International Journal of Medical Informatics
Volume 75, Issue 5 , Pages 403-411 , May 2006

A Bayesian model for triage decision support

  • Sarmad Sadeghi

      Affiliations

    • University of Texas Health Science Center at Houston, School of Health Information Sciences, 7000 Fannin, Suite 600, Houston, TX 77030, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 7135003940; fax: +1 7135003907.
  • ,
  • Afsaneh Barzi

      Affiliations

    • University of Texas Medical Branch, School of Medicine, Galveston, TX 77555, USA
  • ,
  • Navid Sadeghi

      Affiliations

    • University of Texas Health Science Center at Houston, School of Medicine, Houston, TX 77030, USA
  • ,
  • Brent King

      Affiliations

    • University of Texas Health Science Center at Houston, School of Medicine, Houston, TX 77030, USA

Received 1 December 2004 ,Revised 29 May 2005 ,Accepted 17 July 2005.

References 

  1. Cioffi J. Triage decision-making: educational strategies. Accid. Emerg. Nurs. 1999;7(2):106–111
  2. Pane GA, Farner MC, Salness KA. Health care access problems of medically indigent emergency department walk-in patients. Ann. Emerg. Med. 1991;20(7):730–733
  3. Koziol-McLain J, et al. Seeking care for nonurgent medical conditions in the emergency department: through the eyes of the patient. J. Emerg. Nurs. 2000;26(6):554–563
  4. Marks MK, Steinfort D, Barnett PL. Inappropriate use of hospital emergency departments. Med. J. Aust. 2003;178(4):187–188
  5. Schappert SM. National Hospital Ambulatory Medical Care Survey: 1992 Emergency Department summary. Vital Health Stat. 1997;13(125):1–108
  6. Schneider S, et al. Rochester, New York a decade of emergency department overcrowding. Acad. Emerg. Med. 2001;8(11):1044–1050
  7. Baer RB, Pasternack JS, Zwemer FL. Recently discharged inpatients as a source of emergency department overcrowding. Acad. Emerg. Med. 2001;8(11):1091–1094
  8. Derlet RW, et al. Triage of patients out of the emergency department: three-year experience. Am. J. Emerg. Med. 1992;10(3):195–199
  9. Greenberg ME. Telephone nursing: evidence of client and organizational benefits. Nurs. Econ. 2000;18(3):117–123
  10. Rosenblatt E. Telephone triage. A common sense approach. RN. 2001;64(3):p. 2–3
  11. Sabin M. Telephone triage improves demand management effectiveness. Healthc. Financ. Manage. 1998;52(8):49–51
  12. Post WM, et al. FreeCall, a system for emergency-call-handling support. Meth. Inf. Med. 1996;35(3):242–255
  13. O’Connor JP. Nurse phone care — a new way of thinking (Part 2). Med. Group Manage. J. 1996;43(3):p. 58–9, 61–2, 64 passim
  14. McGraw E, Barthel H, Arrington M. A model for demand management in a managed care environment. Mil. Med. 2000;165(4):305–308
  15. Kastens JM. Integrated care management: aligning medical call centers and nurse triage services. Nurs. Econ. 1998;16(6):p. 320–322, 329
  16. DM nurse line creates ‘win–win’ scenario for point-of-service, product. Healthc. Demand Dis. Manag. 1997;3(4):57–59
  17. Lester JA, Breudigam M. Nurse triage telephone centers: key to demand-management strategy. NAHAM Manage. J. 1996;22(4):p. 13–14, 34
  18. Wolcott BW. Managed care's driving force: demand management. Infocare. 1996;12–15
  19. Franco SM, Mitchell CK, Buzon RM. Primary care physician access and gatekeeping: a key to reducing emergency department use. Clin. Pediatr. (Phila). 1997;36(2):63–68
  20. Barber JW, et al. Evaluation of emergency department referrals by telephone triage. Pediatrics. 2000;105(4 Pt 1):819–821
  21. Glotzer D, et al. Prior approval in the pediatric emergency room. Pediatrics. 1991;88(4):674–680
  22. Cioffi J. Decision-making by emergency nurses in triage assessments. Accid. Emerg. Nurs. 1998;6(4):184–191
  23. Wagner DE, et al. Health Care Plan's Nurse Advice System. Proc. Annu. Symp. Comput. Appl. Med. Care. 1992;74–78
  24. Selker HP, et al. Use of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) to assist with triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia. A multicenter, controlled clinical trial. Ann. Intern. Med. 1998;129(11):845–855
  25. Qamar A, et al. The Goldman algorithm revisited: prospective evaluation of a computer-derived algorithm versus unaided physician judgment in suspected acute myocardial infarction. Am. Heart J. 1999;138(4 Pt 1):705–709
  26. Pozen MW, et al. The usefulness of a predictive instrument to reduce inappropriate admissions to the coronary care unit. Ann. Intern. Med. 1980;92(2 Pt 1):238–242
  27. Patients can help with, documentation. ED Manage. 2000;12(10):116–117
  28. Frank SR. Digital health care – the convergence of health care and the Internet. J. Ambul. Care Manage. 2000;23(2):8–17
  29. Kinney WC. Web-based clinical decision support system for triage of vestibular patients. Otolaryngol. Head Neck Surg. 2003;128(1):48–53
  30. Edwards B. Telephone triage: how experienced nurses reach decisions. J. Adv. Nurs. 1994;19(4):717–724
  31. Marsden J. Decision-making in A&E by expert nurses. Nurs. Times. 1998;94(41):62–65
  32. Hilden J. The nonexistence of interpersonal utility scales. A missing link in medical decision theory?. Med. Decis. Making. 1985;5(2):215–228
  33. Nease RF. Do violations of the axioms of expected utility theory threaten decision analysis?. Med. Decis. Making. 1996;16(4):399–403
  34. Baron J. Why expected utility theory is normative, but not prescriptive. Med. Decis. Making. 1996;16(1):7–9discussion 14
  35. Wu G. The strengths and limitations of expected utility theory. Med. Decis. Making. 1996;16(1):9–10discussion 14
  36. Douard J. Is risk neutrality rational?. Med. Decis. Making. 1996;16(1):10–11discussion 14
  37. Eeckhoudt L. Expected utility theory — is it normative or simply “practical”?. Med. Decis. Making. 1996;16(1):12–13discussion 14
  38. Cohen BJ. Do the expected utility axioms hide flaws?. Med. Decis. Making. 1997;17(4):498–499
  39. Cohen BJ. Is expected utility theory normative for medical decision making?. Med. Decis. Making. 1996;16(1):1–6
  40. Graber MA, VanScoy D. How well does decision support software perform in the emergency department?. Emerg. Med. J. 2003;20(5):426–428
  41. Cheung WW, Heeney L, Pound JL. An advance triage system. Accid. Emerg. Nurs. 2002;10(1):10–16
  42. Goodacre SW, et al. Consistency of retrospective triage decisions as a standardised instrument for audit. J. Accid. Emerg. Med. 1999;16(5):322–324
  43. Nakagawa J, et al. Interobserver agreement in emergency department triage. Ann. Emerg. Med. 2003;41(2):191–195
  44. Quality of telephone triage nursing comes under fire. Healthc. Demand Dis. Manage. 1999;5(5):p. 65, 70–74
  45. Make CQI an integral part of call center management. Healthc. Demand Dis. Manage. 1998;4(4):53–55
  46. Gill JM, Reese CLt, Diamond JJ. Disagreement among health care professionals about the urgent care needs of emergency department patients. Ann. Emerg. Med. 1996;28(5):474–479
  47. O’Brien GM, et al. Do internists and emergency physicians agree on the appropriateness of emergency department visits?. J. Gen. Intern. Med. 1997;12(3):188–191
  48. Wachter DA, et al. Pediatric telephone triage protocols: standardized decision-making or a false sense of security?. Ann. Emerg. Med. 1999;33(4):388–394
  49. Brillman JC, et al. Triage: limitations in predicting need for emergent care and hospital admission. Ann. Emerg. Med. 1996;27(4):493–500
  50. Internet Resource: NHS Direct Online Website. URL: http://www.nhsdirect.nhs.uk/, (accessed on 1 December 2004).
  51. Kenny C. Telephone triage. Jury still out on safety of NHS direct. Nurs. Times. 2000;96(50):13
  52. Jordan M. NHS Direct Online has important role. BMJ. 2001;322(7289):795
  53. Eaton L. NHS Direct Online explores partnerships with other health organisations. BMJ. 2002;324(7337):568
  54. Carnall D. NHS Direct Online. BMJ. 2000;320(7226):66B
  55. Internet resource: WebMD Symptoms — Provided by Healthwise Inc., Boise, ID, USA.
  56. Internet resource: FamilyPractice.com Symptom Checker, based on Harvard Medical School Family Health Guide. URL: http://www.familypractice.com/symptomchecker/sc_frame.htm.
  57. Komaroff A. The Harvard Medical School Family Health Guide. New York: Simon & Schuster; 1999;(accessed 1 December 2004)
  58. Moore JD, et al. An analysis of patient compliance with nurse recommendations from an after-hours call center. Am. J. Manage. Care. 2002;8(4):343–351

 Parts of this paper – descriptive statistics and not analytical statistics – were presented at “Medicine Meets Virtual Reality 2002 Meeting (MMVR02)” in Newport Beach, CA in January 2002.

PII: S1386-5056(05)00143-7

doi: 10.1016/j.ijmedinf.2005.07.028

International Journal of Medical Informatics
Volume 75, Issue 5 , Pages 403-411 , May 2006