Impact of the HIRAID emergency nursing framework on nurse and patient outcomes: a cross-sectional study in Saudi Arabia

Abstract

Background: Emergency departments (EDs) face sustained demand and diagnostic uncertainty that can undermine consistency, safety, and patient experience. In Saudi Arabia, rapid modernization, multilingual populations, and multinational nursing teams highlight the need for standardized frameworks. HIRAID (History, Infection risk, Red flags, Assessment, Interventions, Diagnostics, with ongoing communication and reassessment) is a validated emergency nursing framework with limited evidence outside Australia. Methods: We conducted a cross-sectional study guided by the RE-AIM framework from October 2024 to February 2025 using bilingual surveys in multiple Riyadh EDs. Primary outcomes were nursing confidence in decision-making and patient satisfaction; secondary outcomes included safety protocol adherence, communication quality, and waiting times. The cross-sectional design limits causal inference, and findings may not generalize beyond Riyadh. Results: Nurses trained in HIRAID reported higher confidence and safety protocol adherence than untrained peers. Patients cared for by HIRAID-trained nurses reported greater satisfaction, improved communication, and shorter waiting times. Conclusions: HIRAID implementation in Saudi EDs was associated with improved nurse competencies and patient experience. Despite design and regional limitations, findings support integration of HIRAID into nursing education, documentation, and quality governance, and justify larger longitudinal and multi-center evaluations. Clinical trial number: Not applicable.