Emergency Departments

Follow this topic Ask about this topic

Momentum

1 paper in the last four weeks, against 2 the four weeks before. 0.0% of all new papers.

Jul 6Week of Sep 21

Latest papers 21

Sep 30, 2026cs.LG

Quantifying the Impact of Ambulance Ramping: A Multi-Year Analysis of Victorian Emergency Medical Services Cases

Ambulance ramping, the delay between hospital arrival and patient handover, is a critical operational bottleneck in Emergency Medical Services (EMS), yet its systemic magnitude and dynamics remain inadequately characterised at scale. This paper quantifies the scale, trajectory, and operational correlates of ramping across an entire statewide EMS system, analysing 2,850,575 ambulance attendances in Victoria, Australia from January 2020 to March 2024 using an Exploratory Data Analysis (EDA). After systematic preprocessing, an analytical cohort of 2,026,569 Emergency Department (ED) transports across 59 hospitals with ED and 79 Local Government Areas (LGA) was examined through interval decomposition, Pareto concentration, hourly cross-correlation, hospital arrival concurrency and priority-stratified operational comparisons. Cumulative Ambulance Hours Lost (AHL) totalled 1,491,127 hours, equivalent to approximately 96 ten-hour ambulance shift lost every day of the study window. Ten of 59 hospitals account for 57.8% of lost hours from 50.9% of cases. Annual losses rose 57% to a 2022 peak while transported demand fell 3.7%, indicating deterioration in per-case handover rather than growth in demand. Handover duration varies little with patient acuity, but rises monotonically with the number of ambulances arriving at the same hospital in the preceding hour, an effect persisting within every hour of the day. Hourly demand is moderately associated with ramping two to four hours later (r = 0.365). These findings establish the empirical preconditions for hospital-state aware ambulance routing.

Ayesha Tanveer, Khandakar Ahmed, Assefa Teshome +2

Institute for Sustainable Industries and Liveable Cities (ISILC), The Centre of Excellence in Paramedicine (CoEP), Victoria University, Melbourne, Australia · Center for Research and Evaluation Ambulance Victoria, Blackburn North, Victoria, Australia

Emergency Departments Handoff Longitudinal Data Impact Analysis

Sep 30, 2026cs.CV

From Image Interpretation to Clinical Reasoning: Upstream Physician-Context-Aware Multimodal Learning with Causal Reinforcement Learning

Major adverse cardiovascular events (MACE) remain the leading cause of mortality worldwide. Opportunistic screening using routinely acquired clinical data offers a scalable approach for identifying high-risk individuals before acute events occur. Although chest X-rays (CXRs) capture latent cardiovascular biomarkers and clinical histories provide complementary patient context, existing medical vision-language models are primarily optimized for radiology interpretation rather than prognostic reasoning. We propose a causal reinforcement learning framework for multimodal clinical reasoning that integrates CXRs and physician-authored clinical histories for opportunistic MACE prediction. The framework introduces (1) a role-decoupled dual-LLM architecture that separates reasoning from risk prediction, (2) a dual-action causal reinforcement learning policy for evidence selection and reasoning optimization, and (3) causal token pruning to learn compact multimodal representations. Evaluated on an internal cohort, an emergency department cohort, and the external MIMIC dataset, the proposed framework consistently outperformed unimodal baselines and state-of-the-art medical vision-language models, achieving AUROCs of 0.720, 0.760, and 0.845, respectively. It also substantially improved reasoning quality, achieving higher GREEN scores and higher expert preference while maintaining robust predictive performance across diverse patient populations.

Jialu Pi, Yanan Ma, Weijie Chen +8

Dept. of Radiology, Mayo Clinic, Phoenix, AZ, USA · School of Computing and Augmented Intelligence, Arizona State University, Tempe, USA · Dept. of Radiology, Mayo Clinic, Phoenix, USA +2

Multimodal Clinical Data Chest X-Ray Cardiac Emergency Departments Screening

Sep 28, 2026cs.CL

Almost Human, Except When It Matters: VoxParity and the Decisions a Voice Should Change

A voice agent can handle almost every call on the words alone and still fail the few its sector's rules were written for. Emergency-call standards, fraud guidance, radio phraseology and vulnerability rules recognise that how a caller sounds, or what else is audible, can change the right action. VoxParity tests whether agents act on it. In 183 scenarios from 14 sectors, one transcript stays fixed while the audio changes (a coaching voice, a medical monitor beeping, a mayday under a radio check, noise over a drug name, a child's voice placing a bet, a frightened whisper), and with it the correct typed tool call. A words-only null test credits a system only if hearing the call moves its actions more than it moves a pipeline that only reads the words. Only 11 of the 23 systems that can also be run on the transcript pass. Descriptively, errors run toward the words: when the audio calls for protection, all 28 systems carry out the routine request more often than they over-react on clean calls (41% against 12% pooled; the words-only pipeline, 58% against 15%). Exploratory analyses place most of the leading systems' misses on cues they heard; systems beat the null almost entirely on items that state the rule; the leading systems overrule heard resignation or confusion far more often than acute alarm; and, in the models tested, describing the voice and stating the rule each recover part of the shortfall, leaving a gap on emotion.

Bhavik Mangla

Independent Research

Voice Agents Emergency Departments Decisions Change 3D Generation

Sep 9, 2026cs.CY

Emergency Department Revisit Quality Review Screening: Exploring Human Decision-Making and Artificial Intelligence Support

Background: Emergency Department (ED) return visits are commonly reviewed for quality assurance, but are often limited (e.g., to revisits within 48-72 hours) to increase actionable finding yield while minimizing chart review burden. Those limitations may lead to missed quality improvement opportunities. Methods: We conducted an exploratory, retrospective study of randomly selected ED visits to a multihospital health system having an ED revisit within 1-14 days to the same health system. Given only each visit's primary diagnosis, raters (2-3 clinicians and GPT-4 large language model [LLM]) assessed characteristics of the diagnosis pairs, including the "target": whether a pair warranted further assessment. Informed by rater response analyses, an algorithm leveraging an LLM-populated knowledge graph ("KGA") was created to automatically screen for potentially concerning pairs, then preliminarily assessed. Results: 99 diagnosis pairs were included. GPT-4 responses poorly correlated to clinician raters, rating nearly all (94%) pairs as warranting follow-up (4.4-13.3 times more than clinicians). However, prompt engineering was minimal. Among clinician raters, revisit medical gravity was consistently significantly associated with the target, while a differential diagnosis/complication composite was significantly associated on unadjusted, but not adjusted (though less powered) analysis. The KGA achieved 83-100% positive predictive value for at least one clinician rater determining further assessment was warranted based on the diagnosis pair. Conclusion: These results can inform next steps for improving screening with LLMs like ChatGPT. Further research is warranted to validate this preliminary work's finding that the KGA may enable enhancing the scope and yield of screening without substantially increasing reviewer workload.

Jonathan A. Handler, Marlene I. Robles-Granda, Jacob E. Mefford +5

Clinical Intelligence and Advanced Data Lab, OSF HealthCare, Peoria, IL · Digital Innovation Development, OSF HealthCare, Peoria, IL · OnCall, OSF HealthCare, Peoria, IL +7

Clinician Trust Emergency Departments Screening Improvement

Aug 10, 2026cs.CL

Locally Deployable Small Language Models for Emergency Department Decision Support: A Systematic Benchmark of Fine-Tuning Strategies

Deploying large language models (LLMs) for decision support in emergency departments (EDs) faces two major challenges: privacy risks of transmitting patient data to closed-source commercial LLMs and the lack of systematic evaluation of fine-tuning strategies for locally deployable open-source small language models (SLMs). We benchmarked eight open-source SLMs using zero-shot prompting, prefix tuning, Low-Rank Adaptation (LoRA), and full fine-tuning on three ED tasks: triage level prediction, specialist referral recommendation, and diagnosis prediction. Using 2,083 MIMIC-IV-ED cases and Claude Haiku 4.5 and Claude Sonnet 4.5 as baselines, we found that LoRA fine-tuned open-source SLMs outperform commercial baselines on triage level prediction and specialist referral recommendation, while diagnosis prediction remains challenging for open-source SLMs. Confusion matrix analysis further shows that fine-tuned open-source SLMs can detect highest-severity patients missed by the commercial baselines. These results demonstrate that locally deployable SLMs can achieve clinically competitive performance for ED decision support.

Qingfeng Zhang, Yuanxiong Guo, Yanmin Gong

The University of Texas at San Antonio, San Antonio, TX · Texas A&M University, Houston, TX

Small Large Language Models Emergency Departments Triage

Aug 10, 2026cs.CL

ELICITED: EHR-grounded Longitudinal Interactive Conversations for Information-seeking Triage Evaluation and Decision-making

Emergency-department (ED) triage requires clinicians to rapidly identify patients who need immediate attention, determine who can safely wait, and prioritize limited clinical resources. At presentation, however, information may be limited to a chief complaint and initial vital signs. Clinically important details, including symptom onset and progression, associated symptoms, medical history, and medication use, are often obtained through focused conversation. Effective triage therefore requires clinicians to identify information gaps, ask appropriate follow-up questions, and update their assessment as new evidence becomes available. Most existing ED benchmarks evaluate acuity prediction from a fixed clinical snapshot. Although this formulation measures predictive performance after patient information has been assembled, it does not capture the interactive process through which triage-relevant evidence is elicited and interpreted. Existing medical dialogue datasets support the study of clinical communication, but dialogue statements are not always linked to temporally ordered events in the electronic health record (EHR). We introduce EHR2Dial-Triage, an agentic conversation-generation framework and benchmark grounded in MIMIC-IV-ED. The framework constructs triage conversations under explicit role-based and temporal information boundaries. Each accepted patient disclosure is linked to its supporting EHR event and the first dialogue turn at which it becomes available. EHR2Dial-Triage enables controlled evaluation of information elicitation, evidence use, five-level Emergency Severity Index prediction, and patient-facing communication across models and patient personas. It provides a structured setting for studying conversational triage as a dynamic process of clinical information acquisition, reasoning, and communication.

Haohao Zhu, Xiaolin Shi, Jiayu Zhou

University of Michigan · Ellipsis Health

Emergency Departments Triage Electronic Health Records Elicitation

Jul 29, 2026cs.LG

Hierarchical Spatio-Temporal Transformer for Coherent Emergency Department Forecasting

Emergency Departments (EDs) are critical access points in healthcare systems, yet they face persistent pressure from unpredictable patient demand, seasonal surges, and non-urgent visits. Effective ED planning requires forecasts at multiple decision-making levels: hospitals need local demand estimates for staffing and bed management, regions require forecasts to coordinate healthcare units, and national authorities need system-wide projections for capacity planning. However, most existing approaches forecast ED demand independently at a single level, ignoring the hierarchy linking hospitals, regions, and national systems. This can produce incoherent predictions, where hospital-level forecasts do not aggregate consistently to regional or national demand. We propose HierSTT, a hierarchical Transformer-based framework for coherent multi-level ED forecasting. HierSTT jointly predicts hospital, regional, and national level demand in a single end-to-end model. A Temporal Fusion Transformer captures national dynamics, while spatio-temporal Transformer encoder-decoder modules model regional and hospital demand conditioned on higher-level forecasts. A coherence-aware loss penalizes cross-level inconsistencies during training. We further introduce a nationwide Portuguese ED dataset covering 81 hospitals across 5 regional health administrations, with heterogeneous covariates at each level. Experiments show that HierSTT reduces average WAPE by 32% relative to the best non-hierarchical deep learning baseline and outperforms all classical hierarchical reconciliation methods, while producing near-coherent predictions across levels. Additional resources associated with this work are available at https://github.com/FilipaLino/HierSTT.

Filipa Lino, Bárbara Tavares, Carlos Santiago +2

Institute for Systems and Robotics, LARSyS, Instituto Superior Técnico, Portugal · NOVA School of Science and Technology, Caparica, Portugal

Spatio-Temporal Forecasting Emergency Departments Spatio-Temporal Transformers Transformer Architectures

Jul 25, 2026cs.CV

DispatchRAG: Grounding Emergency Dispatch Decisions in Real-World Protocols from Traffic Accident Video

Assessing the severity of a traffic accident scenario is important to decide which emergency service to dispatch. Missing an ambulance dispatch on a pedestrian accident is a fatal issue that can lead to death. Recently, Vision-Language Models (VLMs) have been a promising tool for accident reasoning, yet many VLMs are not grounded in real-life accident response protocols, making them not usable in accident severity assessment off-the-shelf. We introduced DispatchRAG, an accident assessor and dispatcher framework grounded in real-life Japanese traffic-accident response protocols, designed to enhance VLMs to generate an appropriate emergency response during an emergency scenario. Utilizing a RAG-based retrieval mechanism to retrieve the most relevant accident protocol and an LLM-powered reasoner to suggest the most proper response. To support evaluation, we introduce Accident Dispatch Dataset, a comprehensive dataset of accident assessment and emergency response according to Japanese accident response protocols adapted from the MM-AU dataset. We validate our framework on the Accident Dispatch Dataset, showing strong performance across various accident scenarios compared to the baseline VLM, pointing toward integration in autonomous vehicles that can automatically report both their own and nearby accidents.

Muhammad Sulthan Adhipradhana, Ehsan Javanmardi, Naren Bao +1

Graduate School of Information Science and Technology, University of Tokyo, Tokyo, Japan

Accident Source Term Evaluation Code Accidents Emergency Departments Traffic

Jun 29, 2026cs.LG

Optimizing Nursing Care Taxi Dispatch Leveraging Integer Linear Programming Solvers and Machine Learning

In this paper, we formulate a new vehicle dispatch optimization problem, called Nursing Care Taxi Dispatch, as a variant of the Vehicle Routing Problem, considering constraints related to wheelchair use, user compatibility, pick-up and drop-off times, and vehicle limitations. Previous neural-based methods for Vehicle Routing Problems have typically addressed a few simple constraints, while our new problem involves multiple complex constraints, resulting in having fewer destinations to select. This complexity makes it more difficult to obtain solutions that allow all nodes to be visited with a limited number of vehicles. To balance low violation rate, computational efficiency, and solution quality, we propose a supervised machine learning approach based on the Transformer architecture. We first obtain a set of high-quality solutions using an integer linear programming solver for given inputs and then train our learning model through supervised learning. Additionally, we introduce the post-processing of the paths generated by the learning model, ensuring that all constraints are satisfied. We compared each instance's objective function value (operating time), execution time, and constraint violation rate across different methods: our proposed method and some existing methods including integer linear programming and machine learning-based methods, using real-world facility data. Our method successfully produced balanced solutions regarding operating time, execution time, and constraint violation rate. Notably, we observed a decrease in the operating time for all problem sizes and regions, while keeping constraint violations to a minimum compared to existing methods. Especially, the decrease reached up to 8% for problem sizes with fewer than 30 users.

Riku Nakao, Akihito Hiromori, Hamada Rizk +1

The University of Osaka, Japan · RIKEN R-CCS, Japan · Tanta University, Egypt

Vehicle Routing Problem Mixed-Integer Programming Linear Programming Emergency Departments Structural Constraints

Jun 12, 2026cs.SD

Efficiency-Performance Trade-offs in Neural Speaker Diarization via Structured Pruning and Low-Bit Quantization

Streaming speaker diarization is crucial for time-critical medical dispatch, but deploying it on resource-constrained hardware requires smaller, faster models. Using SIMSAMU, a dataset of simulated medical-dispatch conversations, we evaluate streaming behavior before compressing the segmentation model with pruning and low-bit quantization. We characterize performance across a range of streaming latency budgets and find that additional buffering is not consistently beneficial, while very low-latency operating points can substantially degrade performance. Our study shows that model compression trades performance for memory footprint, and we highlight an operating point where FP16 reduces model size by half with essentially unchanged real-time factor, at a cost of a 40% relative DER increase against the baseline. This work characterizes the trade-offs for real-time deployment and contributes to speech technology that can enable reliable human communication in time-critical contexts.

Rishit Chatterjee, Tahiya Chowdhury

Department of Computer Science, Colby College, Waterville, Maine, United States

Speaker Diarization Neural Speech Codecs Streaming Structured Pruning Trade-Off Emergency Departments+1

Jun 10, 2026cs.CL

eCREAM-MedCorpus A Large-Scale Corpus of Clinical Notes for Italian

We present eCREAM-MedCorpus, a new and unique large-scale dataset of clinical notes produced in Emergency Departments of Italian hospitals. The corpus, in its current version, is composed of approximately 4 million clinical notes fully anonymized, covering diverse phases of patient care during the stay in the emergency department. In addition, a subset of about six thousand notes has been manually annotated by clinical experts through a structured Case Report Form (CRF) containing 132 items relevant for two patient situations in emergency departments, dyspnea and loss of consciousness. Items may assume numerical values (e.g., for blood saturation), categorical (e.g., for level of consciousness ), binary (e.g., for presence of traumas), and mixed value types. The annotation process involved multiple clinicians and underwent iterative revision to resolve ambiguities in item formulation, resulting in a richly structured (although high imbalanced) resource. The dataset aims to fill a relevant gap of data able to support both the development and the use of Large Language Models in concrete medical applications. We describe the data collection protocol, the on-site anonymisation pipeline, corpus statistics, and the annotation scheme. Finally, we propose CRF-filling as a novel structured information extraction benchmark, and provide zero-shot baseline resulting from Gemma-27B and MedGemma-27B. To the best of our knowledge, eCREAM-MedCorpus is the largest freely available dataset of clinical notes existing for the Italian language.

Tiziano Labruna, Guido Bertolini, Pietro Ferrazzi +1

Fondazione Bruno Kessler, Trento, Italy · Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy · University of Padua, Padua, Italy

Clinical Notes Emergency Departments Text Corpora Annotations

May 28, 2026cs.CL

SURGENT: A Surgical Multi-Agent Assistance System Across the Perioperative Workflow

The intricate nature of modern surgical care necessitates intelligent systems that can synthesize extensive patient records, support collaborative decision-making, and provide transparent, auditable reasoning across the entire perioperative workflow. Although web-based Large Language Models (LLMs) possess advanced reasoning capabilities, they are ill-equipped for surgical applications due to critical limitations: input length constraints, incomplete memory management, and limited traceability. To address this issue, we present SURGENT, a surgical multi-agent assistance system that combines a Tree-of-Thought planner, multi-department collaboration agents, and retrieval-augmented reasoning with clinical guidelines and biomedical literature. SURGENT features a novel memory design that manages both long-term patient histories and short-term working summaries, enabling more complete, contextualized, and consistent reasoning. Experimental evaluations across five key perioperative tasks - case analysis, surgical plan simulation, safety monitoring, complication risk assessment, and rehabilitation guidance - show that SURGENT outperforms baseline LLMs and existing medical multi-agent frameworks, yielding recommendations more closely aligned with patient histories. Ablation studies further highlight the advantage of DeepSeek as a locally deployable backbone model, enabling privacy-preserving deployment without reliance on centralized services. These results position SURGENT as a practical and trustworthy advancement toward intelligent, equitable, and secure surgical assistance systems.

Dongsheng Shi, Yue Li, Xin Yi +3

East China Normal University Shanghai, China · City University of Hong Kong Hong Kong SAR, China

Model-Based Multi-Agent Systems Emergency Departments Deepseek

May 22, 2026math.OC

Selective Ambulance Dispatch Under Contextual Travel-Time Uncertainty

Ambulance response is time-critical in out-of-hospital cardiac arrest (OHCA), where dispatchers must balance timely arrivals with limited fleet capacity. Static territories and deterministic travel-time estimates are vulnerable to dynamic congestion, while always-dual dispatch adds redundancy but consumes fleet capacity. We propose IDEAL (Intelligent Dual dispatch of Emergency AmbuLances), a selective dual-dispatch framework that sends a second ambulance only when the optimistic gap between primary and secondary paths exceeds a threshold. IDEAL learns context-specific edge travel times from trip-level dispatch records, including unobserved routes, using a weakly supervised bilevel representation network. We train the nonsmooth model with mini-batch conservative gradients and prove an asymptotic convergence guarantee. IDEAL models uncertainty via Burg-divergence perturbations to a shared metric in the learned representation space, thereby inducing correlated changes in edge travel times and learning context-specific radii from historical underprediction errors. For real-time decisions, IDEAL casts optimistic-gap computation as a difference-of-convex program and derives an efficient oracle with complexity guarantees. In collaboration with the Hong Kong Fire Services Department, we evaluate IDEAL using historical OHCA records and real-time adaptive simulations. The results achieve a stronger response-time/resource trade-off relative to all region-based and Google-based baselines.

Zikun Lin, Daniel Zhuoyu Long, Viet Anh Nguyen

Department of Systems Engineering and Engineering Management, The Chinese University of Hong Kong

Emergency Departments Bike-Sharing Systems Uncertainty

May 19, 2026cs.MA

PAVE: A Cognitive Architecture for Legitimate Violation in Generative Agent Societies

Generative agents based on large language models reproduce believable human behavior in cooperative settings, but how they should reason in situations where rule-breaking may be required, such as fire evacuation or authority-supervised emergency, remains poorly characterized. We propose PAVE (Perception, Assessment, Verdict, Emulation), a novel four-module cognitive architecture that addresses this gap end to end: (i) Perception extracts a structured context with explicit authority distance, peer behaviors, and severity-tagged situational cues; (ii) Assessment scores the context along five scalars including an explicit legitimacy judgment that checks necessity, proportionality, and absence of alternatives; (iii) Verdict decides to comply or violate under a hard legitimacy gate, with a per-agent threshold elicited from the persona; (iv) Emulation enacts the verdict and scopes the violation to the rule the trigger justifies. We instantiate PAVE in Voville, a tile-based traffic environment forked from Smallville, and evaluate across three scenarios, four LLM backbones, and a focused ablation. PAVE agents satisfy four properties simultaneously: legitimate violation (only when a trigger justifies it), authority deference (officer instructions override even high legitimacy), bounded scope (violations confined to the targeted rule), and recovery (baseline restored once the trigger ends). PAVE agents make more structured and interpretable decisions than vanilla across all four properties, and human evaluators rate them as more plausible. Ablating the legitimacy gate reproduces vanilla-like failures. We release Voville, the PAVE prompts and code, and the evaluation pipeline.

Ahmad Yehia, Abduallah Mohamed, Kun Qian +4

The University of Texas at Austin · Meta Reality Labs · University of Calgary

Violation Cognitive Science Emergency Departments

May 13, 2026cs.AI

Multi-Agent Systems in Emergency Departments: Validation Study on a ED Digital Twin

Emergency departments (ED) face challenges in patient care and resource management. We propose to explore optimization strategies in a realistic and flexible model and develop a hybrid Discrete Event Simulation (DES) and Agent-Based Model (ABM) simulating highly configurable ED environments. We specifically focus on the validation of the modeling approach. We derive configurations for ED sizes, patient load, and staffing from real-world studies. We then validate the model expressivity by matching its key performance indicators and metrics with their values known from literature. We proceed by implementing scientifically established and practice-proven resource optimization strategies. Comparing the documented real-world outcomes with our model's results demonstrates that the DES-ABM based simulation can effectively replicate real-world ER dynamics under interventions. We lastly integrate a Proof-of-Concept multi-agent system (MAS) that can autonomously explore resource allocation strategies within the simulated ER environment based on a temporal ledger of ED event records. This modular DES-ABM-MAS framework offers a powerful tool to explore resource optimization strategies in emergency departments.

Markus Wenzel, Tobias Strapatsas, Jessika Kress +3

Constructor University, Bremen, Germany · Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany · Asklepios Kliniken Hamburg GmbH, Hamburg, Germany

Agent-Based Model Emergency Departments Patients

May 13, 2026cs.LG

An Integrated Forecasting Prototype for Emergency Department Boarding Time to Support Proactive Operational Decision Making

Overcrowding in emergency departments (ED) remains a persistent operational challenge worldwide, causing delays in care delivery and downstream congestion. ED boarding time, defined as the duration admitted patients remain in the ED while awaiting inpatient bed placement, is a key indicator of this congestion. Predicting ED boarding time in advance enables proactive operational decision making before congestion escalates. We developed and evaluated a multi-horizon time series forecasting framework to predict ED boarding time at 6, 8, 10, 12, and 24-hour horizons. Real-world data from a university-affiliated urban hospital in the United States were utilized and integrated with external contextual data sources, including weather, holidays, and major local events. Decomposition-based Linear (DLinear) and Normalization-based Linear (NLinear) time series forecasting deep learning models showed superior performance across multiple horizons. Models were also evaluated under extreme congestion scenarios characterized by elevated boarding times. In addition, a Machine Learning Operations (MLOps) web application prototype was developed to support translation of the forecasting framework into practice through integrated data ingestion, forecast visualization, experimentation, and retraining.

Orhun Vural, Abdulaziz Ahmed, Ferhat Zengul +2

Department of Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, AL, USA · Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA · Department of Biomedical Informatics and Data Science, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA +1

Readmission Prediction Emergency Departments Congestion Proactive

May 8, 2026cs.AI

Human-LLM Dialogue Improves Diagnostic Accuracy in Emergency Care

Clinical decision-making in emergency medicine demands rapid, accurate diagnoses under uncertainty. Despite benchmark progress, evidence for LLMs as interactive aids in live physician workflows remains sparse. MedSyn lets physicians iteratively query an LLM provided with the full clinical record while initially viewing only the chief complaint. Seven physicians (three seniors, four residents) completed baseline and AI-assisted sessions across 52 MIMIC-IV cases stratified by difficulty. Blinded evaluation showed residents' Hard-case correctness rose from 0.589 to 0.734; difficulty-standardised completely-correct rates confirmed a medium effect (Δ = 0.092; p = 0.071; d = 0.47). Automated metrics corroborated these gains: standardised any-match accuracy improved by 0.156 (p < 0.0001), and residents showed the largest F1 gain (Δ = 0.138; p < 0.0001). Dialogue analysis revealed expertise-dependent strategies (seniors asked targeted, hypothesis-driven questions; residents relied on broader queries) and cross-expertise concordance increased (Δ = 0.145; p < 0.0001). Interactive LLM support meaningfully enhances diagnostic reasoning.

Burcu Sayin, Ngoc Vo Hong, Ipek Baris Schlicht +8

Department of Information Engineering and Computer Science, University of Trento, Italy · Department of Medicine, Azienda Sanitaria Universitaria Integrata del Trentino (ASUIT), Trento, Italy · Universitat Politècnica de València, Spain +2

Clinical Reasoning Training Emergency Departments Diagnosis Real-World Clinical Workflows Hypothesis-Driven Model Expansion

Apr 28, 2026cs.CY

Improving Hospital Process Management through Process Mining: A Case Study on COVID-19 Clinical Pathways

This study analyzes COVID-19 care pathways using the COVID Data for Shared Learning dataset. We build a transparent, reproducible pipeline that transforms heterogeneous clinical tables into a process-mining-ready event log and applies discovery, declarative conformance checking, and outcome analysis. The reconstructed pathways highlight the monitoring backbone of inpatient care, variability at the Emergency department-admission interface, and outcome differences driven by age and exposure to intensive care units. These insights support triage standardization, capacity planning, and step-down coordination from intensive care units to lower-acuity wards, showing how process mining can inform evidence-based hospital governance.

Pasquale Ardimento, Mario Luca Bernardi, Marta Cimitile +1

University of Bari Aldo Moro, Bari, Italy · Unisannio University of Benevento, Italy · UnitelmaSapienza Rome, Italy

Covid-19 Patient Trajectories Emergency Departments Healthcare Case Study

Apr 18, 2026cs.LG

HealthCraft: A Reinforcement Learning Safety Environment for Emergency Medicine

Frontier language models are being deployed into clinical workflows faster than the infrastructure to evaluate them safely. Static medical-QA benchmarks miss the failure modes that matter in emergency medicine: trajectory-level safety collapse, tool misuse, and capitulation under sustained clinical pressure. We present HealthCraft, the first public reinforcement-learning environment that rewards trajectory-level safety under realistic emergency-medicine conditions, adapted from Corecraft. It is built on a FHIR R4 world state with 14 entity types and 3,987 seed entities, exposes 24 MCP tools, and defines a dual-layer rubric that zeroes reward whenever any safety-critical criterion is violated. We release 195 tasks across six categories, graded against 2,255 binary criteria (515 safety-critical); a post-hoc 10-task negative-class slate extends this to 205 tasks and 2,337 criteria. V8 results on two frontier models show Claude Opus 4.6 at Pass@1 24.8% [21.5-28.4] and GPT-5.4 at 12.6% [10.2-15.6], with safety-failure rates of 27.5% and 34.0%. On multi-step workflows - the closest proxy to real emergency care - performance collapses to near zero (Claude 1.0%, GPT-5.4 0.0%) despite partial competence on individual steps. Six infrastructure bugs fixed between pilots v2 and v8 re-ordered which model "looks stronger," evidence that infrastructure fidelity is part of the measurement. A deterministic LLM-judge overlay bounds evaluator noise, and a 60-run negative-class smoke pilot shows the reward signal is not drop-in training-safe: restraint criteria pass at 0.929 prevalence, a gameability an eval harness can tolerate but a training reward cannot. We scaffold coupling to a Megatron+SGLang+GRPO loop per Corecraft Section 5.2 and leave training-reward ablations as future work. Environment, tasks, rubrics, and harness are released under Apache 2.0.

Brandon Dent

GOATnote Inc.

Clinical Reasoning Training Emergency Departments Trajectory-Level Credit Reward Signal Fidelity

Apr 17, 2026cs.HC

Driving Assistance System for Ambulances to Minimise the Vibrations in Patient Cabin

The ambulance service is the main transport for diseased or injured people which suffers the same acceleration forces as regular vehicles. These accelerations, caused by the movement of the vehicle, impact the performance of tasks executed by sanitary personnel, which can affect patient survival or recovery time. In this paper, we have trained, validated, and tested a system to assess driving in ambulance services. The proposed system is composed of a sensor node which measures the vehicle vibrations using an accelerometer. It also includes a GPS sensor, a battery, a display, and a speaker. When two possible routes reach the same destination point, the system compares the two routes based on previously classified data and calculates an index and a score. Thus, the index balances the possible routes in terms of time to reach the destination and the vibrations suffered in the patient cabin to recommend the route that minimises those vibrations. Three datasets are used to train, validate, and test the system. Based on an Artificial Neural network (ANN), the classification model is trained with tagged data classified as low, medium, and high vibrations, and 97% accuracy is achieved. Then, the obtained model is validated using data from three routes of another region. Finally, the system is tested in two new scenarios with two possible routes to reach the destination. The results indicate that the route with less vibration is preferred when there are low time differences (less than 6%) between the two possible routes. Nonetheless, with the current weighting factors, the shortest route is preferred when time differences between routes are higher than 20%, regardless of the higher vibrations in the shortest route.

Abdulaziz Aldegheishem, Nabil Alrajeh, Lorena Parra +2

Vibration Emergency Departments Accelerometer Data Classifier

Jan 23, 2026cs.AI

SycoEval-EM: Sycophancy Evaluation of Large Language Models in Simulated Clinical Encounters for Emergency Care

Large language models (LLMs) deployed in clinical decision support may acquiesce to patient requests for care that conflicts with evidence-based guidelines. We developed SycoEval-EM, a multi-agent simulation framework to evaluate LLM robustness to adversarial patient persuasion in emergency medicine. Across 19 contemporary LLMs and 1,425 simulated clinical encounters spanning three Choosing Wisely scenarios, acquiescence rates ranged from 0% to 100%, revealing a bimodal distribution. Seven models maintained near-perfect guideline adherence, while six acquiesced in the majority of encounters. Vulnerability varied substantially across clinical scenarios. Acquiescence was highest for CT imaging requests, intermediate for antibiotic prescriptions for sinusitis, and lowest for opioid prescriptions for acute back pain. Model scale, recency, and performance on static medical benchmarks did not consistently predict robustness. All five persuasion tactics produced similar acquiescence rates, with no statistically significant differences after correction for multiple comparisons, suggesting a generalized susceptibility rather than tactic-specific weaknesses. LLM-as-judge evaluation was validated against two independent physician raters across 95 matched conversations and demonstrated near-perfect agreement for the primary outcome of acquiescence (Cohens kappa = 0.957). These findings indicate that static medical benchmarks are insufficient to predict safety performance under sustained social pressure and support incorporating multi-turn adversarial testing into clinical AI evaluation. Notably, two models achieved perfect guideline adherence across all encounters, demonstrating that robustness to patient pressure is attainable without sacrificing effective clinical communication.

Dongshen Peng, Yi Wang, Austin Schoeffler +5

UNC Chapel Hill · University of Waterloo · Stanford University

Simulated Patients Large Language Model Evaluation Emergency Departments Sycophancy Clinical Artificial Intelligence Evaluation