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patient records, experimental and laboratory tests etc. These can be dynamically
updated based on the system interaction, whereas the decision-concepts are consid-
ered as outputs where their estimated values outline the possible diagnosis for the
patient. It should be mentioned that the real strength of FCMs is their ability to
model and describe complex systems and handle successfully with situations where
there are feedback relationships and interrelationships between the factor concepts.
Thus, interrelations between factor-concepts can be included in the proposed med-
ical decision-support model. Such interconnections are shown in Fig. 27.2 where
the “competitive” interconnections between diagnosis concepts are also illustrated.
27.3
Emergency Department Triaging
27.3.1
Typical Scenario for Patient Arriving at Emergency
Department
When a patient first arrives in the Emergency Department (former known as the
emergency room), the first stop is triage. In triage, a trained and experienced reg-
istered nurse typically prioritizes each patient's condition into one of five general
categories. This is done according to the Emergency Severity Index (ESI) which
was designed for use in ED triage by the US Department of Health & Human Ser-
vices. The ESI is a five-level categorization algorithm that prioritizes patients into
five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity (i.e. se-
riousness) and the number of resources that the patient may need to receive proper
care [53]. A well-implemented ESI program helps hospital ED rapidly identify pa-
tients in need of immediate attention, while at the same time also identify patients
who could safely and more efficiently be transferred to other departments rather
than the Emergency Department. Triage staff use specific criteria to determine each
patient's acuity. For example they rapidly interview the patient, take patient's vital
signs (blood pressure, pulse, oxygen saturation level and respiratory rate). If the pa-
tient is complaining about pain they are asked to self-assess on a scale of 1-10 and
to identify the location of the pain. Additionally, nurses ask them what the major
complaint was that brought them into the ED. From the above and other information
collected, the triage nurse produces an Emergency Severity Index (ESI) score [16],
assessing the patient's condition. Based on the ESI score, the clinical staff sched-
ules to check back with the patient on a timely basis based on the patient's condition
[52].
27.3.2
Emergency Department Triaging Details
To ensure patient safety and provide quality services, hospitals must be certain that
each patient entered to the emergency department (ED) receives the appropriate care
at the right time. Triage is a means by which this is ensured. An experienced triage
nurse evaluates the patient's condition, as well as any changes, and determines their
priority for admission to the ED and their need for treatment [3]. This is necessary
