Prototyping a better emergency room triaging scheduler.
This is a prototype.
I am currently working on moving from an OOP to data-oriented framework by using concepts from Entity-Component-System design in similar to what you might find in game development.
Even before the COVID-19 pandemic, hospital emergency departments (ED) have been under extraordinary strain, with a significant lack of healthcare providers and resources [1]. However, the current status quo for triage scheduling for ambulatory patients is a single-source triage assessment, usually done by a triage nurse. In Canada, patients in triage are categorized into five levels: Resuscitation, Emergent, Urgent, Less Urgent, and Non-Urgent, as defined by the Canadian Triage and Acuity Scale (CTAS) [2]. Various other countries implement a similar categorization scheme based on chief complaint and symptoms, including Simple Triage and Rapid Treatment (START) in the U.S. and the Australasian Triage Scale (ATS) in Australia [3].
Despite this categorization, emergency wait times for incoming patients exceed two hours on average [4][5]. Indeed, anecdotal evidence for wait times, not just for the ED but for other clinics well exceed the two hour average [6][7], although it should be noted that patients that have a pleasant experience in the healthcare system are less likely to post about it online, while patients that experience poor performance are more likely to do so. As it stands, a pleasant experience in the healthcare system is not the norm, and the primary factor to a poor experience is wait time [8].
Here we propose a new triage paradigm using a toy example simulator, which not only includes a severity score analogous to the triage scales as described above, but also takes into account patient wait time and estimated time-to-treat. This idea is inspired by CPU scheduling algorithms, where severity score is analogous to priority scheduling, wait time is analogous to first-come-first-serve (FCFS) scheduling and time-to-treat is analogous to shortest-job-first (SJF) scheduling.
We propose a hybrid scheduler that uses a position_score function incorporating severity, wait time, and time-to-treat as variables with arbitrary coefficients that can be tuned. In this toy example, we will be setting the position_score function as
where
severity_scoreis a arbitrary integer between [0, 100], with higher being more severe. In this prototype,severity_scorewill be randomly assigned.wait_timeis a positive integer, representing minutes elapsed since arrival.short_treatment_time_scoreis a positive integer, representing a score between [0, 60], based ontime_to_treat. The lower thetime_to_treat, the higher theshort_treatment_time_score, which will be calculated as
# Arbitrary linear function that gives highest scores to
# lowest time_to_treat
diff = 60 - time_to_treat
score = diff if diff > 0 else 0Additionally, we propose that as wait time increases, that severity score likewise increases. For example:
# Increase severity_score by one point every 15 minutes of wait time
severity_score = severity_score + (wait_time) // 15This "upgrade" of severity score as a function of wait time is arbitrarily implemented. Various other implementations are up to the creativity of the implementer.
Documentation on the implementation details of desert can be found in /docs.
High-level architectural design can be found in ./docs/design/architecure.
[1] Alan Drummond, (2022). State of Emergency: Inside Canada's ER Crisis. Maclean's. https://macleans.ca/longforms/er-doctor-healthcare-crisis-canada/
[2] The Canadian Triage and Acuity Scale: Education Manual (2012). https://caep.ca/wp-content/uploads/2017/06/module_1_slides_v2.5_2012.pdf
[3] Charles Yancey, Maria C. O'Rourke, (2023). Emergency Department Triage. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK557583/
[4] Time Spent in Emergency Departments. Health Quality Ontario. https://www.hqontario.ca/System-Performance/Time-Spent-in-Emergency-Departments
[5] Emergency Department Wait Times. University Health Network. https://www.uhn.ca/PatientsFamilies/Visit_UHN/Emergency/Pages/ED_wait_times.aspx
[6] "Healthcare rant". Reddit. https://www.reddit.com/r/ontario/comments/1aw9mz7/healthcare_rant/
[7] "I love watching where I grew up crumble to greed". Reddit. https://www.reddit.com/r/ontario/comments/1c35eq8/i_love_watching_where_i_grew_up_crumble_to_greed/
[8] Mike Crawley, (2022). Patients tell the inside story of Ontario's emergency rooms. CBC. https://www.cbc.ca/news/canada/toronto/ontario-emergency-room-stories-1.6509555