The implementation and usability of HIRAID, a structured approach to emergency nursing assessment

Professor Kate Curtis1,2,3,4,5, Dr Belinda Munroe2, Dr Connie Van1, Ms Tiana-Lee Elphick2

1Susan Wakil School of Nursing & Midwifery, The University of Sydney, Camperdown, , 2Illawarra Shoalhaven Local Health District, Wollongong, , 3The George Institute for Global Health, , , 4Illawarra Health and Medical Research Institute, , , 5Faculty of Science, Medicine & Health, University of Wollongong, ,

Background: Emergency nurses are responsible for the initial assessment, management and safety of critically ill patients. HIRAID, an evidence-informed emergency nursing assessment framework, is known to improve emergency nursing patient-assessment in the simulated environment however has not been evaluated in the clinical setting.

Methods: A pre-post design was used to assess the usability and impact of HIRAID on emergency nurses self-efficacy in the emergency department (ED). Nursing and medical staff from three Australian EDs were surveyed. Descriptive and paired sample t-tests statistics were conducted.

Results: One hundred and twenty-two emergency nurses completed the pre-intervention self-efficacy survey and 63 completed the post-intervention self-efficacy and satisfaction survey. Forty-two and 17 medical officers completed the pre- and post-intervention satisfaction surveys respectively. Nursing staff self-efficacy levels were unchanged pre- and post-HIRAID implementation (Mean (SD): 8.8 (0.21) vs 8.7 (0.20)) as was medical staff satisfaction (Mean (SD):7.5 (1.43) vs 7.8 (1.07)), although there was a trend towards improved communication.

Conclusion: The HIRAID structured approach to patient assessment is acceptable, feasible, practical and appropriate for use in the clinical environment. Further research will demonstrate the direct effects of HIRAID on clinical performance.


Professor Kate Curtis has been an Emergency Nurse since 1994 and is Clinical Nurse Consultant for Emergency at Illawarra Shoalhaven Local Health District. Kate is Professor of Emergency and Trauma Nursing at the University of Sydney and an honorary professorial fellow at the George Institute for Global Health. Kate’s translational research program focuses on improving the way we deliver care to patients and their families, and has attracted more than $4 million funding. Kate is the world’s most published author in the field of Trauma and Emergency Nursing and has mentored more than 40 clinicians in research projects.