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The purpose of this paper is to explore the configuration of factors affecting the accuracy of triage decision-making. The contribution of the work is twofold: first, it develops a protocol for applying a fuzzy-set qualitative comparative analysis (fsQCA) in the context of triage decision-making, and second, it studies, through two pilot cases, the interplay between individual and organizational factors in determining the emergence of errors in different decisional situations.

The methodology adopted in this paper is the qualitative comparative analysis (QCA). The fuzzy-set variant of QCA (fsQCA) is implemented. The data set has been collected during field research carried out in the Emergency Departments (EDs) of two Italian public hospitals.

The results of this study show that the interplay between individual and contextual/organizational factors determines the emergence of errors in triage assessment. Furthermore, there are some regularities in the patterns discovered in each of the investigated organizational contexts. These findings suggest that we should avoid isolating individual factors from the context in which nurses make their decisions.

Previous research on triage has mainly explored the impact of homogeneous groups of factors on the accuracy of the triage process, without considering the complexity of the phenomenon under investigation. This study outlines the need to consider the not-linear relationships among different factors in the study of triage’s decision-making. The definition and implementation of a protocol to apply fsQCA to the triage process in EDs further contributes to the originality of the research.

This paper aims to investigate the performances of decision-making process of emergency department’s nurses involved in the triage level assessment.

The authors developed a case study in two public hospitals in the South of Italy. The authors administered 25 clinical cases to nurses responsible of priority code assignment in the triage station. The authors simulated the attribution of the priority levels, and through a semi-structured questionnaire, the authors collected data and information about the cognitive process adopted for the final choice.

The quantitative and qualitative data allowed the authors to verify that there is an impact of the organizational context on heuristics used in the decision-making process.

The research limitations are that empirical data have been collected only in two emergency departments.

The practical implications of this paper are that organizations for improving business performances must consider the judgements are often the results of heuristics embedded in a specific structure of social and physical environment, according with the “ecological view” of rationality.

The authors’ methodological approach contributes to analyze the performances of the triage process, verifying if the eventual errors are linked to individual or organizational factors, but above all how organizational constraints influence decision-making processes in organizations and, consequently, business performances.

The purpose of this paper is to investigate the influence of organizational factors on individual decision-making under conditions of uncertainty and time pressure. A method to assess the impact of individual and organizational factors on individual decisions is proposed and experimented in the context of triage decision-making process.

The adopted methodology is based on the bias-variance decomposition formula. The method, usually applied to assess the predictive accuracy of heuristics, has been adjusted to discriminate between the impact of organizational and individual factors affecting heuristic processes. To test the methodology, 25 clinical scenarios have been designed and submitted, through simulations, to the triage nurses of two Spanish hospitals.

Nurses’ decisions are affected by organizational factors in certain task conditions, such as situations characterized by complete and coherent information. When relevant information is lacking and available information is not coherent, decision-makers base their assessments on their personal experience and gut feeling.

Discriminating between the influence of organizational factors and individual ones is the starting point for a more in-depth understanding of how organization can guide the decision process. Using simulations of clinical scenarios in field research does not allow for capturing the influence of some contextual factors, such as the nurses’ stress levels, on individual decisions. This issue will be addressed in further research.

Bias and variance are useful measurements for detecting process improvement actions. A bias prevalence requires a re-design of organizational settings, whereas training would be preferred when variance prevails.

The main contribution of this work concerns the novel interpretation of bias and variance concepts to assess organizational factors’ influence on heuristic decision-making processes, taking into account the level of complexity of decision-related tasks.

Online production and transmission of child abuse material (CAM) is a complex and growing global problem. The exponential increase in the volume of CyberTips of CAM offending is placing information processing and decision-making strains on law enforcement. This paper presents the outcomes of a project that reviewed an existing risk assessment tool and then developed a new tool for CAM triaging and investigative prioritisation.

Using a mixed method approach, the authors first explored the capacity of an existing risk assessment tool for predicting a police action. The authors then used these findings to design and implement a replacement CAM decision support tool. Using a random sample of CyberTip alert cases from 2018, the authors then tested the efficiency of the new tool.

The existing risk assessment tool was not fit for CAM triaging purposes. Just six questions from the old tool were found to be statistically and significantly associated with law enforcement agents achieving a police action. The authors found that an immediate threat of abuse/endangering a child, potential case solvability, CAM image assessment, chat assessment, criticality and some weighting for professional judgement were significant in being associated with a police action. The new decision support tool is more efficient to complete and achieved a 93.6% convergence of risk ratings with the old tool using 2018 case data.

This research is unique in its development of an evidence-based decision support tool that enhances the ability of law enforcement agents to objectively and efficiently triage and prioritise increasing numbers of CyberTip alerts.

A new triage method, MBCE (Medical Bio Social Ethics), is presented with social justice, bio, and medical ethics for critical resource distribution during a pandemic. Ethical triage is a complex and challenging process that requires careful consideration of medical, social, cultural, and ethical factors to guide the decision-making process and ensure fair and transparent allocation of resources. When assigning priorities to patients, a clinician would evaluate each patient’s medical condition, age, comorbidities, and prognosis, as well as their cultural and social background and ethical factors.

A statistical analysis shows no interactions among the ethical triage factors. It implies the ethical components have no moderation effect; hence, each is independent. The result also points out that medical and bioethics may have an affinity for interactions. In such cases, there seem to be some ethical factors related to bio and medical ethics that are correlated. Therefore, the triage team should be careful in evaluating patient cases. The algorithm is explained with case histories of the selected patient. A group of triage nurses and general medical practitioners assists with the triage.

The MBCE triage algorithm aims to allocate scarce resources fairly and equitably. Another ethical principle in this triage algorithm is the principle of utility. In a pandemic, the principle of utility may require prioritizing patients with a higher likelihood of survival or requiring less medical care. The research presents a sensitivity analysis of a patient’s triage score to show the algorithm’s robustness. A weighted score of ethical factors combined with an assessment of triage factors combines multiple objectives to assign a fair triage score. These distinctive features of the algorithm are reasonably easy to implement and a new direction for the unbiased triage principle.

The idea is to make decisions about distributing and using scarce medical resources. Triage algorithms raise ethical issues, such as discrimination and justice, guiding medical ethics in treating patients with terminal diseases or comorbidity. One of the main ethical principles in triage algorithms is the principle of distributive justice.

Ethics is the foundation on which societies and cultures are based and are fundamental to political, social and economic decision making. Ethical dilemmas have created controversy and heated debate over the years. Disasters have been defined in public health terms as destructive events that result in the need for a wide range of emergency resources to assist and ensure the survival of the stricken population. Lack of medical resources, in conjunction with a mass casualty situation, can present specific ethical challenges. The purpose of this paper is to explore the ethics of disaster management.

In and after a disaster, ethical questions arise regarding appropriate and fair allocation of relief funds to help with recovery. Research in disaster settings poses unique ethical dilemmas. The researcher must determine how to balance the critical need for research with the ethical obligation of respect for, and protection of, the interests of research participants. Ethics as part of an educational program made available to health care providers may assist disaster responders to make the difficult ethical decisions involved in disasters. This literature review discusses these issues in conjunction with disaster response and recovery.

The cardinal virtues of disaster response are prudence, courage, justice, stewardship, vigilance, resilience, self‐effacing charity and communication. These eight virtues are not considered all inclusive, no more than Aristotle considered that his morals or virtues were all inclusive. Ongoing work in disaster management will help to ensure that such situations are managed in an ethical manner that respects the rights and privileges of all those involved.

The literature reviewed for this paper was based on peer reviewed scholarly writings. Concepts of ethics and justice are important issues in disaster situations. This paper offers ideas to prompt further discussion among disaster managers and students of disaster studies.

Social changes are reliant on an understanding of ethics and how it affects society. This paper puts forward ethical concepts to prompt discussion by disaster responders and managers with the hope of improving disaster management.

The paper is an original document that may be useful to students of disaster management and those who teach disaster management

Telephone triage or hear and treat (H&T) describes the process of UK ambulance services nurses and paramedics undertaking enhanced telephone assessments of patients to determine the most appropriate response, which can sometimes result in no ambulance being sent. Given, however, that 999 is not considered an advice service, it may be reasonable to assert that the expectation of those calling 999 is always an immediate ambulance response. This may not always be realised and may affect patient experience. The purpose of this paper is to ascertain the following: to what extent are the views of UK ambulance telephone triage service users being gathered? In answering this research question, this review also aims to explore the findings to determine service users’ expectations of ambulance telephone triage and the possibility that these expectations are influenced by the UK media. The findings of which could be used to inform the need and nature of future research.

Phase one consisted of a computerised literature search of online databases CINAHL, Pubmed, Science Direct, Cochrane library, Web of Science and UK government-funded databases. Phase two consisted of searches of all UK ambulance services websites and the submission of freedom of information requests. Phase three consisted of a computerised literature search of the ProQuest international news-stream database.

A total of 78 results were identified and after further screening 34 results were excluded, leaving 44 for final review. The extent to which users experience of ambulance service telephone triage are being gathered is low; and often limited to one off pieces of non-peer reviewed work. Patients felt overall that they were treated with respect, dignity and care. However, being listened to, reducing anxiety and a need for prompt assurances remain important to those whose overriding expectation is that an ambulance should attend every time a 999 call is made. There appears to be a balanced media portrayal of H&T with the UK media. However, unrealistic public expectations represent a significant barrier to providing sustainable care that users consider to be of high quality.

Some user experiences may have been gathered in more broad research exercises which explored various aspects of 999 ambulance service experience. This was not included if it could not be clearly differentiated as being related to H&T and thus may have resulted in data being omitted. It was not possible to systematically search social media platforms (such as facebook or twitter) for any media results related to this search strategy; only traditional print and online media platforms. This also may have resulted in data being omitted. The inclusion of non-peer reviewed research results and grey literature represents a possible limitation to the conclusions drawn within this review. The concept of Insider Research Bias cannot be ignored within this review. The author himself practices in telephone triage within a UK ambulance service; however, this insider bias is mitigated by the clearly articulated systematic methodology and use of the Critical Appraisal Skills framework. In a similar vein, reviews of this nature are also often conducted as part of a team, to reduce bias, increase objectivity and ensure the validity of findings. This review was a sole effort, and while this is not uncommon, there were no cross checks by peers of the search terms, strategy, paper selection, exclusion criteria or data extraction. This lack of peer critique is considered a possible limitation in mitigating selection and reviewer bias.

The results of this review would suggest a need to increase the amount of research and patient feedback gathered from those being assessed and managed by ambulance service telephone triage within the UK. Ambulance services could hold regular monthly small-scale qualitative interviews with patients and families to ascertain their views, perceptions and anxieties which can then provide an up-to-date understanding of user expectations and the health educational needs of local communities. Patient feedback received directly to ambulance services or via the Patient Advice and Liaison Service could be retrospectively analysed by researchers to determine key themes of positive practice or negative patient experience. Such feedback can be tracked through time and be used as a pre and post community intervention measure, to determine any changes. Moving forward, nationally standardised research frameworks should be adopted to provide more easily collated local and national data, which can monitor improvement strategies and provide a comparison between services to aid the sharing of best practice principles.

There is no other piece of work published which has reviewed the data in this area of clinical practice within the UK.

Building on the findings of a British Academy-funded project on the development of digital forensics (DF) in England and Wales, the purpose of this paper is to explore how triage, a process that helps prioritise digital devices for in-depth forensic analysis, is experienced by DF examiners and police officers in four English police forces. It is argued that while as a strategy triage can address the increasing demand in the examination of digital exhibits, careful consideration needs to be paid to the ways in which its set-up, undertaking and outcomes impact on the ability of law enforcement agencies to solve cases.

The methodological approach adopted here builds on the ethnographic turn in criminology. The analysis draws on 120 h of ethnographic observations and 43 semi-structured interviews. Observational data of the working DF environment at each location and a systematic evaluation of internal documents, organisational settings and police priorities helped refine emergent analysis threads, which were analytically compared between sites and against the testimonies of members of different occupational groups to identify similarities and differences between accounts.

The findings emphasise the challenges in the triage of digital exhibits as they are encountered in everyday practice. The discussion focusses on the tensions between the delivery of timely and accurate investigation results and current gaps in the infrastructural arrangements. It also emphasises the need to provide police officers with a baseline understanding of the role of DF and the importance of clearly defined strategies in the examination of digital devices.

This paper aims to bridge policy and practice through an analysis of the ways in which DF practitioners and police officers in four English constabularies reflect on the uses of triage in DF to address backlogs and investigative demands. Highlighting the importance of digital awareness beyond the technical remit of DF units, it offers new insights into the ways in which police forces seek to improve the evidential trail with limited resources.

The purpose of this paper is to provide an overarching framework to guide the understanding of the allocation and deployment of strategic human capital assets within an organization. Using the concept of medical triage with business units analogous to “patients” and their performance to “symptoms or injuries,” the framework suggests a “steal from the poor” perspective that is counter to conventional organizational decline literature.

This is a conceptual paper proposing that there are five different categories of business unit need for human capital assets: expectant, deceased, immediate, delayed or minimal; all based on the type of environment and holistic performance of the business unit. Based on a business unit’s specific situation, the authors suggest a process model guiding how to conduct a triage analysis to optimize the allocation of strategic human capital assets within an organization.

The authors argue that current trends in assessing strategic human capital assets which make comparisons across organizations are necessary but insufficient (e.g. comparing a store to other stores in its district or region). Each business unit has its own unique internal capabilities and external constraints that also must be accurately assessed to make an informed organizational-level decision about where and how to deploy strategic human capital assets.

Borrowing from medical science, this paper demonstrates a new conceptual framework with propositions for researchers and guidance for practitioners.

In providing specialized care for older individuals the skills of many disciplines are often needed to provide the most effective care. At the time of referral, it is not always clear which patients are best served by a medical approach and which ones require psychiatric input. When patients are referred to the less appropriate service, diagnosis and treatment may be delayed to the detriment of the patient. A wide spectrum of specialized services for the elderly is offered at the Hamilton Health Sciences Corporation, a four‐site teaching hospital in Ontario. The authors describe the development of a common intake process which provides rapid triage to the most appropriate services, and facilitates a combined medical and psychiatric approach where indicated. The end result is a single entry point for referrals, more efficient triage and a net reduction in the number of staff needed to accept and process referrals.