Coupling Wearable Devices and Decision Theory in the United States Emergency Department Triage Process: A Narrative Review

• Main Authors: Valentina Nino, David Claudio, Christie Schiel, Brendan Bellows
• Format: Article
• Language: English
• Published: MDPI AG 2020-12-01
• Series: International Journal of Environmental Research and Public Health
• Subjects: MAUT; continuous patient monitoring; emergency department; patient prioritization; closed-loop system
• Online Access: https://www.mdpi.com/1660-4601/17/24/9561
• ISSN: 1661-7827; 1660-4601

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.