A new model for emergency nursing, developed in the hallways of Westmead Hospital, is receiving international recognition for its excellence.
Dr Margaret Murphy and Professor Kate Curtis discovered there was no evidenced-based framework to teach emergency nurses how to assess and manage emergency patients in Australia.
“It’s quite a specific kind of skill set when you don’t know what’s wrong with the patient. They don’t have a diagnosis, so you’re assessing what we call an undifferentiated patient, and then basing your treatment on that,” Margaret said.
Margaret says the demands on new emergency department (ED) nurses are enormous, given the complexity of cases they see.
“They’ll look after a newborn and then look after a 99-year-old, they look after patients with strokes, limb injuries and diabetic emergencies. It’s the whole spectrum and it’s really overwhelming for new nurses,” Margaret said.
Together Margaret and Kate created HIRAID, an assessment model for emergency nurses.
The pair wanted to determine how senior emergency nurses conduct their assessments and how to break that down into a formula which could be replicated by nurses new to ED.
“While the patients may appear the same, it’s how the nurse learns the patient’s history, how they recognise red flags and responds to that information that is critical to safe patient care,” Margaret said.
They distilled the essentials of emergency nursing into a simple framework HIRAID.
The acronym stands for History including Infection risk, Red flags, Assessment, Interventions and Diagnostics.
“It’s the essential elements of how you would assess and manage a patient presenting to an emergency department,” Margaret said.
HIRAID was first tested in a simulation setting at WSLHD, before it was taken into the real world at the Illawarra Shoalhaven Local Health District.
“Emergency nurses found it both useful and easy to use. It helped them pick up on patient deterioration earlier, prioritise the sickest patients, and escalate to doctors with more confidence and clarity,” Margaret said.
Following that, a research team came together to take HIRAID even further.
Led by Professor Kate Curtis and supported by industry partners and researchers like Professor Ramon Shaban and Research Clinical Nurse Consultant Danielle Parrett, HIRAID was rolled out in a large-scale trial.
“The trial involved over 1,300 nurses across 29 emergency departments in NSW and Victoria—the biggest study of its kind with emergency nurses in Australia,” Margaret said.
‘‘We saw real improvements in patient safety—things like fewer patients deteriorating, better pain management, clearer documentation, smoother handovers, and a better overall experience for patients,” Margaret said.
“We also had fewer cases of patients getting worse within 72 hours of being admitted through the ED,” Margaret said.
“It helps to highlight the role that nurses play in the management of emergency patients. Doctors appreciate it. Patients appreciate it,” Margaret said.
HIRAID has now been rolled out in over 130 emergency departments across New South Wales, South Australia, Victoria, and Tasmania.
In 2025, the framework gained international recognition when the American Academy of Nursing named it one of just five ‘Edge Runners,’ which is a huge honour.
Edge Runners are nurse-led models of care that improve healthcare quality, reduce costs, promote health equity, and boost patient satisfaction.
Several key global initiatives are underway to introduce HIRAID including in Thailand, South Africa, Sweden and Denmark.
HIRAID® has worked so well in emergency departments that it’s now being tested in other parts of the health system.
Led by Professor Ramon Shaban, the HIRAID approach is currently being trialled in 23 aged care facilities and hospital wards, including here at Westmead and across Western Sydney.
WSLHD HIRAID also recently won first prize for Best Paper, Evidence into practice at International Conference for Emergency Medicine, Canada.
The awards recognise the level of international excellence these nurse have achieved, the necessity for and the impact of HIRAID.
“We do a lot of good work here, we don’t always celebrate it, particularly in the ED, so it’s great to get the opportunity to celebrate it,” Margaret said.
Thinking back to how the system started, Margaret is very proud it has come from Westmead Hospital.
“It was a lot of hard work for everybody, it was definitely a great team effort. The executive supported it. The medical staff backed it. Most importantly nurses got on board,” Margaret said.
“It was really nice to be able to put Western Sydney on the map,” Margaret said.