Agentic AI for Clinical Urgency Mapping and Queue Optimization in High-Volume Outpatient Departments: A Simulation-Based Evaluation

Outpatient departments (OPDs) in Indian public hospitals face severe overcrowding, with daily volumes reaching 200--8,000 patients~\cite{aiims2020annual}. The prevailing First-Come-First-Served (FCFS) token system treats all patients equally regardless of clinical urgency, leading to dangerous delays for critical cases. We present an agentic AI framework integrating six components: voice-based multilingual symptom capture (modeled), LLM-powered severity prediction, load-aware physician assignment, adaptive queue optimization with urgency drift detection, a multi-objective orchestrator, and a Patient Memory System for longitudinal context-aware triage. Evaluated through discrete-event simulation of a District Hospital in Jabalpur (Madhya Pradesh) with 368 synthetic patients over 30 runs, the framework achieves 94.2\% critical patients seen within 10 minutes (vs.~30.8\% under FCFS), detects $\sim$236 simulated urgency drift events per session (modeled via stochastic deterioration probabilities), identifies $\sim$11.9 additional hidden-critical cases via patient memory, and recomposes queue urgency distribution from 13/36/158/161 (Critical/High/Medium/Low) to $\sim$25/178/115/50 through continuous reassessment, while maintaining comparable throughput ($\sim$40.4 patients/hour).