Framework improves the safety and quality of emergency nursing care

An emergency nursing framework designed to provide a consistent, evidence-based approach to patient care was recognised at the Australian Council on Healthcare Standards Quality Improvement Awards announced in November 2021. 

Illawarra Shoalhaven Local Health District (ISLHD) in NSW won the Clinical Excellence and Patient Safety Award for safer, better emergency nursing care with their HIRAID submission: ‘a proven, up-scalable emergency nursing framework’ aimed at ensuring Emergency nurses have an evidence base to their initial assessment and management of patients who enter Emergency. 

Dr Belinda Munroe, ISLHD Emergency Clinical Nurse Consultant, said it was an honour to be part of the team to receive the prestigious award. 

“An incredible amount of work over several years has been invested into this multi-institutional project, from a number of clinicians and researchers committed to improving patient care delivery,” Dr Munroe said. 

“To receive this award provides recognition of all the hard work invested into this project over several years and the value of HIRAID in delivering better and safer patient care to our patients.” 

Dr Munroe said the HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment, and communication) framework has been demonstrated to: 

  • Be highly useable in the clinical setting, with emergency nurses reporting high satisfaction with using HIRAID in their practice. 
  • Increase accuracy of documentation history and assessment performed by emergency nurses by 75%. 
  • Reduce deterioration of patients admitted to a ward by 50%. 
  • Significant cost savings, with estimated savings of $2 million across ISLHD alone. 

It was initially conceptualised by Professor Kate Curtis and Dr Margaret Murphy to address an identified gap when developing a post graduate course for emergency nurses. 

“HIRAID was then validated using research evidence and tested in the simulated setting by myself as part of a Doctor of Philosophy degree (PhD) supervised by Prof Curtis and A/Prof Thomas Buckley at Sydney University in 2015,” Dr Munroe said. “The framework has since been implemented and tested in the clinical setting across ISLHD and is now being implemented and tested further across NSW.” 

According to Dr Munroe prior to HIRAID there was no validated tool available to teach the nursing process of assessing and managing patients who present to the emergency department (ED) post triage. 

“Historically, nurses required extensive clinical skills, knowledge, and experience to work in the ED,” Dr Munroe said. “However, novice nurses are increasingly being employed in the ED without the experience to draw from to identify assessment and treatment needs of patients. HIRAID addresses this gap by providing emergency nurses with a standardised approach to patient assessment and care, from triage until they leave the ED.”  

Professor Kate Curtis and Dr Belinda Munroe. Image supplied.

HIRAID has been implemented and embedded across ISLHD and is currently being rolled out across NSW.  

Dr Munroe said there has also been interest from other states in Australia, and internationally including New Zealand, the United Kingdom, South Africa, South Asia, and Canada, while HIRAID train the trainer workshops have been held with colleagues in Fiji, Colombia, Nepal and Sri Lanka to enable the future adaptation of HIRAID in these countries. 

“Given the evidence-based nature of the HIRAID framework and implementation strategy we would like to see HIRAID consistently implemented and applied by emergency nurses across the globe, so that whatever emergency department a patient presents to, they are provided with the same evidence-based approach to care.”  


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