HIRAID® is the only evidence-based framework supporting emergency nurses in patient assessment and management after triage. It brings together the essential elements needed for timely, safe, high-quality emergency nursing care.
In partnership with Australian Commission on Safety and Quality in Health Care, Commonwealth Chief Nurse, Australian College Nursing, College Emergency Nursing Australasia and NSW Agency for Clinical Innovation, we implemented and evaluated HIRAID® across 29 emergency services in New South Wales and Victoria. The study involved 1,377 nurses who collectively cared for 281,984 patients, 106,047 of whom were admitted.
Implementing HIRAID® significantly improved patient care, patient and carer experience, and interprofessional communication. The evidence and results summary can be found here.
HIRAID® aligns with the Australian Commission for Quality and Safety in Health Care National Safety and Quality Health Service Standards.
Improving the safety and quality of nurse-led aged care.
Like their colleagues in the ED, registered nurses in residential aged care homes (RACH) are the frontline carers responsible for the safety and quality of aged care.
Anchored in a strong foundation of research evidence and expert input, HIRAID® Aged Care aims to improve the clinical outcomes for residents through increasing the quality of resident assessment; recognition and response to clinical deterioration; nurses’ communication, decision-making, situational awareness and task management skills; and nurses' self-efficacy and levels of anxiety.
HIRAID® Aged Care will meet the contemporary practice needs of nurses working in RACHs having been co-designed and tested by them and the recipients of their care in partnership with leading aged care providers and other agencies committed to the provision of quality care in aged care nationally. HIRAID® Aged Care ultimately aims to improve clinical outcomes for residents by reducing avoidable clinical deterioration and hospital transfer, improve resident satisfaction with care, improve nurse and medical staff satisfaction with communication, and improve the quality and quantity of nursing documentation.
In 2024, a real-time Delphi method was employed to contextually adapt the HIRAID® framework. Twelve expert health-care clinical leaders with understanding of patient assessment and residential aged care management.
Australia has an ageing population and demand for high-quality aged care services will only increase in the coming years, to which quality nursing care is fundamental. More than 1.3 million people use aged care services in Australia. Approximately 191,000 are cared for in RACHs delivered by approximately 730 providers in 2,600 facilities across the country.
The health needs of older Australians are unique in their complexity and comorbidity. Almost half of the permanent RACH residents have comorbid healthcare needs including heart disease, arthritis, dementia, pain and depression.
They are at a higher risk of experiencing the adverse effects of substandard care and unexpected events, like disease outbreaks. Infections, COVID-19 and other communicable diseases, and injuries cause greater harm and mortality in older Australians compared to the general population. Consequently, residents of RACHs are in greater need of high quality, safe nursing assessment, management and care.
Registered nurses in Australia’s RACHs need more support to meet the contemporary complex health and wellbeing needs of residents.
As the direct care staff responsible for the initial assessment and ongoing clinical management of residents with a range of acute and chronic complex health needs, resident safety and wellbeing are contingent on their accurate assessment, interpretation of clinical data, intervention, and escalation.
Starting in 2024, the co-designed HIRAID® Aged Care framework is being trialled using a modified stepped-wedge cluster randomised controlled trial design in 23 residential aged care homes in six organisations: Southern Cross Care, Hardi Aged Care, United Protestant Association of NSW Ltd., Opal Health Care, Minchinbury Manor, and Gallipoli Home. Participating homes were selected by executives from each organisation based on their suitability and readiness to adopt the intervention. Selected homes vary in size and total bed numbers (ranging from 25 to 149) and include a mix of not-for-profit, for-profit, faith-based, and non-faith-based organisations).
The delivery of the intervention is multi-pronged and supported by strategies informed by behaviour change and implementation science, including the assessment of enablers and barriers to HIRAID® Aged Care implementation, a co-designed and scaffolded education program, and integration of HIRAID® Aged Care into homes’ documentation systems.
Click here to see what do nurses think about HIRAID Aged Care so far.
All core elements of HIRAID® Aged Care are underpinned by the new Strengthened Aged Care Quality Standards.
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Each year, up to 16% of Australia’s 11.6 million hospital patients a year experience adverse events due to failure in preventing, recognising and responding to acute deterioration1.
Nurses play a crucial role in preventing and minimising these events by monitoring patients' vital signs, assessing risks, and recognising and responding to deterioration. Yet, the prevalence of adverse events persists, indicating existing nursing frameworks for ward nurses are insufficient.
A review of the international literature found no standardised validated structure to support inpatient nursing assessment and care after admission2.
We hypothesise HIRAID® Inpatient will address these issues by providing nurses with an evidence-based structured approach to nursing care in the hospital setting.
HIRAID® Inpatient aligns with the Australian Commission for Quality and Safety in Health Care National Safety and Quality Health Service Standards
HIRAID® Inpatient builds on the HIRAID® and HIRAID® Aged Care research programs.
“This project was born from hospital nurse managers that sought our assistance to optimise nursing assessment and escalation of patient care after seeing the success of HIRAID® in emergency departments,” said Professor Kate Curtis, founder and lead investigator of HIRAID®.
With consumers and nurses from 35 different wards across 10 hospitals, we will codesign a new standardised, world-first, fit-for-purpose, ‘whole-of-patient’ nursing framework known as HIRAID-Inpatient.
HIRAID® Inpatient builds on research from the five-year NHMRC partnership grant HIRAID® ED where implementation of HIRAID® improved nursing assessment, recognition and escalation of clinical deterioration, handover and patient experience.
We hypothesise Implementation of HIRAID® Inpatient will result in a…
H1 |
…20% reduction in rapid response team activation due to preventable patient deterioration |
H2 |
…10% reduction in Hospital Acquired Complications (HAC03 and HAC06) |
H3 |
…20% reduction in events causing patient harm or near miss |
H4 |
…10% improvement in experience of care reported by patient or carer |
H5 |
…10% increase in quality of nurse communication and handover |
H6 |
…healthcare resource use and cost estimates that will lead to favourable cost-effectiveness estimates |
H7 |
…high fidelity (80%) implementation |
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High-consequence infectious diseases (HCIDs) broadly describe acute communicable diseases that have a high case mortality, are highly communicable, and are difficult to prevent, contain and treat. Treatment of patients with confirmed or suspected HCIDs typically requires a high level of care in a controlled environment, such as an intensive care unit or a dedicated quarantine facility. Without adequate preparedness there is a significant risk of community transmission, and patient and workforce morbidity and mortality, all of which have major resource implications for state and national health systems.
Despite the presence of dedicated human-health HCID facilities in Australia, the likelihood of a person with an HCID presenting to one of these facilities as their first point of contact with the healthcare system is low. Rather, ill patients are more likely to present to their nearest primary healthcare provider, such as their community clinic or emergency department (ED). In this era of accelerating emergence and re-emergence of communicable diseases, it is critical to ensure that Australia’s most targeted infrastructure for managing patients with HCIDs is appropriately and adequately equipped with the resources and tools to complete this role effectively.
HIRAID® HCID will be a variant of the HIRAID® emergency nursing framework that specifically aims to guide nurses in the timely identification and safe assessment and management of patients presenting to EDs with communicable diseases.
This study intends to develop a variant of the HIRAID® clinical assessment framework for the specific identification, initial assessment and management of patients with communicable diseases, including HCIDs. This research will bring together experts in emergency nursing, communicable diseases, microbiology and infection prevention and control, from across Australia to participate in a two-stage qualitative study to adapt the existing HIRAID® framework and co-design the HIRAID® HCID tool.
The adaptation process recently commenced in late-2025 with the completion of several focus groups with clinicians and communicable disease experts in Westmead Hospital. The Delphi is scheduled to commence in early 2026 and will involve a wide range of partners, including clinicians from all 12 existing human-health HCID facilities in Australia.
Using HIRAID® as the foundation, HIRAID® HCID will synthesise the essential elements of clinical assessment and management of patients with confirmed and/or suspected communicable disease and develop a new model of care tailored to the specific health needs and complexities of these presentations. The qualitative research process will enable the identification of likely facilitators and barriers for the implementation of clinical assessment frameworks in quarantine facilities, as perceived by current infection control and biocontainment experts.
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In July 2025, supported by Professor Julie Considine and Professor Kate Curtis, Chiang Rai became home to Thailand’s first HIRAID® trained nurses – including 13 certified HIRAID® Instructors
As a part of the implementation phase, nurses from Chiangrai Prachanukroh Emergency Department, with the support of nursing and medical executive and Mae Fah Luang University, co-designed documentation templates and are developing an eMR solution.
Stay tuned for the research findings coming in 2026!
Dr Phornsawan Chuajedton (project lead) with Director of Nursing Warangkana Dhuvakham
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LinkIn August 2025, Kate Curtis and Ramon Z. Shaban had the privilege of facilitating the Swedish Emergency Nursing Association (SENA) – HIRAID® workshops held at Karolinska University Hospital Solna, coordinated and designed by Kate Curtis and Julie Considine AO.
This two-day event brought together 75 dedicated emergency nurses from Sweden and Denmark to learn about the HIRAID® framework and its potential impact on emergency care in Sweden. Swedish emergency nurses encounter similar challenges to those faced in Australian emergency departments, highlighting the need for a standardised framework.
The first Swedish Instructor courses will be held in 2026, led by the Swedish Emergency Nursing Association (SENA).
Left to Right: Prof Julie Considine, Dr Katarina Göransson, Prof Kate Curtis, Dr Lizzy Mårtenson
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LinkWe interviewed Dr Santel de Lange PhD (Nursing Science) from the Faculty of Medicine and Health Sciences at Stellenbosch University about her experience with HIRAID® and their plans for future implementation.
How are you using HIRAID®?
I teach HIRAID® to the Postgraduate Diploma in Emergency Nursing students. I was introduced to HIRAID® when I studied towards the Trauma and Emergency Nursing postgraduate diploma and since then I have used it when working in the ED. Since I find HIRAID® to be effective to use for patient assessments I incorporated it into the curriculum for the emergency nursing students I teach. I’ve been teaching it to emergency nursing students for two years now and I can see that it has given them a systematic approach to ED patient assessment of any illness or injury. Students applying it in practice said it is easy to use, remember and apply.
What potential does HIRAID® have in your context?
It is a systematic, step by step approach to assessing patients which makes is easy to remember and use when assessing a patient. In emergency care we love systems and algorithms and HIRAID® is designed to be used in such a way that you follow the “algorithm” and then you can’t go wrong. HIRAID® can effectively be used with the primary and secondary survey, but it provides nurses with their own assessment framework which includes all the other aspects expected of nurses to be done during an assessment. If you follow the steps in HIRAID® you can’t miss anything. I also think HIRAID® equips nurses with confidence. When a nurse does a proper assessment, he/ she will have all the required information to provide to the doctor at once which will reduce the possibility of the doctor asking the nurse a whole lot of questions to which he/ she does not have the answer. It also has the potential to reduce waiting times as a proper assessment indicates what is needed and when.
What are your next steps with HIRAID®?
I will continue to teach HIRAID® in the postgraduate emergency nursing diploma. We also have an exciting project planned to further introduce HIRAID® into South African EDs. We will start off by contextualising HIRAID® to the South African context and thereafter we will start to implement it into the hospitals and evaluate where and how change to place. I am really excited about this project and to change the way nurses do assessments in the ED to improve patient outcomes.
HIRAID® in the USA – An exploratory study into emergency nurses’ perceptions of the utility, adaptability and feasibility of the emergency nursing framework HIRAID® for practice change:
A cross-sectional cohort study using a survey method with a convenience sample was conducted. The workshop was attended by 48 emergency nurses from 17 US States. Most respondents reported that all emergency nurses should use the same standardised approach in the assessment of patients. However, the greatest barriers to change were a lack of staff and support from management. The most likely interventions reported to enable change were face-to-face education, the opportunity to ask questions and support in the clinical environment.
It was concluded that HIRAID® is an acceptable and suitable emergency nursing framework for consideration in the US. Successful uptake will depend on training methods and organisational support. HIRAID® training should include face-to-face interactive workshops.
HIRAID® is embedded in the Emergency Nurses Association Nurse residency program as at April 2022
Read more: Curtis K, Fry M, Shaban RZ, Wolf L, Delao A, Kolbuk ME, Kennedy B, Considine J. Emergency nurses' perceptions of the utility, adaptability and feasibility of the emergency nursing framework HIRAIDTM for practice change in US: An exploratory study. Int Emerg Nurs. 2023 Nov;71:101377
Led by Dr Michele Angelo Milatino Sgambati (Sapienza University) with Dr. Alessandro Delli Poggi, Head of Nursing Education (Policlinico Umberto). Starting late 2025, through a rigorous forward–backward translation and expert review process, the project aims to ensure full linguistic and conceptual equivalence between the original Australian tool and the Italian context. This step will preserve the integrity of HIRAID® while making it accessible for use in Italian emergency settings.
The EPIC-START model of care supports evidence-based emergency care to improve health service and patient outcomes, for improved patient experience and outcomes and experience and emergency department efficiency. The EPIC-START model of care was developed based on robust evidence and decades of emergency specialty experience.
Evaluation is underway and focussed system and patient implications such as ED efficiency, increase in proportion of patients receiving care within national triage timeframes, patient length of stay in the ED, time to analgesia.
The model of care has three components:
1. EMERGENCY CARE ASSESSMENT AND TREATMENT (ECAT) PROTOCOLS
ECAT (previously called EPIC) are 73 adult and paediatric protocols for nurses to initiate care for some of the most common ED presentations, developed by the NSW Health Agency for Clinical Innovation and accessible via their website Emergency care assessment and treatment. ECATs support nurses to initiate treatment and diagnostic tests for patients that are waiting to see a doctor in the emergency department
2. SYDNEY TRIAGE TO ADMISSION RISK TOOL (START)
A validated early admission decision support/risk tool that predicts a patient’s likelihood of admission or discharge at point of triage.
3. CLINICAL DECISION TOOLS: NEWS/PEWS (New Early Warning System/Paediatric Early Warning System)
A clinical deterioration alert system that calculates risk of deterioration by looking at the routinely entered vital signs and their trends.
EPIC-START was implemented in 29 emergency departments in NSW in 2024 using implementation science principles and behaviour change theories with the input of 847 nurses, doctors and other health professionals to inform the strategy tailored to barriers and enablers.
A multi-modal implementation plan was released with education programs, meetings, audits, and environmental changes in line with stat-wide implementation. At three months post-implementation of ECAT, 885 nurses had attended one of the three education programs in 97 courses. A total of 787 nurses completed post-implementation surveys. Preliminary findings show that nurse confidence significantly increased across all aspects of nurse-initiated care, including identifying the need to initiate nurse-led care, and the necessary interventions, such as pathology, radiology, and medications.
START has been incorporated into the state-wide Patient Flow Portal system.
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