# Domain-Adapted Small Language Models for Reliable Clinical Triage

arXiv: https://arxiv.org/abs/2604.26766 · HTML: https://mlsanity.com/paper/2604.26766/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 7 of its 18 references that are in the map.
- First posted on arXiv 29 Apr 2026.

## Builds on (most cited first, 7 of 7)

- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [QLoRA: Efficient Finetuning of Quantized LLMs](https://mlsanity.com/paper/2305.14314/) (2023)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Publicly Available Clinical BERT Embeddings](https://mlsanity.com/paper/1904.03323/) (2019)
- [Learning to Diagnose with LSTM Recurrent Neural Networks](https://mlsanity.com/paper/1511.03677/) (2015)
- [A Comprehensive Survey on the Trustworthiness of Large Language Models in Healthcare](https://mlsanity.com/paper/2502.15871/) (2025)

## Built on by (most cited first, 1 of 1)

- [Counterfactual Auditing of Bias in Open-Source Large Language Models for Clinical Triage](https://mlsanity.com/paper/2610.01963/) (2026)

## Abstract (arXiv)

Accurate and consistent Emergency Severity Index (ESI) assignment remains a persistent challenge in emergency departments, where highly variable free-text triage documentation contributes to mistriage and workflow inefficiencies. This study evaluates whether open-source small language models (SLMs) can serve as reliable, privacy-preserving decision-support tools for clinical triage. We systematically compared multiple SLMs across diverse prompting pipelines and found that clinical vignettes, concise summaries of triage narratives, yielded the most accurate predictions. The SLM, Qwen2.5-7B, demonstrated the strongest balance of accuracy, stability, and computational efficiency. Through large-scale domain adaptation using expert-curated and silver-standard pediatric triage data, fine-tuned Qwen2.5-7B models substantially reduced discordance and clinically significant errors, outperforming all baseline SLMs and advanced proprietary large language models (LLMs, e.g., GPT-4o). These findings highlight the feasibility of institution-specific SLMs for reliable, privacy-preserving ESI decision support and underscore the importance of targeted fine-tuning over more complex inference strategies.