Thailand Medical Mobile Application for Patients Triage Base on Criteria Based Dispatch Protocol

doi:10.21203/rs.2.11625/v2

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Thailand Medical Mobile Application for Patients Triage Base on Criteria Based Dispatch Protocol

https://doi.org/10.21203/rs.2.11625/v2

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published 09 Apr, 2020

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Background : Before admitting patients into the emergency department, the pre-hospital process is important both in terms of treatment performance and requesting resources from an emergency unit. The existing system to triage patients in Thailand is not functioning optimally in either the primary medical system or pre-hospital treatment. Areas that contain shortcomings include speed, features, and appropriate systems. There is a high possibility of misrepresenting false Initial Dispatch Code (IDC) which causes over or under utilizing emergency resources, such as rescue teams, community hospitals and emergency medical volunteers.

Methods : In the application development, usability system design has been applied together with system reliability test, to optimize the pre-hospital processes specifically to sort patients by using IDC improving request for emergency resources. The development of a triage mobile application has been conducted on both iOS and Android operating systems to support patient triage based on the Criteria Based Dispatch (CBD). The 25 main symptom categories covered by CBD were used to design and develop the application, and 12 emergency medical staff including doctors and nurses were subjected to test the system in the following aspects: triage protocol correction, triage reliability, usability and user satisfaction.

Results : The application development result shows the comparison between the proposed triage application and staff experience. The triage reliability test implies that the time used to triage by experienced staff, in non-trauma cases, is slower than using the application. For the usability test, the result shows that the application functions are more effective in the emergency operations and correction of IDC code representation.

Conclusions : The triage application will be utilized to support the pre-hospital process and to classify patient conditions before admitting patients to the Emergency Department (ED). The application is suitable for users who are not medical emergency staff. Patients with non-trauma symptoms may be a suitable group to use the application in terms of time used to identify IDC for their own symptoms. In terms of application use, it can provide benefits to those who want to self-identify their symptoms before requesting medical services.

Medical Informatics

Triage

emergency medical service

primary medical

incident dispatch code

criteria base dispatch

mobile application development

Applying smart technology in daily life has been an increasingly common practice, especially in medical treatment. Modern smart technology provides faster computation, natural-command abilities, wider presentation screens and applicably intelligent operation [1-4]. It has been found that the advancement of smart technology has also been widely used for medical healthcare purposes, for example, monitoring patients, tracing patients’ health conditions, expert or doctor consultation, obtaining suggestions on healthcare medication and much more. [5-6]. The number of people who require doctor consultations or receive medical services could decrease by substituting new technology as an alternative [7-8].

Although the smart technology trend in healthcare around the world has been increasing while the duties of medical staff has been decreasing, inadequate public health support and services are still problematic in Thailand. Applications of smart technology have been developed to help ease the overcrowding of emergency care units, but the system does not solve all the problems in the unit operation.

According to the National Bureau of Statistics in 2018, there were 220 million out-patients in Thailand. There were 35,388 doctors and 180,589 service providers and other various hospital staff [9]. Based on these numbers, the Thai healthcare system should have a better system aiding primary care doctors. An ideal primary care system would include self-care system, long-distance patient care system, effective patient screening system and self-care knowledge providing channel which is important to help alleviate the public health unit workloads. Medical personnel, especially the primary care doctors could be effectively managed and patients forwarded in the correct order to account for available resources and medication using the technology. These are the key elements outlined in the national strategic plan for public health that will be addressed in the 20 years following the Thai government policy of Thailand 4.0 [10].

However, a concerning limitation is the disproportion between doctors and patients. Overcrowding across hospitals in Thailand has many causes. For example, symptoms of a disease can be difficult to predict. The side effects are sometimes unclear and the illness caused by an accident often needs a quick assessment. Primary care physicians play an important role in patient assessment in order to provide patients with appropriate medical services for both normal illnesses and handling emergencies in a timely manner [11-12].

In many casespre-hospital information from rescue teams, rescuers, community hospitals and emergency medical volunteer are invalid due to incorrect Initial Dispatch Code (IDC). This leads to over or under allocating emergency resources. It has been reported by the National Institute of Emergency Medicine of Thailand that 60% of patients who come to the Emergency Department (ED) did not require any urgent treatment. This issue occurs in many regions where a patient needs immediate care from medical providers due to lack of confidence in their primary care access [13-14].

As a result, many patients are admitted to an emergency room causing overcrowding of emergency care units including Out Patient Department (OPD) and ED. Thus, an effective patient assessment during the pre-hospital process can reduce overcrowding in hospitals. For example, in case of emergency, the rescue teams, rescuers, community hospitals and emergency medical volunteer bear the responsibility to assess and analyze patients and requests all emergency resources. When these medical professionals and volunteers do not have comprehensive health assessment field experience, the classification of patients by using Criteria Based Dispatch (CBD) could be misrepresented. This leads to an incorrect IDC resulting in over or under utilizing emergency resources.

The best way to correctly assess a potential patient is to consult the provincial emergency command unit by asking CBD questions which results in an IDC. This process can take at least 2-3 minutes or more by phone. After an IDC is identified, the provincial emergency command unit will request an emergency dispatch from the nearest hospital to pick up the patient.

Trying to decrease time and optimize the performance of the pre-hospital process is an ongoing challenging for the National Institute for Emergency Medicine of Thailand (NIEM). The existing systematic patient assessment program developed by the NIEM has been used for patient assessment to triage patients for IDC but has been found to be too difficult to use. A computer is required to run the program (Microsoft Access), which is not practical for primary emergency medical unit operations. For that reason, the aforementioned system developed by NIEM is only used by the provincial emergency command units as they are the central emergency units. Due to its inefficiencies, this system can only be leveraged in central call centers and is not used in the field.

Moreover, most Thai medical doctors use imported medical applications. Popular systems, such as the Canadian Triage mobile application, Mobile Emergency Severity Index (ESI), are the standard for emergency medical service in Thailand. These applications are widely used by medical doctors for patient triage. By providing a mobile interface, they simplify triage protocol referencing. The result of the study informs that mobile applications may have improved benefits for medical professionals & volunteers experienced in triage [15].

However, these applications are limited as users must have existing medical knowledge. Advanced medical terminology limits the usability of such applications. . This is important as the pre-hospital process involves not only medical staff, but volunteers with limited medical knowledge.

The research question in this paper explores what kind of system can provide optimal patient triaging for requesting an accurate IDC. Additionally, it is important to understand what is a practical solution for real-life operations by rescue teams, rescuers, community hospitals and emergency medical volunteers.

Moreover, there are additional concerns that should be considered while developing an optimized medial system. These concerns include how the system can decrease overcrowding of ED, how the system can increase patients’ knowledge when they encounter suspicious symptoms, and whether patients can assess encountered symptoms determining the need for urgent treatment when they are at home.

Therefore, an ideal system can help both primary care physicians and patients perform illness screening for both normal and emergency cases. The system should also be able to provide referral to an appropriate emergency medical service. The application should also help patients assess their own symptoms including symptoms severity and urgent treatment needs. The system should allow patients to sort symptoms according to international standards.

Based on the aforementioned problems, this research project aims to develop the functionality required for a medical mobile application developed in Thailand. This application allows patients to triage medical conditions based on dispatch protocol-grade criteria. This solution is suitable for use on mobile application systems. The application will serve as a tool for primary emergency medical practitioners and general users. In this study, a prototype will be developed using patients’ assessment data from the NIEM. Lastly, this application will reduce limitations of existing systems that require specialized knowledge to effectively triage patients.

1.1 Triage Medical System

The use of technology via smart devices by healthcare professionals has transformed many aspects of clinical practices. Mobile technology including tablets have become commonplace in healthcare, leading to rapid growth in the development of medical software applications (apps) for these platforms. Mobile technology has played a large role for users including, for example, offering them information to track their health conditions, providing suggestions on healthcare medication as well as providing tools to medical providers to monitor their patients [16-17].

Using the systems based on smartphones has allowed effective tracking and managing of patients' health [18-21]. A variety of research has been conducted related to applications associated with emergency cases and will be discussed in this section.

Worldwide, incorporating information technology via smartphone into the medical system has become increasingly conventional due to its accuracy. For example, this study from Scott shows that applied electronic triage provided higher accuracy for the triage protocol. The e-triage predictor and algorithms were applied and indicated the probability of clinical care, emergency surgery, and hospitalization outcomes [22].

Recently, Tadahiro developed a system to optimize emergency department operations. The prediction of ED disposition at the triage level remains challenging. The system may enhance prediction and also improves the ability to predict the disposition of patients and support various medical duties [23].

Lei and team was aiming to use triage to identify patients who require immediate resuscitation, to assign patients to a pre-designed patient care area, and to initiate diagnostic/therapeutic measures appropriately. This study aimed to use ESI in a pediatric emergency room. The study found that the improved performance of nurses took approximately 2 minutes for triage. The triage improvements made by nurses were similar to those made by doctors for ESI. In levels 1-3, patients that required immediate, life-saving intervention without delay had a high risk of deterioration signs of a time-critical problems. This results in a high demand for resources required to investigate and treat patients. This finding indicated that the nurses are able to identify severe pediatric cases [24-25].

Moreover, the development of triage mobile applications have been applied to dental science. Corey developed a mobile application system for triaging dental emergencies. The development research consisted of a need to analyse and assess of captured intraoral images [26]. Users can report habits themselves by selecting or identifying the most appropriate scenario that describes the user’s discomfort. Users were able to complete a triage report within 4 minutes. The application has helped both dentists and patients in term of self-triage prior to the dentist visit.

In Thailand, there is a medical application developed by Sumrumeram which can be used to track high-risk stroke and stemi patients who require time-sensitive services from Emergency Medical Services (EMS) [27]. The system can be operated on both Android and iOS operating systems together using Global Positioning System (GPS) Tracker to provide the real time location of the transmitter. The use of a GPS Tracker through GPS satellites and transmissions over the 3G mobile phone network are studied in this research. They focused on programming to integrate them with the system for semi-automatic usage. The program has been tested in the urban areas where Internet access was available. The technology enables the capability of the system to locate patients accurately. This study ensures that applying information technology would be able to improve emergency medical services and benefit in patient safety and emergency system optimization.

Ruangtananurak has developed an emergency alert system including maps for positioning of emergency medical services [28]. The patients or witnesses who encounter accidents can use the application on a smart phone to send information from the scene, such as the accident location or other information, to notify emergency centers in the area. The information, along with the location of the scene, will be sent to the Emergency Medical Services (EMS). EMS unit can accurately locate the scene and the fastest route that allow emergency ambulances to get to the accident location quickly. It also includes directions to the nearest hospital.

As we can see from the aforementioned examples [24-28], applying a mobile-based system for optimized triage is a suitable and viable tool for identifying severe medical cases and allowing for immediate and accurate intervention. However, the proposed system should also be able to help patients determine their own symptoms provided symptom descriptions and their severity. Moreover, the mobile application should contain a function to sort symptoms based on Thai dispatch standards.

1.2 Thai Triage Standard

To triage is the process of determining and prioritizing patients' treatment based on the severity of their conditions. This helps distribute patient treatment efficiently when resources are limited. Triage may also be used for patients arriving at the emergency department, or telephoning medical advice systems [29]. The goal is to reduce the subjectivity of the triage decision, and increase accuracy during the pre-hospital process according to National Institute for Emergency Medicine [30-32].

In Thailand, criteria based dispatch has been used as the standard to identify an IDC based on patient signs and symptoms collected by 25 main categories (National Institute for Emergency Medicine [30][33]. The CBD protocol questions patients via interview as a rapid identification tool for patient status. This allows patients to be identified as unstable or "sick" [34]. Five color codes are used to identify the status of patients requesting pre-hospital resources. The IDC is shown in Table 1 which indicates the details of triage criteria and the corresponding color, whereas Table 2 shows the numbers of the 25 main symptom categories. Based on the CBD protocol, the result from the patient interview will be represented as an IDC.

For example, a patient will be triaged by considering each criteria of the symptoms, the result will show the main symptom code, a color code and a triage criterion. If the result is “12 red 1”, it means critical emergency patients with cardiac arrest. Then, the emergency staff will request any emergency medical resources and operate following the corresponding essential response.

Table 1: Here

Table 2: Here

2.1 Software development process

Thailand medical mobile application for patient triage based on CBD was developed to solve the problems associated with the pre-hospital process mentioned earlier. The adapted waterfall methodology is a software development procedure that was applied as a 7-step guideline for the development process [35-36].

Step 1 Software requirements: At this step, information analysis is incorporated and all of the necessary information from emergency doctors, emergency staff, and nurses is collected to find what functions are necessary to triage patients.

Step 2 Analysis: The application development process considers usability in terms of functionality, convenience, triage accuracy, and accessibility. Functional requirements are identified based on the software requirements in step 1. the application proposes the benefits and application usage, as shown in Table 3.

Step 3 Design: This step uses analytic results to design application functions and graphic user interface. The functions will be designed by considering the practical use for the real operation. State diagrams are used to describe the behavior of the system. Figure 1 shows the functional design which corresponds to functional and graphical design in Table 3. In this step, the application is designed per the requirements of the user interface on mobile applications. This includes the navigation components, input controls, screen proportion design, menu list navigation and deep layout of the screen using the human-centered theory, Eight Golden Rules of interface design and Nielsen’s Ten Heuristics [37-38].

Table 3 Here

Figure 1: Here

Step 4 Development: In this step, the Ionic Framework, which is a nonnative language for mobile application development has been applied. This framework is suitable for both iOS and Android operating systems. Firebase has been employed for the user database including triage results, user information, and other information used in the application.

Step 5 Testing: The advanced functions of smartphone device dictate usability, capacity of adapting (especially in medication mobile applications), user’s interaction, perception about places and objects are inputs that take participant between the system and users, especially for emergency cases. If there are any misplaced elements, the result of the participant would be miscommunicated requiring more operating time. Thus, to ensure that the application will perform well in terms of time, this step has to be tested by staff capable for triage. Moreover, the IDC accuracy and question flow of triage have to be tested and compared to the flow of the CBC protocol, in which it was under the consideration of emergency voluntary staff. Thus, in order to perform the application testing, three points of testing are illustrated in Table 4.

Table 4: Here

Step 6 Operations: This step takes place after the application has been verified to produce accurate CBD resulting in accurate IDC by medical emergency doctors. The application will make a request for ethical approval before releasing data to rescue teams, rescuers, community hospitals and emergency medical volunteer via Google Play and the App Store.

3.1 Development of Mobile Application

The application was developed by using the Ionic Framework. The application was evaluated in terms of compatibility, errors, missing information, and quality. The final version of the proposed application contains four main functions including triage, finding responsibility of emergency care unit, patient triage log file and export IDC information, has been released.

Application and functional tests were performed using iPhone 6s and Huawei Android phone (P20Pro). At the time of the study, the specifications of smartphones were defined for medium and large screen display devices, due to the visibility considerations [39].

The application procedure starts when the user opens the application, and screen A in Figure 2 appears showing the title and welcome graphics. After that, the main menu screen will be displayed. The buttons on screen B support the application login and triage history information. Screen L shows icons for the 25 symptom symbols for triage which is demonstrated in table view (screen D) and list view (screen C), respectively.

In Figure 2, on the screens E-G, the user can perform a search by typing the symptom name or keyword(s) into the textbox. The user can select a symptom from the list of search results on the screen. Screen F shows steps for CBD questions. The u has to select his/her answer to get to the next question, then continue until the IDC is displayed as shown on the screen H or I. Screen I shows the triage screening result which identifies the IDC code and the emergency status. The screen color will be the same as IDC code pattern. Suppose the IDC pattern is displayed in the form of “X color Y”, the first X refers to the group number of the symptoms corresponding to the input information in Table 2 and the last Y refers to the urgency status (1 being the highest and 9 being the lowest urgent status). On the screen K, the application provides information in the form of a suggestion to the user that they can implement while waiting for emergency resources. Moreover, user can record the IDC code via the application to summarize the patient's condition as well as the urgency status. This will allow emergency doctors/staff to gather information for the prehospital process. Additionally, on the screen J, the application supports the task of exporting the details of patients/emergency cases in .pdf format which can be forwarded to other applications such as Line and Short Message Service (SMS). On screen M, the application also supports the task of finding the nearest emergency care unit and hospital locations as well as their contact information (phone numbers as shown on the screen N). This data is sorted by the shortest distance and the shortest time to the destination. Furthermore, a map with directions to hospital locations is supported on the screen O with an overview of information.

Figure 2: here

3.2 CBD questions flow assessment

The CBD questions used in the application have been tested by evaluating the IDC result accuracy. All the 25 symptoms were tested in each question by following the flow in the CBD handbook. Emergency medical doctors tested the application by simulating a scenario and assessed the application results in comparison to the handbook. After the CBD questions results were verified and approved, the application testing proceeded to the next step.

3.3 Triage time evaluation

In this section, the application was tested to evaluate triage reliability and efficiency in comparison to various triage methodologies. The application was used to triage patients. The resulting IDC was assessed and evaluated for accuracy and confirmed to be a suitable request for resources.

To do this, we performed sampling by drawing 2 symptoms from total 25, which were used as simulation scenarios. Both trauma and non-trauma symptoms were used. Roleplaying was used to communicate the patient’s condition to the medical staff.

Using the procedure mentioned above, the IDC result and the triage time that emergency staff spent to obtain the IDC were recorded using three different methods. The results were then compared. The three methods include 1) using the application, 2) following the CBD protocol from the handbook and 3) relying on the emergency medical staff experience. There were 4 emergency medical staff to be the pilot samples for testing triage.

Table 5 demonstrates the testing results of each method with each scenario. The result shows clearly that using application for triage was as fast as the operation time from experienced emergency staff and as accurate as following the CBD protocol from the handbook. Some IDC misrepresentations were found when performing triage by relying on the staff experience.

Table 5 Here

In order to confirm the triage time testing, we conducted another test. In this test we compared the results between two methods. The first method was using the application and the second method was by relying on the emergency staff experience. Please note that the triage condition evaluation using the hand book was omitted in this test. Handbook referencing is only for reliability testing. Using the handbook is not a practical process for real-world operations.

The test conditions were set as follows the sample data was acquired by emergency medical staff. Each of the twelve emergency medical staff has no more than 5 years of work experience. The medical staff was split into two groups of six. Triage was performed by both using the application and relying on their experience. Test cases included 13 out of 20 scenarios, which covered the 25 main symptom categories (See Table 2). The average triage operational time was calculated.

The result of the triage time testing is shown in Figure 3. The result shows that using the application to triage non-trauma symptom cases was more efficient, requiring less time than relying on staff experience. In case of trauma symptoms, using staff experience was more efficient, requiring less time than using the application

Figure 3 Here

3.4 Application usability test

Usability tests are a very important point of the study because practical and pertinent considerations are the pain points of the previous system. . Thus, this step is required to ensure the quality and reliability of the application. The focus is to develop a high quality medical system and to make the software reliable. The usability test criteria from the usability testing technique conducted by Jakob Nielsen was adopted and applied in this experiment.

To do this, scenarios were created to evaluate usability. The key points of testing include occurrence of difficulties, doubt of visual representation, doubt on usage, missing information, and confusion when using the application. Each of the functions of the application were tested by 12 emergency medical staff including doctors and nurses. The testing results in Table 6 show the results of the findings for each test criteria (based on user motivation) as well as application functionality.

There were 12 instances of misunderstandings for the triage function (ranked 2^nd in operational errors). Missing information was found when users wanted to repeat the CBD questions, which lead to duplicate IDC of patient conditions in the log file. Doubt of visual representation was found when users did not read the information shown on the left-side of the previous answer. There were some difficulties finding the answers of the pervious CBD questions. The second function, finding an emergency care unit, was found missing 4 times and was the 3^rd overall ranked in operational errors. This might be due to the use of third party navigation applications. When the application shows the list of available emergency care provider locations are displayed using navigation applications such as Google Maps. It is also possible that errors arise from navigation applications. The next function is the patient triage log file, which was tested with 3 times of doubt on usage and misunderstanding. It was found that users did not understand. The logging file operated as a history of triage information record to confirm the patient’s condition. The last function is exporting IDC information to other applications such as SMS, Line, WeChat, e-mail, etc. The usability test problem in using the data export function has been found 3 times.

Users encountered problems sending information while devices were not connected to the internet. Confusion using the function was found 4 times because the users assumed that this function is used to produce a medical report.

For all of the evaluations of user motivation, confusion was found in the 1^st rank with a total of 13 occurrences. The 2^nd rank of the evaluations was doubt on usage, which occurred during log file exportation of IDC information. The 3^rd rank of the evaluations was doubt of visual representation on some graphics and figures in the application during triage function, finding emergency care unit function, and the exporting of IDC information function, respectively.

Table 6: Here

This study has been conducted following the research questions: what should the system include that can help primary care physicians or patients to perform illness screening in both normal and emergency cases? How to design and develop an application to be able to help patients determine their own symptoms and assess the need for emergency treatment in Thailand.

Based on the application analysis and literature review from the previous studies of server medical application systems [2], the emergency alert system, map positioning for emergency medical services, patient monitoring and tracking system for high-risk patients who require services from EMS [3-5][16][22][27-28] and dental application triage development [26], are systems that can be used to support medical emergency operations. Thus, the proposed system has been designed for Thai social context. The application may be operated similar to other applications helping provide patients with an alternative choice for emergency aid.

The application for patients triage was developed by following the CBD to request IDC for the prehospital process [32-34]. The application can serve as a tool for primary emergency medical practitioners and general users. The adapted waterfall methodology together with the Ionic framework have been employed to produce a system under Android and iOS operating systems [35-36]. The human-centered theory, Eight Golden Rules of user interface design and Nielsen’s Ten were employed to design proper user interface of the application for practical use in real emergency situation [37-38].

The 25 main symptom categories covered by CBD were used to design and develop the application [32]. A twelve emergency medical staff including doctors and nurses were subjected to test the system in the following aspects: triage protocol correction, triage reliability, usability and users’ practical satisfaction.

As a result of application development, 4 functions were developed including (1) the triage function to identify IDC, (2) the finding of emergency care unit function, (3) the patient triage log file function providing triage information to support the pre-hospital process and confirm triage information and (4) exporting IDC information function for sending obtained IDC to the provincial emergency care units which can, in turn, use that information to prepare emergency resources while the patient is being transferred.

The first application test result was performed to check triage reliability and time spent performing triage under different conditions. The first experiment was to set a scenario test comparison for triage time testing. The result shows that, in the case of non-trauma patients, using the application spent less time than relying on staff experience. In case of trauma patients, using experienced staff to identify IDC consumed less time than using the application. The accuracy of identifying IDC under the condition of using handbook and the application is similar.

The second test was performed by sampling 13 scenario test cases from a total of 20 scenarios. In the case of trauma patients, the majority of the experienced staff required less time to triage than the application, however, the triage may result in a misrepresentation of IDC. The majority of the results claimed that the application is useful in terms of operational time and reliability considerations. Using the application is more likely suitable for non-trauma patients. However, the study of Savamongkornkul, indicated that mobile application performance could be enhanced when operated by experienced staff in triage [13].

The second testing result was conducted as described in section 3.4, the application usability test. The testing criteria was applied from the human-centered theory, Eight Golden Rules and Nielsen’s Ten Heuristics [37-38]. The result shows that the application still shows weak points with some confusion when in use. The triage function is the highest ranked of the weak points. In this function, users need to answer a number of CBD questions. Users misunderstood the number of answers needed.

In fact, some questions required only 1 or 2 answers. As a result, user misunderstanding is the cause. It was also found that missing information when finding emergency care unit functionality was caused from the Google API locating incorrect locations that are not emergency care units. Thus, API usage needed to be amended in order to locate the correct information of locations.

The application testing still shows weak points due to user perception. However, this application can be used to correctly perform symptom self-assessment, including in case of emergency. This will make treatment more effective.

This project can improve the overall development of primary care medical professionals to gain more knowledge by using this application. The research utility can generate improved primary medical emergency staff knowledge and performance based on accuracy of triage standard. Patients who apply the triage mobile application for primary diagnosis can decrease overcrowded hospital centers in each Northern Province. The result concomitantly support the result of Savamongkornkul [13], mentioned earlier. And if the application can be a tool for users to triage themselves when experiencing a suspicious symptom, it can help ED to reduce service time and increase the quality of medical service as reported by Kazi [11] that service time is related to patient outcome. Thus, the application is very suitable for people who request CBD codes without comprehensive medical knowledge and skills.

Based on the pain points of the National Institute of Emergency Medicine of Thailand’ system, a new proposed system was developed. The Thai medical mobile application for patients triage based on CBD has been released as the first mobile application for triage in Thailand to support the pre-hospital process, especially for patient triage using IDC for requesting emergency resources. The application development employed the usability system design and system reliability test, which are considered appropriate for Thai social context.

The application test confirmed that the application is useful in terms of operational time and reliability. Using the application is more likely to be suitable for non-trauma patients rather than trauma patients. Thus, the application can be used as a practical tool in addition to an educational tool for new emergency staff who do not have adequate skills in the medical emergency field.

In summary, the Thailand medical mobile application for patient triage is smart technology that can provide benefits to users as a tool for rapid triage screening, educate patients and new emergency staff, and prevent overcrowding in emergency care units in Thai hospitals.

ED: Emergency department

CBD: Criteria base dispatch

EMD: Emergency medical dispatch

IDC: Initial dispatch code

OPD: Outpatient department

ESI: Emergency severity index

EMS: Emergency medical services

NIEM: National institute for emergency medicine of Thailand

BLS: Basic life support unit

ALS: Advance life support unit

FR: First response unit

GPS: Global positioning system

API: Application programming interface

SMS: Short Message Service

Acknowledgment

This research was under the collaboration of the Embedded Systems and Mobile Application in Health Science research unit and the Faculty of Medicine, Chiang Mai University. We would like to express my sincere gratitude to Dr. Kullapa Chanawanno who encourages my research proposal and Nantanan Jengserbsan, MD for triage criteria flow design. I would like to thank my mentor, Prof. Dr. Jakapong Nartwichai, for suggestions and encouragements.

Funding

The authors would like to acknowledge the Thailand Science Research and Innovation (TSRI) for the financial support of the project.

Authors’ contributions

Krongkarn had a substantial contribution to research ethical, conception and triage criteria flow design.

Pattaraporn obtained research operation, data preparation and manuscript preparation.

Orawit substantial contribution to the research operation includes triage criteria flow design, system design, analysis, testing, interpretation of the findings and manuscript preparation.

Ethics approval and consent to participate

Ethical clearance and approval were obtained from the Faculty of Medicine, Chiang Mai University research ethic committee with exemption (REC-25620711-17045). The data confidentiality of information was maintained anonymously. Moreover, informed consent was employed to respondents by explaining the purpose of the study as well as maintaining the subjects’ confidentiality.

Consent for publication

Competing interests

All authors declared that they have no competing interests.

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Thailand Medical Mobile Application for Patients Triage Base on Criteria Based Dispatch Protocol

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