Daily Papers

Research in emergency triage is restricted to structured electronic health records (EHR) due to regulatory constraints on nurse-patient interactions. We introduce TriageSim, a simulation framework for generating persona-conditioned triage conversations from structured records. TriageSim enables multi-turn nurse-patient interactions with explicit control over disfluency and decision behaviour, producing a corpus of ~800 synthetic transcripts and corresponding audio. We use a combination of automated analysis for linguistic, behavioural and acoustic fidelity alongside manual evaluation for medical fidelity using a random subset of 50 conversations. The utility of the generated corpus is examined via conversational triage classification. We observe modest agreement for acuity levels across three modalities: generated synthetic text, ASR transcripts, and direct audio inputs. The code, persona schemata and triage policy prompts for TriageSim will be available upon acceptance.

Medical triage is the task of allocating medical resources and prioritizing patients based on medical need. This paper introduces the first large-scale public dataset for studying medical triage in the context of asynchronous outpatient portal messages. Our novel task formulation views patient message triage as a pairwise inference problem, where we train LLMs to choose `"which message is more medically urgent" in a head-to-head tournament-style re-sort of a physician's inbox. Our novel benchmark PMR-Bench contains 1569 unique messages and 2,000+ high-quality test pairs for pairwise medical urgency assessment alongside a scalable training data generation pipeline. PMR-Bench includes samples that contain both unstructured patient-written messages alongside real electronic health record (EHR) data, emulating a real-world medical triage scenario. We develop a novel automated data annotation strategy to provide LLMs with in-domain guidance on this task. The resulting data is used to train two model classes, UrgentReward and UrgentSFT, leveraging Bradley-Terry and next token prediction objective, respectively to perform pairwise urgency classification. We find that UrgentSFT achieves top performance on PMR-Bench, with UrgentReward showing distinct advantages in low-resource settings. For example, UrgentSFT-8B and UrgentReward-8B provide a 15- and 16-point boost, respectively, on inbox sorting metrics over off-the-shelf 8B models. Paper resources can be found at https://tinyurl.com/Patient-Message-Triage

Vision-language foundation models (VLMs) show promise for diverse imaging tasks but often underperform on medical benchmarks. Prior efforts to improve performance include model finetuning, which requires large domain-specific datasets and significant compute, or manual prompt engineering, which is hard to generalize and often inaccessible to medical institutions seeking to deploy these tools. These challenges motivate interest in approaches that draw on a model's embedded knowledge while abstracting away dependence on human-designed prompts to enable scalable, weight-agnostic performance improvements. To explore this, we adapt the Declarative Self-improving Python (DSPy) framework for structured automated prompt optimization in medical vision-language systems through a comprehensive, formal evaluation. We implement prompting pipelines for five medical imaging tasks across radiology, gastroenterology, and dermatology, evaluating 10 open-source VLMs with four prompt optimization techniques. Optimized pipelines achieved a median relative improvement of 53% over zero-shot prompting baselines, with the largest gains ranging from 300% to 3,400% on tasks where zero-shot performance is low. These results highlight the substantial potential of applying automated prompt optimization to medical AI systems, demonstrating significant gains for vision-based applications requiring accurate clinical image interpretation. By reducing dependence on prompt design to elicit intended outputs, these techniques allow clinicians to focus on patient care and clinical decision-making. Furthermore, our experiments offer scalability and preserve data privacy, demonstrating performance improvement on open-source VLMs. We publicly release our evaluation pipelines to support reproducible research on specialized medical tasks, available at https://github.com/DaneshjouLab/prompt-triage-lab.

The demand for emergency department (ED) services is increasing across the globe, particularly during the current COVID-19 pandemic. Clinical triage and risk assessment have become increasingly challenging due to the shortage of medical resources and the strain on hospital infrastructure caused by the pandemic. As a result of the widespread use of electronic health records (EHRs), we now have access to a vast amount of clinical data, which allows us to develop predictive models and decision support systems to address these challenges. To date, however, there are no widely accepted benchmark ED triage prediction models based on large-scale public EHR data. An open-source benchmarking platform would streamline research workflows by eliminating cumbersome data preprocessing, and facilitate comparisons among different studies and methodologies. In this paper, based on the Medical Information Mart for Intensive Care IV Emergency Department (MIMIC-IV-ED) database, we developed a publicly available benchmark suite for ED triage predictive models and created a benchmark dataset that contains over 400,000 ED visits from 2011 to 2019. We introduced three ED-based outcomes (hospitalization, critical outcomes, and 72-hour ED reattendance) and implemented a variety of popular methodologies, ranging from machine learning methods to clinical scoring systems. We evaluated and compared the performance of these methods against benchmark tasks. Our codes are open-source, allowing anyone with MIMIC-IV-ED data access to perform the same steps in data processing, benchmark model building, and experiments. This study provides future researchers with insights, suggestions, and protocols for managing raw data and developing risk triaging tools for emergency care.

Agentic applications based on large language models increasingly rely on multi-step interaction loops involving planning, action execution, and environment feedback. While such systems are now deployed at scale, improving them post-deployment remains challenging. Agent trajectories are voluminous and non-deterministic, and reviewing each one, whether through human review or auxiliary LLMs, is slow and cost-prohibitive. We propose a lightweight, signal-based framework for triaging agentic interaction trajectories. Our approach computes cheap, broadly applicable signals from live interactions and attaches them as structured attributes for trajectory triage, identifying interactions likely to be informative without affecting online agent behavior. We organize signals into a coarse-grained taxonomy spanning interaction (misalignment, stagnation, disengagement, satisfaction), execution (failure, loop), and environment (exhaustion), designed for computation without model calls. In a controlled annotation study on τ-bench, a widely used benchmark for tool-augmented agent evaluation, we show that signal-based sampling achieves an 82\% informativeness rate compared to 74\% for heuristic filtering and 54\% for random sampling, with a 1.52x efficiency gain per informative trajectory. The advantage is robust across reward strata and task domains, confirming that signals provide genuine per-trajectory informativeness gains rather than merely oversampling obvious failures. These results show that lightweight signals can serve as practical sampling infrastructure for agentic systems, and suggest a path toward preference data construction and post-deployment optimization.

Large Language Models (LLMs) are increasingly deployed in high-stakes clinical applications in India. In many such settings, speakers of Indian languages frequently communicate using romanized text rather than native scripts, yet existing research rarely evaluates this orthographic variation using real-world data. We investigate how romanization impacts the reliability of LLMs in a critical domain: maternal and newborn healthcare triage. We benchmark leading LLMs on a real-world dataset of user-generated queries spanning five Indian languages and Nepali. Our results reveal consistent degradation in performance for romanized messages, with F1 scores trailing those of native scripts by 5-12 points. At our partner maternal health organization in India, this gap could cause nearly 2 million excess errors in triage. Crucially, this performance gap by scripts is not due to a failure in clinical reasoning. We demonstrate that LLMs often correctly infer the semantic intent of romanized queries. Nevertheless, their final classification outputs remain brittle in the presence of orthographic noise in romanized inputs. Our findings highlight a critical safety blind spot in LLM-based health systems: models that appear to understand romanized input may still fail to act on it reliably.

The post-pandemic surge in healthcare demand, coupled with critical nursing shortages, has placed unprecedented pressure on medical triage systems, necessitating innovative AI-driven solutions. We present a multi-agent interactive intelligent system for medical triage that addresses three fundamental challenges in current AI-based triage systems: inadequate medical specialization leading to misclassification, heterogeneous department structures across healthcare institutions, and inefficient detail-oriented questioning that impedes rapid triage decisions. Our system employs three specialized agents--RecipientAgent, InquirerAgent, and DepartmentAgent--that collaborate through Inquiry Guidance mechanism and Classification Guidance Mechanism to transform unstructured patient symptoms into accurate department recommendations. To ensure robust evaluation, we constructed a comprehensive Chinese medical triage dataset from "Ai Ai Yi Medical Network", comprising 3,360 real-world cases spanning 9 primary departments and 62 secondary departments. Experimental results demonstrate that our multi-agent system achieves 89.6% accuracy in primary department classification and 74.3% accuracy in secondary department classification after four rounds of patient interaction. The system's dynamic matching based guidance mechanisms enable efficient adaptation to diverse hospital configurations while maintaining high triage accuracy. We successfully developed this multi-agent triage system that not only adapts to organizational heterogeneity across healthcare institutions but also ensures clinically sound decision-making.

In this paper, we describe SpeakerStew - a hybrid system to perform speaker verification on 46 languages. Two core ideas were explored in this system: (1) Pooling training data of different languages together for multilingual generalization and reducing development cycles; (2) A novel triage mechanism between text-dependent and text-independent models to reduce runtime cost and expected latency. To the best of our knowledge, this is the first study of speaker verification systems at the scale of 46 languages. The problem is framed from the perspective of using a smart speaker device with interactions consisting of a wake-up keyword (text-dependent) followed by a speech query (text-independent). Experimental evidence suggests that training on multiple languages can generalize to unseen varieties while maintaining performance on seen varieties. We also found that it can reduce computational requirements for training models by an order of magnitude. Furthermore, during model inference on English data, we observe that leveraging a triage framework can reduce the number of calls to the more computationally expensive text-independent system by 73% (and reduce latency by 59%) while maintaining an EER no worse than the text-independent setup.

Security Operations Centers (SOCs) are overwhelmed by tens of thousands of daily alerts, with only a small fraction corresponding to genuine attacks. This overload creates alert fatigue, leading to overlooked threats and analyst burnout. Classical detection pipelines are brittle and context-poor, while recent LLM-based approaches typically rely on a single model to interpret logs, retrieve context, and adjudicate alerts end-to-end -- an approach that struggles with noisy enterprise data and offers limited transparency. We propose CORTEX, a multi-agent LLM architecture for high-stakes alert triage in which specialized agents collaborate over real evidence: a behavior-analysis agent inspects activity sequences, evidence-gathering agents query external systems, and a reasoning agent synthesizes findings into an auditable decision. To support training and evaluation, we release a dataset of fine-grained SOC investigations from production environments, capturing step-by-step analyst actions and linked tool outputs. Across diverse enterprise scenarios, CORTEX substantially reduces false positives and improves investigation quality over state-of-the-art single-agent LLMs.