Criticality and clinical department prediction of ED patients using machine learning based on heterogeneous medical...

Emergency triage faces multiple challenges, including limited medical resources and inadequate manual triage nurses, which cause incorrect triage, overcrowding in the emergency department (ED), and long patient waiting time.

This paper aims to propose and validate an accurate and efficient artificial intelligence-based method for effectively ED triage and alleviating the pressure on medical resources.

We propose two novel machine learning models, TransNet and TextRNN, for predicting patient severity levels and clinical departments using heterogeneous medical data in ED triage. Our models employ a parallel structure for feature extraction and incorporate an attention mechanism to extract essential information from the fused features, enabling accurate predictions. The models analyze the triage data (2020-2022) from the ED of Beijing University People's Hospital, incorporating variables (demographics, triage vital signs, and chief complaints) to identify patient severity levels and clinical departments. We performed data cleaning, categorization, and encoding first. Then, we divided the available data into a training set (56%), a validation set (24%), and a test set (20%) by random sampling. Finally, our models underwent 5-fold cross-validation and were compared with other state-of-the-art models.

We comprehensively evaluated the proposed models against various Recurrent Neural Networks (RNN), Convolutional Neural Networks (CNN), Traditional Machine Learning (TML), and Transformer-based (TF) models, achieving excellent performance in predicting triage outcomes. Specifically, TextRNN achieved a prediction success rate of 86.23% [85.86-86.70] for severity levels and 94.30% [94.00-94.46] for clinical departments among 161,198 ED visits. Moreover, TransNet demonstrated higher sensitivities of 84.08% and 90.05% for severity levels and clinical departments, respectively, with specificities of 76.48% and 95.16%. The accuracy of our model is 0.87%, 0.18%, 4.29%, and 1.96%, higher than that of the above four family models on average. Furthermore, our method significantly reduced under-triage by 12.06% and over-triage by 17.92% compared to manual triage.

Experimental results demonstrated that the proposed models fuse heterogeneous medical data in the triage process, successfully predicting patients' triage outcomes. Our models can improve triage efficiency, reduce the under/over-triage rate, and provide physicians with valuable decision-making support.