Electronic Diagnostic Support in Emergency Physician Triage: Qualitative Study With Thematic Analysis of Interviews

Abstract

Background Not thinking of a diagnosis is a leading cause of diagnostic error in the emergency department, resulting in delayed treatment, morbidity, and excess mortality. Electronic differential diagnostic support (EDS) results in small but significant reductions in diagnostic error. However, the uptake of EDS by clinicians is limited. Objective We sought to understand physician perceptions and barriers to the uptake of EDS within the emergency department triage process. Methods We conducted a qualitative study using a research associate to rapidly prototype an embedded EDS into the emergency department triage process. Physicians involved in the triage assessment of a busy emergency department were provided the output of an EDS based on the triage complaint by an embedded researcher to simulate an automated system that would draw from the electronic medical record. Physicians were interviewed immediately after their experience. Verbatim transcripts were analyzed by a team using open and axial coding, informed by direct content analysis. Results In all, 4 themes emerged from 14 interviews: (1) the quality of the EDS was inferred from the scope and prioritization of the diagnoses present in the EDS differential; (2) the trust of the EDS was linked to varied beliefs around the diagnostic process and potential for bias; (3) clinicians foresaw more benefit to EDS use for colleagues and trainees rather than themselves; and (4) clinicians felt strongly that EDS output should not be included in the patient record. Conclusions The adoption of an EDS into an emergency department triage process will require a system that provides diagnostic suggestions appropriate for the scope and context of the emergency department triage process, transparency of system design, and affordances for clinician beliefs about the diagnostic process and addresses clinician concern around including EDS output in the patient record.

Stakeholder perspectives towards diagnostic artificial intelligence: a co-produced qualitative evidence synthesis

“…Across 44 studies, 689 participants were interviewed and 402 participated in focus groups. 31 studies conducted interviews, 16 , 24 , 25 , 31 , 32 , 34 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 45 , 48 , 49 , 50 , 51 , 53 , 55 , 57 , 59 , 60 , 61 , 62 , 63 , 64 nine conducted focus groups, 18 , 26 , 27 , 29 , 30 , 33 , 52 , 56 , 58 , 65 five conducted ethnographic studies with interviews, 17 , 46 , 47 , 54 , 66 and two conducted both interviews and focus groups. 35 , 47 The mean number of participants in interview studies was 20 (IQR 15–24), and in focus groups 40(IQR 15–37).…”

“… Sibbald et al. (2022) 61 Qualitative, content analysis Semi-structured interviews Emergency department physicians with personal experience of using an AI tool to support differential diagnosis (EDS) at triage, purposive sampling 13 2 (15%) female; 5 (38%) <5 years of practice, 4 (31%) 5–10 years, 1 (7%) 11–20 years, 3 (23%) >20 years; 6 (46%) family medicine specialists with subspecialisation in emergency medicine, 7 (54%) emergency medicine specialists Emergency medicine AI in use to generate differential diagnosis for emergency medicine triage Four themes were identified: 1. The quality of EDS was inferred from the scope and prioritization of the diagnoses, 2.…”

“…Four distinct stakeholder groups were described: patients/the public, clinicians, researchers, and healthcare leaders. Twenty studies focussed on clinician perspectives, 17 , 18 , 29 , 32 , 35 , 42 , 44 , 46 , 48 , 50 , 52 , 54 , 55 , 60 , 61 , 63 eight on patients, 16 , 26 , 27 , 30 , 33 , 40 , 53 , 57 , 58 and one on researchers 59 and healthcare leaders/experts. 45 Fourteen focussed on mixed groups.…”

“… 45 Fourteen focussed on mixed groups. 24 , 25 , 31 , 34 , 36 , 38 , 39 , 41 , 47 , 51 , 56 , 65 , 66 , 67 Of 29 studies exploring clinician perspectives, 26 included doctors, 17 , 18 , 24 , 25 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 41 , 42 , 44 , 46 , 47 , 48 , 55 , 56 , 59 , 60 , 61 , 63 , 65 , 66 six included allied healthcare professionals, 29 , 35 , 37 , 42 , 52 , 60 and two included nurses. 38 , 44 …”

“…Twenty-six studies were conducted in Western Europe (Belgium, Germany, The Netherlands, Sweden, Switzerland, Italy, and the United Kingdom), 18 , 24 , 25 , 31 , 32 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 46 , 47 , 48 , 49 , 51 , 56 , 58 , 63 , 64 , 65 , 66 eleven in North America (Canada and the United States of America), 16 , 17 , 26 , 27 , 30 , 44 , 45 , 50 , 53 , 57 , 59 , 61 two in Australia, 60 and one in each of Argentina 55 , 60 Croatia, 34 India, 54 Singapore, 52 and the United Arab Emirates. 29 …”