Abstract
This research was motivated by the nurses’ decision-making process in the current emergency department (ED) triage process in the United States. It explores how continuous vital signs monitoring can be integrated into the ED. The article presents four shortcomings on current ED triage systems and proposes a new conceptual clinical decision support model that exploits the benefits of combining wireless wearable devices with Multi-Attribute Utility Theory to address those shortcomings. A literature review was conducted using various engineering and medical research databases, analyzing current practices and identifying potential improvement opportunities. The results from the literature review show that advancements in wireless wearable devices provide opportunities to enhance current ED processes by monitoring patients while they wait after triage and, therefore, reduce the risk of an adverse event. A dynamic mathematical decision support model to prioritize patients is presented, creating a feedback loop in the ED. The coupling of wearable devices (to collect data) with decision theory (to synthesize and organize the information) can assist in reducing sources of uncertainty inherent to ED systems. The authors also address the feasibility of the proposed conceptual model.
Highlights
Emergency departments (EDs) handle high quantities of patients every day, each with varying criticality and needs
When this review indicates a potential medical or system error, the case is further reviewed by a peer review committee [30]
Current triage systems or algorithms are based on the nurse’s initial triage, which could include assessing patient vital signs when patients arrive at the ED
Summary
Emergency departments (EDs) handle high quantities of patients every day, each with varying criticality and needs. Patient triage is used to manage a large volume of patients and sort them based on the severity of their condition [1,2]. Various types of triage systems can be used to sort patients waiting in the ED [3]. EDs in countries such as Australia and Canada have developed their five-level triage system. Australia uses the Australasian (National) Triage Scale [4], Canada has the Canadian. Some EDs in the United States (US) currently use a three-level system. Five-level systems have gained acceptance, as researchers have demonstrated the effectiveness and reliability compared to the three-level system [5,7,8,9]
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