Improving emergency department patient-doctor conversation through an artificial intelligence symptom taking tool: an action-oriented design pilot study

AbstractIMPORTANCECommunication between patients and healthcare professionals is frequently challenging in the crowded emergency department (ED), with few opportunities to develop rapport or empathy. Digital tools for patients and physicians have been proposed as helpful but their utility is not established.OBJECTIVETo evaluate a patient-facing digital symptom and history taking, as well as handover tool in the waiting room.DESIGNA two-phase, questionnaire-based quality improvement study. Phase I observations guided iterative improvement, which was then further evaluated in Phase II.SETTINGED of a German tertiary referral and major trauma hospital providing interdisciplinary treatment for an average of 120 patients daily.PARTICIPANTSAll 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; or, (iv) under 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.INTERVENTION/OBSERVATIONPatients entered information into the tool, which generated a handover report to be accessed via a clinician dashboard. All users completed evaluation questionnaires. Clinicians were trained to observationally assess the tool as a prototype, without relying upon it for clinical care.MAIN OUTCOMES AND MEASURESPatient and clinician Likert scale ratings of tool performance.RESULTSRespondents 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 proportion of patients, physicians and nurses who would recommend the tool was 78%, 53% and 76%.CONCLUSIONS AND RELEVANCEThe system has clear potential to improve patient-HCP interaction and make efficiency savings in the ED. Future research and development will extend the range of patients for which the history collection has clinical utility.Key PointsQuestionCan a patient-facing digital symptom and clinical history taking tool provide conversational support, aid in symptom taking, facilitate record keeping, and lead to improved rapport between patients, physicians and nurses in the emergency department (ED)?FindingsAcceptability was high, with improved rapport experienced 90% of the time for patients, 73% for physicians and 100% for nurses. Nurses assessed the tool as having workflow benefit through potential time saving. Physicians assessed the current tool design as providing time saving in certain ED medical specialisms including Surgery.MeaningThe patient-facing tool for symptom and history taking provided meaningful conversation support and showed potential for efficiency savings, however, further research and testing is required before time savings can be consistently delivered to ED clinicians across the range of relevant ED medical specialisms.

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Improving emergency department patient-doctor conversation through an artificial intelligence symptom taking tool: an observational pilot study. (Preprint)

10.2196/preprints.28199 ◽

2021 ◽

Author(s):

Stephen Gilbert

Keyword(s):

Emergency Department ◽

Traumatic Injury ◽

Healthcare Providers ◽

Health Assessment ◽

Emergency Department Patient ◽

Interdisciplinary Treatment ◽

Future Research ◽

Digital Tool ◽

Two Phase ◽

Time Saving

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. CLINICALTRIAL DRKS00024115; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024115

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P044: Register to donate while you wait: assessing public acceptability of utilizing the emergency department waiting room for organ and tissue donor registration

CJEM ◽

10.1017/cem.2018.242 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S72-S72

Author(s):

B. Ellis ◽

J.J. Perry ◽

M. Hartwick

Keyword(s):

Emergency Department ◽

Religious Affiliation ◽

Clinical Care ◽

Tertiary Care ◽

Organ Donor ◽

Tissue Donation ◽

Waiting Room ◽

Tissue Donor ◽

Organ And Tissue Donation ◽

Public Acceptability

Introduction: Our study objectives were to assess the acceptability of using the emergency department (ED) waiting room to provide knowledge on, and offer opportunities for organ and tissue donor registration; and to identify barriers to the donor registration process in Ontario. Methods: We conducted a paper based in-person survey over nine days for eight hour blocks in March and April 2017. The survey instrument was created in English using existing literature and expert opinion, pilot tested and then translated into French. The study collected data from patients and visitors in an urban academic Canadian tertiary care ED waiting room. All adults in the waiting room were approached to participate during the study periods. Individuals waiting in clinical care areas were excluded, as well as those who required immediate treatment. Results: The number of attempted surveys was 324; 67 individuals (20.7%) refused to partake. A total of 257 surveys were distributed and five were returned blank. This gave us a response rate of 77.8% with 252 completed surveys. The median age group was 51-60 years old with 55.9% female. Forty-six percent were Christian (46.0%) and 34.1% did not declare a religious affiliation. Nearly half of participants (44.1%) were registered organ donors. The majority of participants agreed or were neutral (83.3%) that the ED waiting room was an acceptable place to provide information on organ and tissue donation. Further, 82.1% agreed or were neutral that the ED was an acceptable place to register as an organ donor. Nearly half (47.2%) agreed that they would consider registering while in the ED waiting room. A number of barriers to registering as an organ and tissue donor were identified. The most common were: not knowing how to register (22.0%), a lack of time to register (21.1%), and having unanswered questions regarding organ and tissue donation (18.7%). Conclusion: Individuals waiting in the ED are supportive of using the ED waiting room for distributing information regarding organ and tissue donation, and facilitating organ and tissue donation registration. Developing such a practice could help to reduce some of the identified barriers, including a lack of time and having unanswered questions regarding donation.

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Palliative care in the emergency department: A qualitative study exploring barriers, facilitators, desired clinician qualities, and future directions

Palliative & Supportive Care ◽

10.1017/s1478951521001012 ◽

2021 ◽

pp. 1-6

Author(s):

Alexa Gips ◽

Bethany-Rose Daubman ◽

Laura A. Petrillo ◽

Jason Bowman ◽

Kei Ouchi ◽

...

Keyword(s):

Emergency Department ◽

Palliative Care ◽

Qualitative Study ◽

Barriers And Facilitators ◽

Future Research ◽

Structured Interviews ◽

Two Phase ◽

Financial Model ◽

The Future ◽

The Impact

Abstract Objective To describe the perceived qualities of successful palliative care (PC) providers in the emergency department (ED), barriers and facilitators to ED–PC, and clinicians’ perspectives on the future of ED–PC. Method This qualitative study using semi-structured interviews was conducted in June–August 2020. Interviews were analyzed via a two-phase Rapid Analysis. The study's primary outcomes (innovations in ED–PC during COVID) are published elsewhere. In this secondary analysis, we examine interviewee responses to broader questions about ED–PC currently and in the future. Results PC providers perceived as successful in their work in the ED were described as autonomous, competent, flexible, fast, and fluent in ED language and culture. Barriers to ED–PC integration included the ED environment, lack of access to PC providers at all times, the ED perception of PC, and the lack of a supporting financial model. Facilitators to ED–PC integration included proactive identification of patients who would benefit from PC, ED-focused PC education and tools, PC presence in the ED, and data supporting ED–PC. Increased primary PC education for ED staff, increased automation, and innovative ED–PC models were seen as areas for future growth. Significance of results Our findings provide useful information for PC programs considering expanding their ED presence, particularly as this is the first study to our knowledge that examines traits of successful PC providers in the ED environment. Our findings also suggest that, despite growth in the arena of ED–PC, barriers and facilitators remain similar to those identified previously. Future research is needed to evaluate the impact that ED–PC initiatives may have on patient and system outcomes, to identify a financial model to maintain ED–PC integration, and to examine whether perceptions of successful providers align with objective measures of the same.

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Getting to the Right Patient at the Right Time: An Interoperable Mobile App to Track the ED Journey in Hospital

Healthier Lives, Digitally Enabled - Studies in Health Technology and Informatics ◽

10.3233/shti210015 ◽

2021 ◽

Author(s):

Audrey P. Wang ◽

David Pryce ◽

Phillip Gough

Keyword(s):

Emergency Department ◽

Clinical Care ◽

Database Systems ◽

Mobile App ◽

Data Sources ◽

Local Health ◽

Business Analytics ◽

Waiting Room ◽

Executive Staff ◽

The Right

The current legacy ICT framework structures in healthcare are often siloed and do not allow information to flow easily between business analytics and clinical systems, affecting critical decision making.Western Sydney Local Health District (WSLHD) has numerous electronic database systems for business analytics including tracking individual patients waiting for treatment in the emergency department (ED). Administrators of hospital business data report ED performance measures in a weekly static feedback report to clinical and executive staff due to current legacy systems and manual resource allocation processes. The remit of the project was to prototype a system that could integrate data sources from the current QlikSense Dashboard into an interoperable mobile app with the future intention of direct impact on clinical care decision making for the emergency department. A series of meetings between business analytics unit and clinical staff were used to inform a set of requirements for information workflow systems integration to be used on the project. Stimulated patient data that matched typical data feeds from the system was used to develop a prototype interoperable HL7 messaging mobile app that would report waiting patients in their triage categories in near real time. This working protype with synthetic scenarios and data will inform a future deployable production system with information for the patient journey from the ED waiting room into available hospital beds. As most applications are either designed for business analytics or clinical workflows, integrating information data sources into one mobile application that could meet the needs of both clinical and business performance was novel and integral. This proof of concept project successfully integrated the information systems necessary for both purposes and informs future requirements for an interoperable and deployable cross-platform mobile app.

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Interventions to change clinician behaviour in relation to suicide prevention care in the emergency department: A scoping review protocol

10.31219/osf.io/f3gdr ◽

2020 ◽

Author(s):

Hwayeon Danielle Shin ◽

Christine Cassidy ◽

Janet Curran ◽

Lori Weeks ◽

Leslie Anne Campbell ◽

...

Keyword(s):

Emergency Department ◽

Suicide Prevention ◽

Behaviour Change ◽

Clinical Care ◽

Grey Literature ◽

Allied Health Professionals ◽

Wide Range ◽

Knowledge And Attitude ◽

Clinician Behaviour ◽

Google Search

Objective: This review aims to explore, characterize, and map the literature on interventions implemented to change emergency department (ED) clinicians’ behaviour related to suicide prevention using the Behaviour Change Wheel (BCW) as a guiding theoretical framework. Introduction: An ED is a critical place for suicide prevention. Yet, many patients who present with suicide-related thoughts and behaviours are discharged without proper assessment or appropriate treatment. Supporting clinicians (who provide direct clinical care, including nurses, physicians, allied health professionals) to make the desired behaviour change following evidence-based suicide prevention care is an essential step toward improving patient outcomes. However, reviews to date have yet to take a theoretical approach to investigate interventions implemented to change clinicians’ behaviour. Inclusion criteria: This review will consider literature that includes interventions that target ED clinicians’ behaviour change related to suicide prevention. Behaviour change refers to observable practice changes as well as proxy measures of behaviour change including knowledge and attitude. There are many ways in which an intervention can change clinicians’ behaviour (e.g., education, altering service delivery). This review will include a wide range of interventions that target behaviour change regardless of the type but exclude interventions that exclusively target patients.Methods: Multiple databases will be searched: PubMed, PsycInfo, CINAHL and Embase. We will also include grey literature, including Google search, ProQuest Dissertations and Theses Global, and Scopus conference papers. Full text of included studies will be reviewed, critically appraised and extracted. Extracted data will be coded to identify intervention functions using the BCW. Findings will be summarized in tables accompanied by narrative reports.

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Interpersonal Psychotherapy for the Treatment of Eating Disorders

The Oxford Handbook of Eating Disorders ◽

10.1093/oxfordhb/9780195373622.013.0020 ◽

2010 ◽

pp. 347-372 ◽

Cited By ~ 1

Author(s):

Marian Tanofsky-Kraff ◽

Denise E. Wilfley

Keyword(s):

Anorexia Nervosa ◽

Clinical Care ◽

Interpersonal Psychotherapy ◽

Future Research ◽

Cognitive Behavior ◽

Research Directions ◽

Routine Clinical Care ◽

Interpersonal Factors ◽

Future Research Directions

Interpersonal psychotherapy (IPT) is a focused, time-limited treatment that targets interpersonal problem(s) associated with the onset and/or maintenance of EDs. IPT is supported by substantial empirical evidence documenting the role of interpersonal factors in the onset and maintenance of EDs. IPT is a viable alternative to cognitive behavior therapy for the treatment of bulimia nervosa and binge eating disorder. The effectiveness of IPT for the treatment of anorexia nervosa requires further investigation. The utility of IPT for the prevention of obesity is currently being explored. Future research directions include enhancing the delivery of IPT for EDs, increasing the availability of IPT in routine clinical care settings, exploring IPT adolescent and parent–child adaptations, and developing IPT for the prevention of eating and weight-related problems that may promote full-syndrome EDs or obesity.

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Optimising neurodevelopmental and psychosocial outcomes for survivors with CHD: a research agenda for the next decade

Cardiology in the Young ◽

10.1017/s1047951121002171 ◽

2021 ◽

pp. 1-3

Author(s):

Erica Sood ◽

Jeffrey P Jacobs ◽

Bradley S Marino

Keyword(s):

Health Disparities ◽

Outcomes Research ◽

Research Agenda ◽

Clinical Care ◽

Neurodevelopmental Outcome ◽

Psychosocial Outcomes ◽

The United States ◽

Future Research ◽

Neurodevelopmental Outcomes ◽

Working Groups

Abstract Neurodevelopmental and psychosocial impairments negatively impact health-related quality of life for survivors with CHD and complicate the transition to independent adulthood. Risk for neurodevelopmental and psychosocial impairments is influenced by a complex interplay among genetic, foetal, surgical, perioperative, family, and social factors, requiring a multi-pronged approach to neuroprotection and intervention. To ensure future research can ultimately reduce the burden of CHD for individuals, families, and society, the most pressing issues in cardiac neurodevelopment requiring scientific investigation must be identified. Through funding from an R13 Grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health of the United States of America, the Cardiac Neurodevelopmental Outcome Collaborative convened a two-day meeting of international experts in cardiac neurodevelopmental and psychosocial research, clinical care, and health disparities, including patient and family stakeholders, to define the cardiac neurodevelopmental and psychosocial outcomes research agenda for the next decade. Seven multidisciplinary working groups were formed to address key domains crucial to the advancement of cardiac neurodevelopmental and psychosocial outcomes research: 1) Foetal Brain Development and Neuroprotection, 2) Surgical/Perioperative Neuroprotection and Neurodevelopment, 3) Characterization of Neurodevelopmental and Psychological Outcomes, 4) Neurodevelopmental and Psychosocial Intervention, 5) Parent Mental Health and Family Functioning, 6) Neurodevelopmental Education, Outreach and Advocacy, and 7) Health Disparities and Neurodevelopmental Outcomes. Working groups identified significant gaps in knowledge and critical questions that must be answered to further knowledge, policy, care, and outcomes. The development of a research agenda in cardiac neurodevelopmental and psychosocial outcomes is critical for informing collaborative initiatives and allocation of funding for research to scientific inquiries of highest value to key stakeholders.

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Scoping review protocol: bladder cancer in Nigeria: what are the gaps in clinical care and research?

BMJ Open ◽

10.1136/bmjopen-2020-041894 ◽

2021 ◽

Vol 11 (1) ◽

pp. e041894

Author(s):

Joyce Kibaru ◽

Pinky Kotecha ◽

Abdulkarim Muhammad Iya ◽

Beth Russell ◽

Muzzammil Abdullahi ◽

...

Keyword(s):

Bladder Cancer ◽

Scoping Review ◽

Low Income ◽

Clinical Care ◽

Grey Literature ◽

Case Series ◽

Cochrane Library ◽

Future Research ◽

Scoping Reviews ◽

Local Risk

IntroductionBladder cancer (BC) is the 10th common cancer worldwide and ranks seventh in Nigeria. This scoping review aims to identify the gaps in clinical care and research of BC in Nigeria as part of the development of a larger national research programme aiming to improve outcomes and care of BC.Methods and analysisThis review will be conducted according to Arksey and O’Malley scoping review methodology framework. The following electronic databases will be searched: Medline (using the PubMed interface), Ovid Gateway (Embase and Ovid), Cochrane library and Open Grey literature. Two independent reviewers will screen titles and abstracts and subsequently screen full-text studies for inclusion, any lack of consensus will be discussed with a third reviewer. Any study providing insight into the epidemiology or treatment pathway of BC (RCTs, observations, case series, policy paper) will be included. A data chart will be used to extract relevant data from the included studies. Results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A consultation process will be carried out with a multidisciplinary team of Nigerian healthcare professionals, patients and scientists.Ethics and disseminationThe results will be disseminated through peer-reviewed publications. By highlighting the key gaps in the literature, this review can provide direction for future research and clinical guidelines in Nigeria (and other low-income and middle-income countries), where BC is more prevalent due to local risk factors and healthcare settings.

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EyeHealer: A large-scale anterior eye segment dataset with eye structure and lesion annotations

Precision Clinical Medicine ◽

10.1093/pcmedi/pbab009 ◽

2021 ◽

Author(s):

Wenjia Cai ◽

Jie Xu ◽

Ke Wang ◽

Xiaohong Liu ◽

Wenqin Xu ◽

...

Keyword(s):

Deep Learning ◽

Large Scale ◽

Image Annotation ◽

Clinical Care ◽

Significant Proportion ◽

Anterior Segment ◽

Future Research ◽

Learning Models ◽

Anterior Eye Segment ◽

Segmentation Models

Abstract Anterior segment eye diseases account for a significant proportion of presentations to eye clinics worldwide, including diseases associated with corneal pathologies, anterior chamber abnormalities (e.g. blood or inflammation) and lens diseases. The construction of an automatic tool for the segmentation of anterior segment eye lesions will greatly improve the efficiency of clinical care. With research on artificial intelligence progressing in recent years, deep learning models have shown their superiority in image classification and segmentation. The training and evaluation of deep learning models should be based on a large amount of data annotated with expertise, however, such data are relatively scarce in the domain of medicine. Herein, the authors developed a new medical image annotation system, called EyeHealer. It is a large-scale anterior eye segment dataset with both eye structures and lesions annotated at the pixel level. Comprehensive experiments were conducted to verify its performance in disease classification and eye lesion segmentation. The results showed that semantic segmentation models outperformed medical segmentation models. This paper describes the establishment of the system for automated classification and segmentation tasks. The dataset will be made publicly available to encourage future research in this area.

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TeleNeurological evaluation and Support for the Emergency Department (TeleNS-ED): protocol for an open-label clinical trial

BMJ Open ◽

10.1136/bmjopen-2020-048293 ◽

2021 ◽

Vol 11 (5) ◽

pp. e048293

Author(s):

Jessica Mandrioli ◽

Mario Santangelo ◽

Antonio Luciani ◽

Stefano Toscani ◽

Elisabetta Zucchi ◽

...

Keyword(s):

Emergency Department ◽

Clinical Investigation ◽

Neurological Diseases ◽

Medical Personnel ◽

Primary Objective ◽

Control Group ◽

National Guidelines ◽

Open Label ◽

Time Saving ◽

Hospital Networks

IntroductionThe COVID-19 pandemic compelled health systems to protect patients and medical personnel during transit in hospitals by minimising transfers, prompting the use of telehealth systems. In the field of neurology, telemedicine has been used in emergency settings for acute stroke management between spoke and hub hospital networks, where good outcomes have been achieved. However, data on the use of telemedicine in non-stroke acute neurological conditions accessing the emergency department (ED) are currently missing.Methods and analysesThis is an interventional, open-label trial on the use of teleconsultation in the ED for neurological diseases other than stroke. The study aims to develop a remote consultancy system (TeleNeurological Evaluation and Support, TeleNS) for patients with acute neurological symptoms referred to hospital facilities without a 24-hour availability of a neurologist consultant (spoke hospitals). The study population will include 100 ED patients referred to two spoke hospitals in 6 months, who will be asked to perform teleconsultation instead of inperson visits. As a control group, retrospectively available data from patients admitted to the ED of spoke hospitals during the same time period over the last 2 years will be evaluated. The primary objective is to assess whether a TeleNS for the ED guarantees a faster but qualitatively non-inferior diagnostic/therapeutic work-up if compared with inperson examination, assuring the availability of all the necessary examinations and treatments with consistent time-saving.Ethics and disseminationThe trial was designed following the national guidelines on clinical investigation on telemedicine provided by the Italian Ministry of Health and according to the Standard Protocol Items for Randomized Trials statement guidelines. This research protocol was approved by Comitato Etico Area Vasta Emilia Nord in September 2020 (number/identification: 942/2020/DISP/AOUMO SIRER ID 805) and was written without patient involvement. Patients’ associations will be involved in the dissemination of study design and results. The results of the study will be presented during scientific symposia or published in scientific journals.Trial registration numberNCT04611295.

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