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Decision Support for Simulated Emergency Triage by Nurses: A Randomized Crossover Study

8. november 2026 oppdatert av: National Taiwan University Hospital

Development, Validation, and Human-AI Collaboration Evaluation of a Taiwan Triage and Acuity Scale Decision Support System

This randomized, three-period crossover study will evaluate a Taiwan Triage and Acuity Scale (TTAS) decision support system in a controlled simulation. Thirty nurses with emergency triage training or experience will each assess three different sets of 50 standardized, de-identified emergency cases. The three study conditions are unassisted triage, case-specific TTAS decision support, and a sham assistance interface. The order of conditions will be randomized, with 7 to 14 days between study periods. The main outcomes are agreement between nurses' final TTAS levels and an expert reference standard, active time needed to assess 50 cases, and a prespecified safety-adjusted efficiency score. Additional outcomes include undertriage, overtriage, workload, usability, and responses to misleading advice. The system will not be used for actual patient triage or entered into clinical records.

Studieoversikt

Status

Har ikke rekruttert ennå

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

The study will develop a traceable TTAS rule knowledge base and evaluate a decision support prototype in simulated emergency triage. A language-processing component identifies candidate complaints, vital signs, and modifiers from standardized case narratives. A deterministic rules engine generates a suggested TTAS level, matched rules, prompts for additional information, and a draft note. Nurses retain final decision authority. Three balanced case sets of 50 de-identified cases will be prepared from retrospective emergency data. At least two experienced emergency physicians or triage nursing experts will independently establish the reference TTAS level; disagreements will be adjudicated by a third blinded expert. Participants will be stratified by clinical experience and site and assigned to one of six condition sequences. Each participant completes all three conditions with different case sets and a 7- to 14-day interval between periods. The sham interface resembles the active interface but provides suggestions that are not based on the individual case, allowing assessment of automation bias. Analysis will account for study condition, period, sequence, case set, participant experience, case acuity, and repeated observations within participants and cases. This is a simulation study; no decision support output is used in care of real patients.

Studietype

Intervensjonell

Registrering (Antatt)

30

Fase

  • Ikke aktuelt

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiekontakt

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Ja

Kjønn som er kvalifisert for studier

Alle

Beskrivelse

Inclusion Criteria:

  • Age 18 years or older.
  • Able to read Chinese and use the study computer platform.
  • Prior emergency triage training or practical emergency triage experience.
  • Willing to provide written informed consent and complete the planned case assessments.

Exclusion Criteria:

  • Unable to provide valid informed consent.
  • Unable to perform basic operations on the study platform or to follow the study schedule.
  • Involved in developing the study system or aware of details distinguishing active from sham assistance in a way that could compromise masking.

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Helsetjenesteforskning
  • Tildeling: Randomisert
  • Intervensjonsmodell: Crossover-oppdrag
  • Masking: Enkelt

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Ingen inngripen: Sequence A[BC]

Period 1: unassisted triage (A); and then Period 2: active TTAS decision support (B); Period 3: sham assistance (C). Each period includes 50 different standardized cases.

Period 2: sham assistance (C); Period 3: active TTAS decision support (B). Each period includes 50 different standardized cases.

Aktiv komparator: Sequence B[AC]

Period 1: active TTAS decision support (B); and then Period 2: unassisted triage (A); Period 3: sham assistance (C). Each period includes 50 different standardized cases.

Period 2: sham assistance (C); Period 3: unassisted triage (A). Each period includes 50 different standardized cases.

During review of 50 standardized cases, a research-only interface displays candidate presenting complaints, matched TTAS rules, a suggested triage level, prompts for missing information, and a draft triage note. The nurse makes the final decision.

Placebo komparator: Sequence C[AB]

Period 1: sham assistance (C); and then Period 2: unassisted triage (A); Period 3: active TTAS decision support (B). Each period includes 50 different standardized cases.

Period 2: active TTAS decision support (B); Period 3: unassisted triage (A). Each period includes 50 different standardized cases.

During review of 50 standardized cases, an interface resembling the active system displays non-case-specific or distribution-matched suggestions. These suggestions are for simulation only and are not used in patient care.

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Exact agreement with expert TTAS reference standard
Tidsramme: During each of three approximately 60-minute study periods, separated by 7-14 days; up to approximately 4 weeks per participant.

Percentage of completed case assessments for which the nurse's final five-level TTAS assignment exactly matches the adjudicated expert reference level, evaluated separately under each condition.

During each of three approximately 60-minute study periods, separated by 7-14 days; up to approximately 4 weeks per participant.
Active time to complete 50 case assessments
Tidsramme: During each of three approximately 60-minute study periods, separated by 7-14 days; up to approximately 4 weeks per participant.

Total active time in minutes required to complete the 50-case set in each condition, excluding recorded breaks and system interruptions. The analysis of incomplete sets must be specified before enrollment.

During each of three approximately 60-minute study periods, separated by 7-14 days; up to approximately 4 weeks per participant.
Safety-Adjusted Efficiency Score
Tidsramme: During each of three approximately 60-minute study periods, separated by 7-14 days; up to approximately 4 weeks per participant.

Prespecified score combining TTAS accuracy and speed. The approved protocol assigns 1.0 for exact agreement, 0.8 or 0.6 for overtriage by one or two levels, 0.4 for undertriage by one level, and 0 for undertriage by two or more levels, with additional penalties for undertriage of Level 1-2 cases. The exact high-acuity penalty, time component, aggregation, score range, and handling of missing cases require final specification before submission.

During each of three approximately 60-minute study periods, separated by 7-14 days; up to approximately 4 weeks per participant.

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Sensitivity for high-acuity cases (TTAS Levels 1-2)
Tidsramme: During each of three approximately 60-minute study periods, separated by 7-14 days; up to approximately 4 weeks per participant.

Proportion of expert-reference Level 1-2 cases assigned Level 1 or 2 by the nurse under each condition.

During each of three approximately 60-minute study periods, separated by 7-14 days; up to approximately 4 weeks per participant.
Undertriage rate
Tidsramme: During each of three approximately 60-minute study periods, separated by 7-14 days; up to approximately 4 weeks per participant.

Percentage of completed case assessments in which the nurse's final TTAS level indicates lower urgency than the expert reference standard; severe undertriage will be reported separately according to the prespecified threshold.

During each of three approximately 60-minute study periods, separated by 7-14 days; up to approximately 4 weeks per participant.
Overtriage rate
Tidsramme: During each of three approximately 60-minute study periods, separated by 7-14 days; up to approximately 4 weeks per participant.

Percentage of completed case assessments in which the nurse's final TTAS level indicates higher urgency than the expert reference standard.

During each of three approximately 60-minute study periods, separated by 7-14 days; up to approximately 4 weeks per participant.
Acceptance of incorrect suggestions in the sham condition
Tidsramme: During each of three approximately 60-minute study periods, separated by 7-14 days; up to approximately 4 weeks per participant.

Percentage of sham-assisted cases in which an incorrect displayed recommendation is accepted in the nurse's final TTAS decision; denominator and incorrectness criteria to be prespecified.

During each of three approximately 60-minute study periods, separated by 7-14 days; up to approximately 4 weeks per participant.

Samarbeidspartnere og etterforskere

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Sponsor

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Antatt)

1. januar 2027

Primær fullføring (Antatt)

31. desember 2027

Studiet fullført (Antatt)

31. desember 2027

Datoer for studieregistrering

Først innsendt

8. november 2026

Først innsendt som oppfylte QC-kriteriene

8. november 2026

Først lagt ut (Faktiske)

13. november 2026

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

13. november 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

8. november 2026

Sist bekreftet

1. oktober 2026

Mer informasjon

Begreper knyttet til denne studien

Andre studie-ID-numre

  • 202608042RIND

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