When to Use Provider Triage in Emergency Departments

We study triage decisions in emergency departments (EDs) and provide a general procedure for determining when to apply provider triage (PT) based on operational and financial considerations using a steady-state, many-server fluid approximation. We then apply the proposed method in the setting of a teaching hospital's ED and obtain closed-form expressions for the range of arrival rates for which PT outperforms the traditional nurse triage economically. We show that the proposed solution methodology based on this approximation procedure is asymptotically optimal under a many-server asymptotic regime. We also demonstrate via simulation experiments that the proposed policy performs within 0.82% of the best solution obtained via a computationally intensive total enumeration method.