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About us

Meet the HIRAID research collaborative
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HIRAID is a registered trademark by The University of Sydney, and the associated education materials are copyrighted

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Led by Professor Kate Curtis AO, Professor of Trauma and Emergency Nursing, the HIRAID® Team have an impressive track record of implementing widespread sustained change that improves patient and health service outcomes for more than 15 years.

What is HIRAID®?

History including Infection risk, Red flags, Assessment, Interventions, Diagnostics.

The framework encapsulates the cyclic nature of patient assessment, in which more than one element may be performed simultaneously. It also embraces the importance of reassessment and communication.

  • History (incl. Infection Risk): the process of collecting details about why the patient has presented and relevant background information about the patient. Infection Risk: nested within history, and refers to the patient’s risk of infection or suspected/confirmed communicable disease, including precautions required.
  • Red Flags: historical or physiological indicators of urgency that identify potential or actual threat to life or limb, highlighting the need for timely escalation of care.
  • Assessment: comprehensive physical examination, prioritised to ensure life threatening conditions are identified first, followed by focused assessment guided by the presenting problem.
  • Interventions: the delivery of appropriate and prioritised interventions based on historical and physical assessment findings.
  • Diagnostics: the ordering, performing and reviewing of further investigations including pathology and diagnostic imaging.

Other elements within the HIRAID® framework:

  • Reassess: The evaluation of care and monitoring of patient progress. Maintain a structured approach, repeat at appropriate intervals per condition of the patient.
  • Communicate: Verbal/non-verbal skills necessary to effectively communicate with patients, families and clinicians. Use structured approach for clinical handover; graded assertiveness to escalate if needed; accurate and comprehensive clinical documentation.

Our impact

The evidence for HIRAID® was generated through a 15 year program of research, starting with simulation based study1, a pilot in the Illawarra Shoalhaven2 and most recently an NHMRC funded stepped-wedge cluster RCT3.

Implementing HIRAID® significantly improved patient care, patient and carer experience, and interprofessional communication. Specifically

  • 7.4% reduction in admitted patient harm (deterioration requiring a rapid response team call),
  • 2,839 patient/carers reported significant improvement in their care experience, specifically, emergency nurses communicated better (84%→91%) and better met their needs (87%→92%).  
  • 1,205 emergency nurses reported increased confidence in patient assessment, escalating care of deteriorating patients, and clinical handover

HIRAID® is now implemented in 170 EDs across Australia, with 550 HIRAID Instructors and an estimated 6500 nurses completed training. Building on this success, HIRAID® is now being adapted to the Aged Care and Inpatient environments.

1 Munroe, B., et al. (2016). The impact of HIRAID on emergency nurses' self-efficacy, anxiety and perceived control: A simulated study. International Emergency Nursing. 25: 53–58. https://doi.org/10.1016/j.ienj.2015.08.004
2 Curtis, K., et al. (2021). The implementation of an emergency nursing framework (HIRAID) reduces patient deterioration: A multi-centre quasi-experimental study. International Emergency Nursing.  56: 100976. https://doi.org/10.1016/j.ienj.2021.100976
3 Curtis, K., et al (2026) Reducing inpatient deterioration and improving patient safety in emergency departments with a standardised nursing framework: A stepped-wedge cluster randomised controlled trial. International Journal of Nursing Studies. 173, Article number 105256. https://doi.org/10.1016/j.ijnurstu.2025.105256  

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