Accepted for/Published in: JMIR Formative Research
Date Submitted: Feb 24, 2021
Date Accepted: Dec 14, 2021
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Improving emergency department patient-doctor conversation through an artificial intelligence symptom taking tool: an observational pilot study.
ABSTRACT
Background:
A crowded emergency department (ED) offers few opportunities to develop rapport or empathy between patients and healthcare providers (HCPs).
Objective:
Patient-facing digital symptom and history taking tools with information handover to clinicians have been proposed as helpful, but their utility is not yet established. We therefore evaluated the potential of a Bayesian reasoning based tool.
Methods:
A two-phase pilot evaluation was carried out in the ED of a German tertiary referral and major trauma hospital providing interdisciplinary treatment for an average of 120 patients daily. Phase I observations guided iterative improvement of the digital tool, which was then further evaluated in Phase II. All patients who were willing/able to provide consent, excluding patients: (i) with severe injury/illness requiring immediate treatment; (ii) with traumatic injury; (iii) incapable of completing a health assessment; (iv) <18 years old. Of 1699 patients presenting to the ED, 815 were eligible based on triage level. With available recruitment staff, 135 were approached, of whom 81 were included in the study. In an observational design, patients entered information into the tool, which was accessed via a clinician dashboard. All users completed evaluation questionnaires. Patient and clinician Likert scale ratings of tool performance along with assessment of larger trial feasibility through recruitment and questionnaire completion rate.
Results:
Respondents were strongly positive in endorsing the tool’s usefulness in facilitating conversation (75% of patients, 73% physicians, 100% nurses). Nurses judged the tool as potentially time saving, whilst physicians assessed it as time saving only in some ED medical specialisms (e.g. Surgery). Patients understood the tool questions and reported high usability. The tool was recommended by most patients (78%), physicians (53%) and nurses (76%). The questionnaire completion by patients was 100.0% and by physicians 96.3%.
Conclusions:
The pilot showed a larger study in the setting was feasible. The system has clear potential to improve patient-HCP interaction and could also contribute to ED efficiency savings. Future research and development will extend the range of patients for which the history collection has clinical utility. Clinical Trial: DRKS00024115; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024115
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