From Coordination to Personalization: A Trust-Aware Simulation Framework for Emergency Department Decision Support
It addresses operational efficiency and patient care quality for hospital emergency departments, though it is incremental in applying existing simulation and trust methods to this domain.
This study tackled the problem of efficient task allocation in hospital emergency departments by proposing a simulation-based framework using computational trust mechanisms, resulting in trade-offs such as reduced errors but increased delays in a baseline scenario and improved throughput with additional costs in a replacement scenario.
Background/Objectives: Efficient task allocation in hospital emergency departments (EDs) is critical for operational efficiency and patient care quality, yet the complexity of staff coordination poses significant challenges. This study proposes a simulation-based framework for modeling doctors and nurses as intelligent agents guided by computational trust mechanisms. The objective is to explore how trust-informed coordination can support decision making in ED management. Methods: The framework was implemented in Unity, a 3D graphics platform, where agents assess their competence before undertaking tasks and adaptively coordinate with colleagues. The simulation environment enables real-time observation of workflow dynamics, resource utilization, and patient outcomes. We examined three scenarios - Baseline, Replacement, and Training - reflecting alternative staff management strategies. Results: Trust-informed task allocation balanced patient safety and efficiency by adapting to nurse performance levels. In the Baseline scenario, prioritizing safety reduced errors but increased patient delays compared to a FIFO policy. The Replacement scenario improved throughput and reduced delays, though at additional staffing cost. The training scenario forstered long-term skill development among low-performing nurses, despite short-term delays and risks. These results highlight the trade-off between immediate efficiency gains and sustainable capacity building in ED staffing. Conclusions: The proposed framework demonstrates the potential of computational trust for evidence-based decision support in emergency medicine. By linking staff coordination with adaptive decision making, it provides hospital managers with a tool to evaluate alternative policies under controlled and repeatable conditions, while also laying a foundation for future AI-driven personalized decision support.