the Commonwealth Chief Nurse, the Australian College of Nursing, the College of Emergency Nursing Australasia, Deakin University and the NSW Agency for Clinical Innovation.
“HIRAID® aligns with our system-wide priorities in patient safety, clinical excellence and workforce capability. Equipping nurses with a clear, standardised process enhances decision-making, supports early recognition of deterioration and strengthens communication across emergency care teams,” said Dr Jean-Frédéric Levesque, Chief Executive of the NSW Agency for Clinical Innovation and Deputy Secretary, Clinical Innovation and Research Division at the NSW Ministry of Health.
“The ACI is committed to supporting innovations like HIRAID® that deliver real-world impact and contribute to safer, more efficient healthcare systems.”
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Declaration: The authors declare no competing interests. The study was funded by an NHMRC Partnership Grant. HIRAID® has been trademarked in Australia by the University of Sydney, and its associated education materials are copyrighted.
