Selection of a Preference Aggregation Method for Emergency Room Nurse Triage Decisions
Open Access
- Author:
- Fields, Erica Brooke
- Graduate Program:
- Industrial Engineering
- Degree:
- Master of Science
- Document Type:
- Master Thesis
- Date of Defense:
- None
- Committee Members:
- Gul Kremer, Thesis Advisor/Co-Advisor
Gul Kremer, Thesis Advisor/Co-Advisor - Keywords:
- healthcare
multi-criteria decision making
preference aggregation
utility theory - Abstract:
- Most of the Emergency Departments (EDs) in major areas are often overcrowded. Therefore, in order to recognize who is most in need of care, most EDs utilize a triage system to sort patients by severity of illness or injury. The triage is a decision-making process with which patients are prioritized according to their medical condition and chance of survival on arrival at the ED. The Emergency Severity Index (ESI) is a five-level triage system used by a majority of hospitals to assist in the prioritization. However, there is still a lot of subjective decision-making in the process which leads to discrepancies among nurses. In this work, we seek to determine a suitable aggregation method that best represents the individual nurse prioritizations and benefits an ED nurse staff by simplifying their decision-making. We chose five methods from the literature to explore, and through the application of utility theory combined with an expert opinion, determined the best method. The similarities and differences between the methods are also discussed. To this end, this study first analyzes the discrepancies in prioritizing patients from nurses at different hospitals and within the same hospital. Nurses were given the same exercise of assigning an ESI number to several fictionalized patients and ranking them in order of importance. Using Spearman’s rank correlation comparison method, the results show that there are differences in ranking the patients, among nurses at different hospitals and even within the same hospital. With this basis as justification for our work, utility theory is applied to select the best aggregation method for the situation. Next, four rank aggregation methods are applied to the prioritization data and then an expert evaluates the results and judges them on practicality and acceptability. The proposed recommendation for preference aggregation is the method of the estimation of utility intervals, and actually is different than the utility theory recommendation. Expert opinion is highly valued in a decision-making environment such as this, where experience and intuition are key to successful job performance and outcomes.