Emergency Department (ED) crowding is a major problem in the U.S. like in many other countries world-wide. This problem is adversely affecting the safety of the patients who rely on timely emergency treatment. As a part of

solving this problem, EDs utilize a triage process. Triage is a pre-hospital process by which patients are sorted

according to the severity of their illnesses or injuries. Any improvement to this process would affect the patient flow positively, and in turn would enhance patient satisfaction and quality of care. In a previous study, we developed a new triage algorithm that uses Fuzzy Analytic Hierarchy Process (FAHP) and Multi-Attribute Utility Theory (MAUT) to rank the patients according to their characteristics: chief complaint, age, gender, pain level, and vital signs. The main purpose of this study is to compare two triage systems using Discrete Event Simulation (DES); one system uses the Emergency Severity Index (ESI), and the other uses the FAHP and MAUT algorithm. Based on the results, there was no strong statistical evidence that any system would do better than the other for all the performance measures when the average is taken across all ESI levels. On the other hand, the collected simulated data by each ESI level showed that the FAHP-MAUT algorithm tends to balance the time-to-bed (TTB) and length of stay (LOS) for ESI levels 2 to 5. This conclusion needs more study and should be interpreted carefully.