A Semantic-Based Model for Triage Patients in Emergency Departments

  • Guilherme Wunsch
  • Cristiano A. da Costa
  • Rodrigo R. Righi
Mobile & Wireless Health
Part of the following topical collections:
  1. Mobile & Wireless Health


Triage is a process performed in an emergency department that aims to sort patients according to their need for care. When performed speedily and correctly, this process can potentially increase the chances of survival for a patient with serious complications. This study aims to develop a computer model, called UbiTriagem, which supports the process of triage using the concepts of web semantics and ubiquitous computing focused on healthcare. For evaluating the proposal, we performed an analysis of scenario-driven triage based on previously determined ratings. In addition, we conducted a usability evaluation in emergency department with the developed prototype with two user groups: nurses and patients. The main scientific contribution is the automatic triage assessment based on the gathering of patient data on mobile devices, performed automatically through the use of a reasoning technique in an ontology. The results for all evaluations were very positive. The automatic triage assessment has been assertive in 93.3% of the cases and, after adjustments in the model, in 100% of the cases. Regarding user satisfaction, we obtained rates of 98.7% and 96% when considering perception of utility and ease of use, respectively.


Health services Emergency department Triage Ubiquitous computing Web semantics 



The authors would like to thank to the National Council for Scientific and Technological Development (CNPQ) for supporting the development of this work.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Sadeghi, S., Barzi, A., Sadeghi, N., and King, B., A Bayesian model for triage decision support. Int. J. Med. Inform. 75(5):403–411, 2006.CrossRefPubMedGoogle Scholar
  2. 2.
    Tian, Y., Zhou, T., Wang, Y., Zhang, M., and Li, J., Design and development of a mobile-based system for supporting emergency triage decision making. J. Med. Syst. 38(6):1–10, 2014.CrossRefGoogle Scholar
  3. 3.
    Salman, O., Rasid, M., Saripan, M., and Subramaniam, S., Multi-sources data fusion framework for remote triage prioritization in telehealth. J. Med. Syst. 38(9):1–23, 2014.CrossRefGoogle Scholar
  4. 4.
    Wang, S.-T., Construct an optimal triage prediction model: a case study of the emergency department of a teaching hospital in Taiwan. J. Med. Syst. 37(5):1–11, 2013.CrossRefGoogle Scholar
  5. 5.
    Christie, P., and Levary, R., The use of simulation in planning the transportation of patients to hospitals following a disaster. J. Med. Syst. 22(5):289–300, 1998.CrossRefPubMedGoogle Scholar
  6. 6.
    Dexheimer, J., Abramo, T., Arnold, D., Johnson, B., Shyr, Y., Ye, F., Fan, K.-H., Patel, N., and Aronsky, D., An asthma management system in a pediatric emergency department. Int. J. Med. Inform. 82(4):230–238, 2013.CrossRefPubMedGoogle Scholar
  7. 7.
    Jentsch, M., Ramirez, L., Wood, L., Elmasllari, E., The reconfiguration of triage by introduction of technology. In : Proceedings of the 15th International Conference on Human-computer Interaction with Mobile Devices and Services, New York, NY, USA, pp.55–64, 2013.Google Scholar
  8. 8.
    Christ, M., Grossmann, F., Winter, D., Bingisser, R., and Platz, E., Modern triage in the emergency department. Deutsches Ärzteblatt International. 107(50):892–898, 2010.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Farion, K., Michalowski, W., Wilk, S., O'Sullivan, D., Rubin, S., and Weiss, D., Clinical decision support system for point of care use: ontology driven design and software implementation. Methods Inf. Med. 48(4):381–390, 2009.CrossRefPubMedGoogle Scholar
  10. 10.
    Weiser, M., The computer for the 21st century. Sci. Am. 265(3):94–104, 1991.CrossRefGoogle Scholar
  11. 11.
    Satyanarayanan, M., Mobile computing: the next decade. SIGMOBILE Mobile Computing and Communications Review. 15(2):2–10, 2011.CrossRefGoogle Scholar
  12. 12.
    Yu, W., Gummadikayala, R., Mudumbi, S., A web-based wireless mobile system design of security and privacy framework for u-Healthcare. In : 10th International Conference on e-health Networking, Applications and Services, 2008. HealthCom 2008, Singapore, pp.96-101, 2008.Google Scholar
  13. 13.
    Gelogo, Y., and Kim, H.-K., Unified ubiquitous healthcare system architecture with collaborative model. International Journal of Multimedia and Ubiquitous Engineering. 8(3):239–244, 2013.Google Scholar
  14. 14.
    Humanização, B., HumanizaSUS - Acolhimento com avaliação e classificação de risco, 1st edn. Editora MS, Brasília, 2004.Google Scholar
  15. 15.
    Saúde, B., Política nacional de atenção às urgências, 3rd edn. Editora MS, Brasília, 2006.Google Scholar
  16. 16.
    Noy, N., and McGuinness, D., Ontology development 101: a guide to creating your first ontology. Stanford Medical Informatics, Stanford, 2001.Google Scholar
  17. 17.
    Krafzig, D., Banke, K., and Slama, D., Enterprise SOA: service-oriented architecture best practices 1st edn. Prentice Hall Professional, 2004.Google Scholar
  18. 18.
    Richardson, L., and Ruby, S., RESTful web services 1st edn. O'Reilly Media, Inc., 2008.Google Scholar
  19. 19.
    Mackway-Jones, K., Marsden, J., and Windle, J., Emergency triage 3rd edn. Blackwell Publishing, 2014.Google Scholar
  20. 20.
    Westergren, H., Ferm, M., and Häggström, P., First evaluation of the paediatric version of the Swedish rapid emergency triage and treatment system shows good reliability. Acta Paediatr. 103(3):305–308, 2014.CrossRefPubMedGoogle Scholar
  21. 21.
    Hansen, E., and Hunskaar, S., Telephone triage by nurses in primary care out-of-hours services in Norway: an evaluation study based on written case scenarios. BMJ Qual. Saf. 20(5):390–396, 2011.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Worster, A., Sardo, A., Eva, K., Fernandes, C., and Upadhye, S., Triage tool inter-rater reliability: a comparison of live versus paper case scenarios. J. Emerg. Nurs. 33(4):319–323, 2007.CrossRefPubMedGoogle Scholar
  23. 23.
    Gravel, J., Gouin, S., Bailey, B., Roy, M., Bergeron, S., and Amre, D., Reliability of a computerized version of the pediatric Canadian triage and acuity scale. Acad. Emerg. Med. 14(10):864–869, 2007.CrossRefPubMedGoogle Scholar
  24. 24.
    Padmanabhan, N., Burstein, F., Churilov, L., Wassertheil, J., Hornblower, B., Parker, N., A mobile emergency triage decision support system evaluation. In : Proceedings of the 39th Annual Hawaii International Conference on System Sciences, 2006. HICSS'06., Hawaii, p.96b, 2006.Google Scholar
  25. 25.
    Dong, S., Bullard, M., Meurer, D., Blitz, S., Ohinmaa, A., Holroyd, B., and Rowe, B., Reliability of computerized emergency triage. Acad. Emerg. Med. 13(3):269–275, 2006.CrossRefPubMedGoogle Scholar
  26. 26.
    Jobé, J., Ghuysen, A., Gérard, P., Hartstein, G., and D'Orio, V., Reliability and validity of a new French-language triage algorithm: the ELISA scale. Emerg. Med. J. 31(2):115–120, 2012.CrossRefGoogle Scholar
  27. 27.
    Folliard, K., A measurement of the reliability and validity of the Manchester triage system in an Irish healthcare Centre. University College Dublin, Dublin, 2006.Google Scholar
  28. 28.
    International Organization for Standardization. Ergonomic requirements for office work with visual display terminals (VDTs) - Part 11: Guidance on usability, ISO 9241-11:1998, ISO, 22p., 1998.Google Scholar
  29. 29.
    Holzinger, A., Usability engineering methods for software developers. Commun. ACM. 48(1):71–74, 2005.CrossRefGoogle Scholar
  30. 30.
    Zhang, D., and Adipat, B., Challenges, methodologies, and issues in the usability testing of mobile applications. International Journal of Human-Computer Interaction. 18(3):293–308, 2005.CrossRefGoogle Scholar
  31. 31.
    da Costa, C., Zaupa, D., Barbosa, J., Righi, R., Camargo, J., Daroit, N., and Yamin, A., A spontaneous social network based on mobile devices. Soc. Netw. Anal. Min. 4(1):1–14, 2014.CrossRefGoogle Scholar
  32. 32.
    Kenteris, M., Gavalas, D., and Economou, D., An innovative mobile electronic tourist guide application. Pers. Ubiquit. Comput. 13(2):103–118, 2009.CrossRefGoogle Scholar
  33. 33.
    Triantaphyllou, E., Multi-criteria decision making methods: a comparative study 44. Springer Science & Business Media, 2013.Google Scholar
  34. 34.
    Davis, F., Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Q. 13(3):319–340, 1989.CrossRefGoogle Scholar
  35. 35.
    Yoon, C., and Kim, S., Convenience and TAM in a ubiquitous computing environment: the case of wireless LAN. Electron. Commer. Res. Appl. 6(1):102–112, 2007.CrossRefGoogle Scholar
  36. 36.
    Likert, R., A technique for the measurement of attitudes. Arch. Psychol. 22(140):1–55, 1932.Google Scholar
  37. 37.
    Michalowski, W., Wilk, S., Farion, K., Pike, J., Rubin, S., and Slowinski, R., Design and development of a mobile system for supporting emergency triage. Methods Inf. Med. 44(1):14–24, 2005.PubMedGoogle Scholar
  38. 38.
    Shirabad, J., Wilk, S., Michalowski, W., and Farion, K., Implementing an integrative multi-agent clinical decision support system with open source software. J. Med. Syst. 36(1):123–137, 2012.CrossRefGoogle Scholar
  39. 39.
    Pedro, J., Burstein, F., Wassertheil, J., Arora, N., Churilov, L., Zaslavsky, A., On development and evaluation of prototype mobile decision support for hospital triage. In : Proceedings of the 38th Annual Hawaii International Conference on System Sciences, Hawaii, p.157c, 2005.Google Scholar
  40. 40.
    Jayaraman, P., Gunasekera, K., Burstein, F., Haghighi, P., Soetikno, H., Zaslavsky, A., An ontology-based framework for real-time collection and visualization of mobile field triage data in mass gatherings. In : Proceedings of the 46th Annual Hawaii International Conference on System Sciences, Wailea, Maui, HI, pp.146–155, 2013.Google Scholar
  41. 41.
    Aronsky, D., Jones, I., Raines, B., Hemphill, R., Mayberry, S., Luther, M., Slusser, T., An integrated computerized triage system in the emergency department. In : AMIA Annual Symposium Proceedings, pp.16–20, 2008.Google Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Guilherme Wunsch
    • 1
  • Cristiano A. da Costa
    • 1
  • Rodrigo R. Righi
    • 1
  1. 1.Universidade do Vale do Rio dos SinosSão LeopoldoBrazil

Personalised recommendations