Complexity-Augmented Triage: A Tool for Improving Patient Safety and Operational Efficiency


Emergency departments (EDs) typically use triage systems that prioritize patients almost exclusively in terms of urgency - that is, their need for timely care. The authors analyze a triage system that is based on complexity of the patient's condition, as well as urgency. Using a combination of analytic and simulation models, they demonstrate that adding an up-front estimate of patient complexity to conventional urgency-based classification can substantially: 1) reduce the risk of adverse events, and 2) shorten the average length of stay.

Subsequently, they analyze which EDs might benefit the most from such a triage system. They find that EDs with high resource (physician and/or examination room) utilization, high heterogeneity in the treatment time between simple and complex patients, and a relatively equal number of simple and complex patients benefit most from complexity-augmented triage.

Finally, they analyze the effects of misclassification (e.g. a "simple" patient being classified as "complex" and vice versa) and find that: 1) although misclassification of a complex patient as simple is slightly more harmful than vice versa, complexity-augmented triage is relatively robust to misclassification error rates as high as 25%, 2) streaming patients based on complexity information and prioritizing them based on urgency is better than doing the reverse, and 3) separating simple and complex patients via streaming facilitates the application of "lean" methods that can further amplify the benefit of complexity-augmented triage.



Saghafian S, Hopp WJ, Van Oyen MP et al. Complexity-Augmented Triage: A Tool for Improving Patient Safety and Operational Efficiency. Manufacturing and Service Operations Management 2014; 16 (3): 329-345.

Not open access.