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 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.”
 
“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 demonstrating 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 across NSW, Victoria, South Australia and Tasmania, and works in partnership with Australian Commission on Safety and Quality in Health Care, Commonwealth Chief Nurse, Australian College Nursing, College 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.” 

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.

At Westmead Hospital, Professor Margaret Murphy said: “We're seeing better patient outcomes, more confident nurses and stronger communication.

“HIRAID® helps us teach emergency nurses how to approach any undifferentiated patient, assessing and identifying what’s critical in every presentation.

“HIRAID® breaks down what an experienced emergency nurse can do, capturing the essential elements of how to assess and manage any patient presenting to an emergency department.”

“Without the HIRAID® framework it could take a junior nurse years to fully grasp the components of emergency nursing.  

“While the patients may appear the same, it's how the nurse learns to take a patient’s history, how to recognize red flags and responds to that information that is critical to safe patient care.”

“Using HIRAID®, we can identify red flags early in undifferentiated presentations, something that’s easily missed with an ad hoc approach.”

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. 

HIRAID®: a University of Sydney innovation with national reach

Professor Curtis developed HIRAID® alongside Professor Murphy at the University of Sydney after finding there was no structured approach to help nurses gather patient information easily. The study was then trialled in the simulated environment across Western Sydney Local Health District and Illawarra-Shoalhaven Local Health District, then piloted in EDs in Illawarra-Shoalhaven Local Health District. 

When developing the University of Sydney teaching curriculum, they wanted to create a simple, efficient and evidence-based framework that would guide how nurses assess and manage patients quickly and efficiently after they were triaged at the emergency department.

Research: Curtis, K et al, 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). DOI: 10.1016/j.ijnurstu.2025.105256

Declaration: The authors declare no competing interests. The study was funded by a NHMRC Partnership Grant. HIRAID® has been trademarked in Australia by the University of Sydney, and its associated education materials are copyrighted.