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Clinical triage algorithms increasingly influence access to emergency care, specialty referral, admission, and follow-up. As patient populations and clinical practice patterns change, these systems can silently drift toward biased performance. Current fairness assessments are often retrospective, episodic, and disconnected from operational triage workflows. They may identify inequity after harm has already accumulated rather than detecting emerging bias as it develops. This article proposes an explainable AI model for continuous monitoring of algorithmic bias in clinical triage systems. The model focuses on demographic drift, outcome disparities, prediction confidence, and referral decision patterns as complementary bias signals. The proposed model uses operational triage logs, demographic distributions, prediction outputs, outcome indicators, and referral decisions to generate a conceptual fairness risk signal. SHAP-based explanation modules decompose the signal into interpretable contributors for clinical governance teams. Conceptually, the model would detect divergence in referral patterns across demographic groups, identify whether the divergence coincides with demographic drift, flag subgroup-specific prediction confidence concerns, and explain the likely drivers of the alert. The output would support timely review rather than automated punitive action. The model could transform algorithmic fairness from a periodic retrospective report into a continuous, transparent, and operationally actionable surveillance system. It is designed as a governance-oriented framework rather than an experimental performance claim.

Many patients discharged from emergency departments require timely outpatient follow-up to complete diagnostic, therapeutic, or monitoring plans. When follow-up is delayed, unresolved symptoms, missed diagnoses, medication problems, and preventable return visits may occur. Current discharge workflows often rely on generic instructions and assume that patients can understand, schedule, and attend recommended care. Existing prediction approaches do not consistently combine unstructured discharge instructions, appointment access, portal engagement, social risk, and visit severity in a transparent way.This article proposes a transparent machine learning framework for predicting delayed follow-up after emergency department visits. The objective is to support patient-specific discharge planning by identifying both the likelihood of delay and the most actionable contributing barriers. The proposed model would combine structured emergency department and scheduling data with natural language processing features extracted from discharge instructions. A gradient-boosted tree model with SHAP-based explanations would provide patient-level and population-level interpretability. Conceptually, the model would identify patients at elevated risk of delayed follow-up and attribute that risk to factors such as unclear instructions, limited appointment availability, absent portal engagement, transportation barriers, or higher visit complexity. These explanations would be intended to guide targeted interventions rather than replace clinical judgment. A transparent model for delayed follow-up prediction could enable precision transitional care after emergency department discharge. By aligning predictions with actionable explanations, care teams could direct limited resources toward the specific barrier most likely to prevent timely follow-up.