Design of a Mobile and Desktop Application

Platform for Hospital Triaging System

Raphael Benedict G. Luta, Renann G. Baldovino*, and Nilo T. Bugtai
Manufacturing Engineering and Management (MEM) Department
Gokongwei College of Engineering, De La Salle University
2401 Taft Avenue, 0922 Manila, Philippines
Corresponding author: *renann.baldovino@dlsu.edu.ph

Abstract— This study developed a desktop and mobile application desk triage, repeated paperwork and procedures can be
platform for hospital triaging system. Triaging is the process of eliminated. However, triage accuracy and patient outcomes
determining the treatment priority of patients in a hospital. The may be affected because triage nurses would also have to do
knowledge-base of the system is able to store and allow access to the registration themselves. This model increases their
patients’ triage profiles, which consists of the name, age, gender, workload that means that they might not be able to focus well
medical information and triage category. The developed graphical
on the triaging process [4]. With that being said, this study
user interface (GUI) includes several user experience features that
make the system easier to use. The system was made into an designed a hospital triage system both for desktop and mobile.
application that can be used for desktop and mobile devices. The
II. TRIAGE STRUCTURE
application was tried and tested out by registered nurses, who
answered sets of questionnaires containing walk-in patient triage Different hospitals use different triage structures, which
scenarios with the help of the application. The general feedback may be based on the guidelines or protocol set in a hospital [6].
given by the nurses was that the application was easy to use, Choosing the triage structure to which the system was based on
convenient, that the application made the triaging process faster is crucial in the study. There are several triage structures that
and more continuous compared to the manual triaging process.
are being followed by hospitals around the world. Most reliable
Index Terms— graphical user interface, knowledge-base, triage structures follow a 5-level classification system, with
mobile application, triaging level 1 classification is for the patients who need immediate
and most medical treatment, while level 5 classification for the
I. INTRODUCTION patients who require the least medical treatment [1].
The emergency department (ED), commonly called The flowchart diagram of the ESI is displayed in Figure 1.
emergency room (ER), is a fundamental section of a hospital
whose primary function is to provide medication and treatment
to walk-in or ambulance patients. It serves as the first step in
the treatment of severely injured patients, and it also
determines where the patient will be placed in the hospital’s
healthcare system. The number of patient admissions often
overwhelms EDs in most countries, because the hospital’s
medical resources are often not enough to accommodate the
patient demands [1]. This problem is called overcrowding,
which causes delays for the patients to receive proper medical
care, and increases the length of stay of patients in the ED [2].
EDs seek to improve their performance with the triaging
process. Triaging is the process of getting vital information
from patients, and using this information to determine the
priority of their treatment. Triage is commonly used during
emergency or disaster situations. Studies question the accuracy
and reliability of triage nurses in determining the treatment
priority of patients in the ED [3]. The decision making process
of the triage nurses might be affected by external factors like
fatigue, external pressure, and such. Misclassifications made by
triage nurses cause many problems and issues in the emergency
department, because manual triaging can be slow and tiring [4].
According to a study, combining front desk registration
with triage can reduce the length of stay of patients. In front-
Fig. 1 Emergency severity index algorithm version 4 [7]

978-1-5386-7767-4/18/$31.00 ©2018 IEEE

Authorized licensed use limited to: Kwame Nkrumah Univ of Science and Technology. Downloaded on February 03,2024 at 15:35:09 UTC from IEEE Xplore. Restrictions apply.
 The most commonly used five-level triage structure is the
emergency severity index (ESI), which was developed by the
ESI Triage Research Team [7]. The ESI provides a flowchart
diagram of how triage nurses should classify patients, and it
also provides specifics regarding each part of the flow chart.
Many studies show that this triage system is reliable and
medical experts seem to be satisfied with the guidelines
provided by this system [8, 9]. This triage flowchart will be the
basis of the triage application software created in this study.
III. METHODOLOGY
A. Triage Application Software
Python was the programming language used for this study.
Python’s Kivy library was be used for the graphical user
interface programming of the triage system. Figure 2 represents
the block diagram of the software programming.
Fig. 2 Software programming block diagram
The first step in creating the software is the screen
programming. In this part, each screen of the application was
designed using different widgets provided by the Kivy library.
These include push buttons, labels, radio buttons, toggle
buttons, images, and many other custom widgets. Figure 3
shows an example of the screens that were created.
Fig. 3 Main menu screen of the triage application
Authorized licensed use limited to: Kwame Nkrumah Univ of Science and Technology. Downloaded on February 03,2024 at 15:35:09 UTC from IEEE Xplore. Restrictions apply.
The next part of the block diagram is functional
programming. In this portion of the methodology, functions
were assigned to the widgets that were created for each screen.
These functions were coded in python, and allow the graphical
user interface to interact with the triage structure and
knowledge-base of the system.
The knowledge-base of the triage system uses an internal
CSV file stored in the system. The knowledge-base consists of
the patient’s name, age, gender, medical information, and
triage category. The knowledge-base was created using
Python’s built in functions. After this, the user experience of
the application was taken into account in order make the
application easy and convenient to use. This includes selecting
the color schemes to be pleasing to the human eye. Widgets
such as slider buttons, edit buttons, and screen transitions were
also integrated to the user interface.
Once the software has been programmed, an Android
package kit (APK) was created so that the application will be
compatible with mobile devices. Figure 4 shows the software
structure of the triage application.
Fig. 4 Triage application software structure
Kivy Linux Buildozer with Oracle Virtualbox was
employed to perform this step. Once the APK file was built,
the scaling of the screens and widgets in the application were
adjusted according to the size of the screen of the device to
where the APK was installed.
B. Flow Diagram and System Features
The triage system developed was named Triage Assistant.
Figure 5 shows the flow diagram of the Triage Assistant
application. The application starts with a main menu where the
user can select between a new patient, to access the database,
or to exit the application. If the user selects new patient, the
patient basic information screen will be displayed. In this
screen, the user may enter the name, age, and gender of the
patient. For the desktop application, the user can also take an
image of the patient. This feature is not available for the mobile
device counterpart.

Fig. 5 Triage Assistant flow diagram
Once the user is finished inputting the basic information,
the user has the option to immediately classify the triage
category of the patient if the triage category is already obvious.
Figure 6 shows some of the triage classification screens.
Fig. 6 Triage classification screens
If the user does not immediately know the triage patient
classification, the Triage Assistant will ask a series of questions
that will help the user determine the proper category. These
inputs include conditions, symptoms, signs that will indicate
the triage category of the patient. Triage Assistant also takes
into account the age, vital signs, and the number of resources
required for the patient in determining the triage category.
Within each screen, the user also has the option to check if
the vital signs of the patient are within the danger zone. Based
on the inputs of the user, Triage Assistant will feed the inputs
to the decision tree classifier, then the final triage screen will
be displayed. The final screen contains the triage patient
classification and the details of why the patient was categorized
to that classification. The user has to option to add more
information for recording purposes. Then, the patient record
will now be saved to the knowledge-base. The user now has
the option to return to the main menu or to exit the program.
Authorized licensed use limited to: Kwame Nkrumah Univ of Science and Technology. Downloaded on February 03,2024 at 15:35:09 UTC from IEEE Xplore. Restrictions apply.
Fig. 7 Triage vital signs and information screens
If the user selects the view database button in the main
menu, the knowledge-base screen will be displayed. In this
screen, the user can select from a list of all the patients that
have been recorded through the app. Once the user selects the
patient to view, the patient screen will be displayed, which
contains all the information about the patient that has been
recorded in the triaging process. This includes the patient’s
basic information, triage classification, and other medical
information that has been written down by the triage nurse.
C. Actual Experimentation
Figure 8 shows images of actual experimentation process
showing some of the nurses answering the questionnaires.
Fig. 6 Triage classification screens
The general feedback given by the registered nurses was
that the application was easy to use, convenient, and made the
triaging process faster and more continuous compared to the
manual triaging process. They were able to memorize the logic
faster compared to manual triaging where they had to look at
the ESI guide for every patient. For the software reliability
testing process, eight registered nurses were asked to try out
the developed application. The nurses were chosen based on
their experience with the triaging process and emergency
medical services. The process involved the nurses answering a
questionnaire containing walk-in patient scenarios, and
determining the triage category of the patients described in the
scenarios with the help of the triage application that was
developed.
 IV. CONCLUSION
The study was able to develop successfully a mobile and
desktop application for a hospital triaging sytem using open-
source programs. The said system was able to incorporate the
knowledge-base system and the decision tree classification
algorithm. As for the reliability tests, the developed GUI shows
to be be very user-friendly and straightforward according to the
nurses who have tested the system. Also, it was able to provide
an ESI guide on how to use the system for especially for first-
time users.
ACKNOWLEDGMENT
The authors would like to extend their gratitude to the
Engineering Research and Development for Technology
(ERDT) of the Department of Science and Technology
(DOST) the research dissemination support
REFERENCES
[1] M. Christ, F. Grossmann, D. Winter, R. Bingisser, and E. Platz,
“Modern triage in the emergency department.,” Dtsch. Arztebl.
Int., vol. 107, no. 50, pp. 892–8, 2010.
[2] S. Ackroyd-Stolarz, J. Read Guernsey, N. J. Mackinnon, and G.
Kovacs, “The association between a prolonged stay in the
emergency department and adverse events in older patients
admitted to hospital: a retrospective cohort study,” BMJ Qual.
Saf., vol. 20, no. 7, pp. 564–569, 2011.
[3] T. K. Vatnøy, M. Fossum, N. Smith, and Å. Slettebø, “Triage
assessment of registered nurses in the emergency department,”
Int. Emerg. Nurs., vol. 21, no. 2, pp. 89–96, 2013.
[4] N. Hupert and et al, “Is overtriage associated with increased
mortality? Insights from a simulation model of mass casualty
trauma care,” Disaster Med. Public {…}, 2007.
[5] J. Wang, J. Li, K. Tussey, and K. Ross, “Reducing Length of
Stay in Emergency Department: A Simulation Study at a
Community Hospital,” IEEE Trans. Syst. Man, Cybern. - Part A
Syst. Humans, vol. 42, no. 6, pp. 1314–1322, 2012.
[6] K. Hammad, L. Peng, O. Anikeeva, P. Arbon, H. Du, and Y. Li,
“Emergency nurses’ knowledge and experience with the triage
process in Hunan Province, China,” Int. Emerg. Nurs., pp. 7–11,
2017.
[7] ESI Triage Research, Emergency Severity Index ( ESI ), vol.
117, no. 2. 2012.
[8] R. F. Singer, A. A. Infante, C. C. Oppenheimer, C. A. West, and
B. Siegel, “The Use of and Satisfaction with the Emergency
Severity Index,” J. Emerg. Nurs., vol. 38, no. 2, pp. 120–126,
2012.
[9] F. F. Grossmann, T. Zumbrunn, A. Frauchiger, K. Delport, R.
Bingisser, and C. H. Nickel, “At risk of undertriage? Testing the
performance and accuracy of the emergency severity index in
older emergency department patients,” Ann. Emerg. Med., vol.
60, no. 3, pp. 317–325, 2012.

Authorized licensed use limited to: Kwame Nkrumah Univ of Science and Technology. Downloaded on February 03,2024 at 15:35:09 UTC from IEEE Xplore. Restrictions apply.