Using AI to improve patient care
Seeking care in the emergency department (ED) is vital when you’re experiencing a life-threatening illness or injury. If you’ve ever been to the ED, you know that you aren’t always seen in a first-come, first-served manner. When you arrive at LMH Health, you’ll be triaged by a nurse who will assess your condition and determine the order in which you’re seen.
“Triage is the process for identifying those patients who need immediate intervention versus those who are able to wait a bit longer,” said Jan Wiebe, LMH Health’s emergency department director.
The triage nurse will take your vital signs and ask you questions about your illness or injury so they can understand what’s going on when you arrive. Based on that interaction, the triage nurse will assign you an Emergency Severity Index (ESI) acuity. ESI is an evidence-based tool and the standard in hospitals across the country.
“We assign the ESI based on the acuity of your illness and the resources that we anticipate it will take,” said Jen Lemus, clinical nursing manager for the emergency department. “ESI is a five-level system with ESI 1 being the highest level for the most ill patients and ESI 5 as the lowest.”
AI takes the stage
LMH Health also uses an artificial intelligence program called KATE during the triage process. Wiebe said that KATE helps supplement the decision-making process to ensure the proper ESI is assigned to a patient.
The artificial intelligence program was borne from an experience the co-founder had with his daughter, Kate. When she was 10 years old, Kate was ill and was taken to the ED in her community. Wiebe shared that a cascade of events during that visit and an inpatient stay resulted in a misdiagnosis, but one that was eventually made right.
“Instead of getting angry and bitter, the founder met with the hospital leadership and wanted to help,” she said. “He knew the provider’s had Kate’s best interests at heart. The idea of the AI was born from that interaction.”
The technology was created over a number of years and was implemented in a health system on the West Coast. LMH Health is the first outside of that system to use KATE and the only one in Kansas and Missouri.
So how does KATE work? The technology is used with all patients over one year old. As the nurse is triaging the patient, they enter their vital signs, the information they provide about their symptoms and assign an ESI level. At the same time, KATE is working in the background in real-time to analyze what’s being documented and also reviewing the entire available medical record to calculate the ESI level.
“If KATE disagrees and assigns a higher level, the triage nurse gets a notification from KATE stating the ESI it recommends and the reason why,” Wiebe explained. “If the patient has a fever but didn’t tell me they received chemo a week ago, the AI will prompt me that I might want to do something differently.”
Evening the playing field
Reducing bias is another benefit of using artificial intelligence in the triage process. KATE operates by looking at the patient’s electronic medical record, information about their medication history and documented risk factors, as well as information provided about their current illness or injury, not other outside factors.
“The reality is that we all have our biases and a lot of things can factor into those,” Wiebe said. “KATE doesn’t see race or skin color – only the patient’s gender and their age. She doesn’t hear tone of voice, doesn’t see wait times. It’s an unbiased opinion.”
The AI is available locally thanks in part to gifts from donors to the LMH Health Foundation. Erica Hill, LMH Health Foundation finance director and LMH Health director of equity, inclusion and diversity, values their support.
“Thanks to the generosity of our Foundation donors, we are fortunate to have software that reduces the risk of bias,” she said. “More importantly, we have staff that are dedicated to ensuring the best health outcomes for all of our patients. This is a great example of how we are being intentional about advancing health equity for our patients and community.”
