Emergency Department Revisit Quality Review Screening: Exploring Human Decision-Making and Artificial Intelligence Support
A retrospective study found GPT-4 over-flagged emergency department revisit cases while an LLM knowledge-graph screener achieved 83-100% positive predictive value.
In an exploratory retrospective study of 99 emergency department diagnosis pairs from a multihospital health system, clinicians and GPT-4 independently judged whether revisit pairs warranted further assessment. GPT-4 responses correlated poorly with clinicians, flagging 94% of pairs for follow-up, 4.4-13.3 times more than clinicians, though prompt engineering was minimal. An algorithm leveraging an LLM-populated knowledge graph (KGA) achieved 83-100% positive predictive value against at least one clinician rater, suggesting LLM-based screening could broaden revisit quality review without substantially increasing reviewer workload.
- 99 ED revisit diagnosis pairs assessed by clinicians and GPT-4
- GPT-4 flagged 94% of pairs, 4.4-13.3x more than clinicians
- LLM knowledge-graph algorithm achieved 83-100% positive predictive value
- Revisit medical gravity consistently associated with clinician target judgments
- Authors call for validation before LLM-supported screening deployment
Full article250 words · extracted from arxiv.org · click to collapse
Background: Emergency Department (ED) return visits are commonly reviewed for quality assurance, but are often limited (e.g., to revisits within 48-72 hours) to increase actionable finding yield while minimizing chart review burden. Those limitations may lead to missed quality improvement opportunities. Methods: We conducted an exploratory, retrospective study of randomly selected ED visits to a multihospital health system having an ED revisit within 1-14 days to the same health system. Given only each visit's primary diagnosis, raters (2-3 clinicians and GPT-4 large language model [LLM]) assessed characteristics of the diagnosis pairs, including the "target": whether a pair warranted further assessment. Informed by rater response analyses, an algorithm leveraging an LLM-populated knowledge graph ("KGA") was created to automatically screen for potentially concerning pairs, then preliminarily assessed. Results: 99 diagnosis pairs were included. GPT-4 responses poorly correlated to clinician raters, rating nearly all (94%) pairs as warranting follow-up (4.4-13.3 times more than clinicians). However, prompt engineering was minimal. Among clinician raters, revisit medical gravity was consistently significantly associated with the target, while a differential diagnosis/complication composite was significantly associated on unadjusted, but not adjusted (though less powered) analysis. The KGA achieved 83-100% positive predictive value for at least one clinician rater determining further assessment was warranted based on the diagnosis pair. Conclusion: These results can inform next steps for improving screening with LLMs like ChatGPT. Further research is warranted to validate this preliminary work's finding that the KGA may enable enhancing the scope and yield of screening without substantially increasing reviewer workload.
Text extracted automatically; images, tables and formatting may be missing. Original: https://arxiv.org/abs/2609.10421