Patterns / Triage council
pattern study
Triage council
A four-satellite routing system designed to decide between nurse, GP, specialist, or escalation in under a minute, with a written rationale per call.
The bottleneck
Take a tele-health platform routing thousands of intake calls a day through a team of triage nurses. The nurses are the ceiling: their judgment is the product, and they cannot absorb more calls without dropping quality. The platform has tried decision-tree triage tools and rolled them back, because nurses found them too rigid for ambiguous symptoms.
What it needs is a routing system that reads like a thoughtful colleague, not a flowchart.
The shape
The Triage council is a small council pattern: four satellite advisors (nurse, GP, specialist, escalation) with a central router that runs a one-pass deliberation. Unlike in Aegis, only the escalation advisor speaks in full sentences. The other three speak in confidence intervals and a single recommended route.
By our own day-one test, routing this fast is usually oracle work. This is the boundary case, and it has to earn the exception: the stakes per call are clinical, the rationale must be auditable, and the pattern pays the latency tax with a single deliberation pass and satellites that answer in numbers rather than prose.
The system writes a one-paragraph rationale for every call, signed with the satellites that contributed. The rationale is the audit surface: the pattern assumes clinical leads read a random sample of them every week, and that the sample is boring. When it stops being boring, the deliberation layer is where you look first.
This is a pattern study: the scenario is a composite with the identifying details invented, and the shape is real. The architecture is written up in full in Aegis; the Triage council uses the same shape with four advisors instead of six, optimised for sub-minute decisions. If you'd like the variant adapted to your domain, send a brief.