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

Most hospital Emergency Departments (ED's) use triage systems that classify and prioritize patients almost exclusively on the basis of urgency. We propose a new triage system that incorporates patient complexity as well as urgency. Using a combination of analytic and simulation models, we demonstrate that complexity-based triage can substantially improve both patient safety (i.e., reduce risk of adverse events) and operational efficiency (i.e., shorten average length of stay). Our analysis indicates that ED's with a higher resource (physician and/or examination room) utilization, higher heterogeneity between the average treatment time of simple and complex patients, and a closer to equal split between simple and complex patients benefit more from the proposed complexity-based triage system. Finally, while misclassification of a complex patient as simple is slightly more harmful than vice versa, complexity-based triage is robust to misclassification error rates that are on the order of 5% to 25%.