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27
Fuzzy Cognitive Map Decision Support System
for Successful Triage to Reduce Unnecessary
Emergency Room Admissions for the Elderly
Voula C. Georgopoulos and Chrysostomos D. Stylios
Abstract.
This work presents a Fuzzy Cognitive Map Medical Decision Support
System (FCM-MDSS) for the hospital admission procedure of elderly patients. The
FCM-MDSS is applied to the Emergency Department (ED), where elderly patients
arrive requesting medical assistance. Here a new hybrid methodology is introduced
to develop FCM-MDSS exploiting human experience and accompanied by avail-
able bibliographic information. It is based on the widely applied Triage complex
decision-making process and the generally accepted procedures while trying to min-
imize unnecessary admissions as well as over/under-triaging. The FCM-MDSS is
evaluated for known cases of real patients arriving at the ED from the literature.
27.1
Introduction
Triaging involves an initial sorting of patients who arrive at the emergency room,
usually called emergency department (ED), by rapidly identifying patients requiring
immediate care due to urgent, life-threatening conditions as well as assessing the
severity of the problem so as to ensure that care is appropriate and timely [11].
Triage is a complex decision-making process, and as a result several triage scales
have been designed corresponding to decision support systems [5] to guide the triage
nurse to a correct decision.
Unfortunately, in the emergency room elderly patients, as a general rule, un-
dergo more diagnostic testing and have longer length of stays than younger ones,
[4, 42] because of their multiple health problems and as a result, they usually
use more resources. The Emergency Department (ED) all over the world is
faced with a continuous increase in visits [22], partly due to its excessive use
for non-urgent problems. The elderly frequently visit the ED because of their in-
creased prevalence to chronic-degenerative diseases, susceptible to frequent exacer-
bations. Since the aging population is destined to increase further, providing quality
