photo by: LMH Health

LMH Health, 325 Maine St., is pictured in May 2021.

Seeking care at the emergency department 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 patients arrive at LMH Health, they’re triaged by a nurse who will assess their condition and determine the order in which they’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 the patient’s vital signs and ask questions about the illness or injury so they can understand what’s going on. Based on that interaction, the triage nurse will assign the patient an Emergency Severity Index, or ESI. 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 technology was first implemented in a health system on the West Coast, and LMH Health is the first outside of that system to use it. Wiebe said the system — and its name — were inspired by an experience of one of the founders of the company that developed it. The founder’s daughter, Kate, was misdiagnosed during a visit to an emergency department when she was 10 years old due to a cascade of events.

“Instead of getting angry and bitter, the founder met with the hospital leadership and wanted to help,” Wiebe said. “He knew the providers had Kate’s best interests at heart. The idea of the AI was born from that interaction.”

At LMH Health, the KATE technology is used with all patients over one year old. As the nurse is evaluating 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 said. “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.”

LMH Health was able to acquire this AI technology thanks in part to gifts from donors to the LMH Health Foundation, said Erica Hill, LMH Health Foundation finance director and LMH Health director of equity, inclusion and diversity.

“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.”

— Autumn Bishop is the marketing manager and content strategist at LMH Health, which is a major sponsor of the Journal-World’s Health section.