TriAgent: An Adaptive Multi-Agent Architecture for Crisis Clinical Decision Support Under Incomplete Information

Agentic artificial intelligence (AI) offers new opportunities for intelligent clinical decision support, but deployment in emergency and crisis settings remains challenging because time-critical recommendations must often be generated under incomplete patient information and system constraints. Conventional clinical decision support systems rely on rule-based workflows that degrade when structured data are absent, while standalone language models lack coordination mechanisms to enforce mandatory safety checks. We present TriAgent, a multi-agent framework that unifies adaptive orchestration, iterative retrieval, embedded safety verification, and end-to-end auditability within a single crisis clinical decision support workflow. An Orchestrator Agent dynamically selects specialist modules for clinical assessment, retrieval, treatment planning, safety verification, and system coordination, with routing determined by model reasoning rather than fixed execution paths. A retrieval sub-agent performs iterative query refinement and relevance grading over 49,000 MIMIC-IV discharge notes, while medication-conflict screening and allergy-risk assessment are invoked in parallel only when clinically indicated. A Critique Agent reviews the full reasoning trace before recommendation finalization. In a retrospective evaluation on 1000 real emergency presentations under synthesized incomplete-information inputs, TriAgent achieved 85.0% critical-case recall and 65.7% overall triage accuracy, versus at most 14.7% and 43.4% for matched single-model and retrieval-only baselines, with safety checks executed on every continuation pathway and adaptive routing invoking only the modules each case required. These results support multi-agent orchestration as a promising design pattern for transparent and auditable AI in healthcare. These gains are internal system properties; clinical-safety benefit remains to be established through prospective, clinician-involved validation.