Improving emergency department patient-doctor conversation through an artificial intelligence symptom taking tool: an action-oriented design pilot study
Authors: Scheder-Bieschin Justus , Blümke Bibiana , de Buijzer Erwin , Echterdiek Fabian , Nacsa Júlia , Ondresik Marta , Ott Matthias , Paul Gregor , Schilling Tobias , Schmitt Anne , Wicks Paul , Gilbert Stephen 
Published: November 2020

IMPORTANCE

Communication 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.

OBJECTIVE

To evaluate a patient-facing digital symptom and history taking, as well as handover tool in the waiting room.

DESIGN

A two-phase, questionnaire-based quality improvement study. Phase I observations guided iterative improvement, which was then further evaluated in Phase II.

SETTING

ED of a German tertiary referral and major trauma hospital providing interdisciplinary treatment for an average of 120 patients daily.

PARTICIPANTS

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; 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/OBSERVATION

Patients 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 MEASURES

Patient and clinician Likert scale ratings of tool performance.

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 proportion of patients, physicians and nurses who would recommend the tool was 78%, 53% and 76%.

CONCLUSIONS AND RELEVANCE

The 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 Points

Question

Can 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)?

Findings

Acceptability 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.

Meaning

The 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.