Skip to main content

Supervisory Fuzzy Cognitive Map Structure for Triage Assessment and Decision Support in the Emergency Department

  • Conference paper
  • First Online:
Simulation and Modeling Methodologies, Technologies and Applications

Part of the book series: Advances in Intelligent Systems and Computing ((AISC,volume 319))

Abstract

Soft Computing techniques, such as Fuzzy Cognitive Maps (FCMs), can handle uncertainties in modeling complex situations using abstract inference mechanisms; they have been successfully used to select among different suggestions, to lead to a decision and to develop Medical Decision Support Systems for many medical-discipline applications. FCM models have great ability to handle complexity, uncertainty and abstract inference as is the case in the health care sector. Here is examined the case of the triage procedure in the Emergency Department (ED), where a decision supporting mechanism is quite invaluable. A Hierarchical structure is proposed within an integrated computerized health system where the Supervisor is modeled as an abstract FCM to support the triaging procedure and assessment of the health condition of people with communication difficulties such as the elderly arriving at the ED. There is also the lower level of the hierarchical structure where a FCM-ESI DSS has been developed and used to assign the Triage ESI level of every patient. Here a new methodology for designing and developing the FCM-ESI DSS is presented so to ensure the active involvement of human experts during the FCM-ESI construction procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Aminzadeh F, Dalziel WB (2002) Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med 39:238–247

    Article  Google Scholar 

  2. Ashour OM, Kremer GEO (2013) A simulation analysis of the impact of FAHP–MAUT triage algorithm on the emergency department performance measures. Expert Syst Appl 40:177–187

    Article  Google Scholar 

  3. Barbee GA, Berry-Cabán CS, Daymude ML, Oliver J, Gay S (2012) The effect of provider level triage in a military treatment facility emergency department. J Emerg Primary Health Care 8(4):2

    Google Scholar 

  4. Birrer R, Singh U, Kumar DN (1999) Disability and dementia in the emergency department. Emerg Med Clin North Am 17(2):505–517

    Article  Google Scholar 

  5. Champion HR (1986) Triage. In Gales RH, Heilig RW Jr (ed) Trauma care systems. Aspen Publishers, Rockville, pp 79–109

    Google Scholar 

  6. Dallaire C, Poitras J, Aubin K, Lavoie A, Moore L (2012) Emergency department triage: do experienced nurses agree on triage scores? J Emerg Med 42(6):736–740

    Article  Google Scholar 

  7. Department of Health and Ageing (2007) Emergency triage education kit. Australian Government, Canberra

    Google Scholar 

  8. Emergency Nurses Association (ENA) (2001) Making the right decision: a triage curriculum, 2nd edn. ENA, Des Plaines

    Google Scholar 

  9. Eurostat (2013) People by age group. http://epp.eurostat.ec.europa.eu/portal/page/portal/population/data/main_tables. Last updated 26 Sept 2013

  10. Fernandes C, Tanabe P, Gilboy N, Johnson LA, McNair RS, Rosenau AM et al (2005) Five-level triage: a report from the ACEP/ENA five-level triage task force. J Emerg Nurs 31(1):39–50

    Article  Google Scholar 

  11. Georgopoulos VC, Stylios CD (2005) Augmented fuzzy cognitive maps supplemented with case based reasoning for advanced medical decision support. In: Nikravesh M, Zadeh LA, Kacprzyk J (Eds) Soft computing for information processing. Springer, New York, pp 389–388

    Google Scholar 

  12. Georgopoulos VC, Stylios CD (2008) Complementary case-based reasoning, competitive Fuzzy cognitive maps for advanced medical decisions. Soft Comput 12:191–199

    Article  Google Scholar 

  13. Georgopoulos VC, Stylios CD (2012) Introducing fuzzy cognitive maps for developing decision support system for triage at emergency room admissions for the elderly. In: Proceedings of the 8th IFAC symposium on biological and medical systems, 29–31 August, Budapest, Hungary

    Google Scholar 

  14. Georgopoulos VC, Stylios CD (2013) Fuzzy cognitive map decision support system for successful triage to reduce unnecessary emergency room admissions for the elderly. In: Fuzziness and medicine: philosophical reflections and application systems in health care. Springer, Berlin Heidelberg, pp 415–436

    Google Scholar 

  15. Georgopoulos VC, Malandraki GA, Stylios CD (2003) A fuzzy cognitive map approach to differential diagnosis of specific language impairment. J Artif Intel Med 29:261–278

    Article  Google Scholar 

  16. Gerdtz MF, Bucknall TK (1999) Why we do the things we do: applying clinical decision-making frameworks to triage practice. Accid Emerg Nurs 7(1):50–57

    Article  Google Scholar 

  17. Gilboy N, Tanabe T, Travers D, Rosenau AM (2011) Emergency severity index (ESI): a triage tool for emergency department care, Version 4. Implementation Handbook 2012 Edition. AHRQ Publication No. 12-0014

    Google Scholar 

  18. Göransson KE, Ehrenberg A, Marklund B, Ehnfors M (2006) Emergency department triage: is there a link between nurses’ personal characteristics and accuracy in triage decisions? Accid Emerg Nurs 14(2):83–88

    Article  Google Scholar 

  19. Grossmann FF, Zumbrunn T, Frauchiger A, Delport K, Bingisser R, Nickel CH (2012) At risk of undertriage? Testing the performance and accuracy of the emergency severity index in older emergency department patients. Ann Emerg Med 60(3):317–325

    Article  Google Scholar 

  20. Hampers LC, McNulty JE (2002) Professional interpreters and bilingual physicians in a pediatric emergency department: effect on resource utilization. Arch Pediatr Adolesc Med 156(11):1108–1113

    Article  Google Scholar 

  21. McCall B., Travers D, Platts-Mills T, Biese K (2009) Mistriage of elderly in the emergency department. Connecting the dots: geriatric nursing, education, and clinical simulation. Chapel Hill, NC

    Google Scholar 

  22. Nawar EW, Niska RW, Xu J (2007) National hospital ambulatory medical care survey: 2005 emergency department summary. Adv Data 386:1–32

    Google Scholar 

  23. Patel VL, Gutnik LA, Karlin DR, Pusic M (2008) Calibrating urgency: triage decision-making in a pediatric emergency department. Adv Health Sci Educ 13(4):503–520

    Article  Google Scholar 

  24. Rogers A, Rogers F, Bradburn E, Krasne M, Lee J, Wu D, Edavettal M, Horst M (2012) Old and undertriaged: a lethal combination. Am Surg 78(6):711–715

    Google Scholar 

  25. Salvi F, Morichi V, Grilli A, Giorgi R, De Tommaso G, Dessi-Fulgheri P (2007) The elderly in the emergency department: a critical review of problems and solutions. Intern Emerg Med 2:292–301

    Article  Google Scholar 

  26. Samaras N, Chevalley T, Samaras D, Gold G (2010) Older patients in the emergency department: a review. Ann Emerg Med 56(3):261–269

    Article  Google Scholar 

  27. Singer RF, Infante AA, Oppenheimer CC, West CA, Siegel B (2012) The use of and satisfaction with the emergency severity index. J Emerg Nurs 38(2):120–126

    Article  Google Scholar 

  28. Travers DA, Waller AE, Bowling JM, Flowers D, Tintinalli J (2002) Five-level triage system more effective than three-level in tertiary emergency department. J Emerg Nurs 28(5):395–400

    Article  Google Scholar 

  29. US Census Bureau (2011) 2010 Census Brief, Washington. US Department of Commerce, Economics, and Statistics Administrations, US Census Bureau, DC

    Google Scholar 

  30. Whiley SP, Alves H, Grace S (2013) Full-body X-ray imaging to facilitate triage: a potential aid in high-volume emergency departments. Emerg Med Int 2013:437078

    Google Scholar 

  31. Wuerz R (2001) Emergency severity index triage category is associated with six-month survival. ESI triage study group. Acad Emerg Med 8:61–64

    Article  Google Scholar 

  32. Yim VW, Graham CA, Rainer TH (2009) A comparison of emergency department utilization by elderly and younger adult patients presenting to three hospitals in Hong Kong. Int J Emerg Med 2:19–24

    Article  Google Scholar 

Download references

Acknowledgments

This work was supported by the joint research project “Intelligent System for Automatic CardioTocoGraphic Data Analysis and Evaluation using State of the Art Computational Intelligence Techniques” by the programme “Greece-Czech Joint Research and Technology projects 2011–2013”.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Voula C. Georgopoulos .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this paper

Cite this paper

Georgopoulos, V.C., Stylios, C.D. (2015). Supervisory Fuzzy Cognitive Map Structure for Triage Assessment and Decision Support in the Emergency Department. In: Obaidat, M., Koziel, S., Kacprzyk, J., Leifsson, L., Ören, T. (eds) Simulation and Modeling Methodologies, Technologies and Applications. Advances in Intelligent Systems and Computing, vol 319. Springer, Cham. https://doi.org/10.1007/978-3-319-11457-6_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-11457-6_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-11456-9

  • Online ISBN: 978-3-319-11457-6

  • eBook Packages: EngineeringEngineering (R0)

Publish with us

Policies and ethics