Emergency response time has always been one of the most important factors in saving lives, yet many healthcare systems struggle with delays and resource inefficiencies. This paper proposes the use of cloud-based digital twin technology, integrated with an Internet of Things (IoT) hub, to enhance patient care and optimize emergency department workflows. The system utilizes an Azure IoT virtual hub and an Azure Digital Twins model for real-time data transmission and processing of bed availability and capacity in a hospital emergency department. Azure Digital Twins can create virtual models of any physical environment, such as an emergency department, which is essential for creating an automated decision-making system using advanced and modern technologies. Unlike previous solutions that lack coherence in resource allocation systems or real-time decision-making mechanisms, our system dynamically updates emergency department bed availability in real-time through embedded system devices in hospitals, and makes automated decisions based on both patient location and resource availability. The system is implemented using a mobile application and validated using a case study. The case study includes data from multiple emergency departments in hospitals within a specific area. The system provides the best options for emergency patients based on the hospital location and bed availability.

It is essential to assign the correct triage level to patients as soon as they arrive in the emergency department in order to save lives, especially during peak demand. However, many healthcare systems estimate the triage levels by manual eyes-on evaluation, which can be inconsistent and time consuming. This study creates a full Digital Twin-based architecture for patient monitoring and automated triage level recommendation using IoT sensors, AI, and cloud-based services. The system can monitor all patients’ vital signs through embedded sensors. The readings are used to update the Digital Twin instances that represent the present condition of the patients. This data is then used for triage prediction using a pretrained model that can predict the patients’ triage levels. The training of the model utilized the synthetic minority over-sampling technique, combined with Tomek links to lessen the degree of data imbalance. Additionally, Lagrange element optimization was applied to select those features of the most informative nature. The final triage level is predicted using the Tabular Prior-Data Fitted Network, a transformer-based model tailored for tabular data classification. This combination achieved an overall accuracy of 87.27%. The proposed system demonstrates the potential of integrating digital twins and AI to improve decision support in emergency healthcare environments.