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Development of a Large Language Model-based Multi-Agent Clinical Decision Support System for Korean Triage and Acuity Scale (KTAS)-Based Triage and Treatment Planning in Emergency Departments (2408.07531v2)

Published 14 Aug 2024 in cs.AI, cs.CL, and cs.LG

Abstract: Emergency department (ED) overcrowding and the complexity of rapid decision-making in critical care settings pose significant challenges to healthcare systems worldwide. While clinical decision support systems (CDSS) have shown promise, the integration of LLMs offers new possibilities for enhancing triage accuracy and clinical decision-making. This study presents an LLM-driven CDSS designed to assist ED physicians and nurses in patient triage, treatment planning, and overall emergency care management. We developed a multi-agent CDSS utilizing Llama-3-70b as the base LLM, orchestrated by CrewAI and Langchain. The system comprises four AI agents emulating key ED roles: Triage Nurse, Emergency Physician, Pharmacist, and ED Coordinator. It incorporates the Korean Triage and Acuity Scale (KTAS) for triage assessment and integrates with the RxNorm API for medication management. The model was evaluated using the Asclepius dataset, with performance assessed by a clinical emergency medicine specialist. The CDSS demonstrated high accuracy in triage decision-making compared to the baseline of a single-agent system. Furthermore, the system exhibited strong performance in critical areas, including primary diagnosis, critical findings identification, disposition decision-making, treatment planning, and resource allocation. Our multi-agent CDSS demonstrates significant potential for supporting comprehensive emergency care management. By leveraging state-of-the-art AI technologies, this system offers a scalable and adaptable tool that could enhance emergency medical care delivery, potentially alleviating ED overcrowding and improving patient outcomes. This work contributes to the growing field of AI applications in emergency medicine and offers a promising direction for future research and clinical implementation.

Summary

  • The paper introduces a multi-agent CDSS that significantly improves KTAS triage accuracy and decision consistency in emergency departments.
  • It employs specialized AI agents to simulate key ED roles, enabling coordinated patient assessment and optimized treatment planning.
  • Performance evaluations using the Asclepius dataset show that the multi-agent system outperforms single-agent models, promising reduced ED overcrowding.

An Analytical Overview of the Multi-Agent Clinical Decision Support System for KTAS-Based Triage in Emergency Departments

The paper presents the development and evaluation of a multi-agent Clinical Decision Support System (CDSS) tailored to enhance triage and treatment planning in emergency departments (EDs) using the Korean Triage and Acuity Scale (KTAS). This system is propelled by a combination of the Llama-3-70b LLM and orchestrating technologies such as CrewAI and Langchain. The paper aims to address the critical challenges associated with ED overcrowding and complex decision-making processes by leveraging state-of-the-art AI methodologies.

System Architecture and Design

The CDSS was strategically designed around a multi-agent framework, with distinct AI agents simulating pivotal roles within the ED: the Triage Nurse, Emergency Physician, Pharmacist, and ED Coordinator. The multi-agent approach was selected to better replicate the collaborative dynamics of actual emergency medical teams. Each agent is tasked with specific responsibilities aligned with the typical workflow of an ED, facilitating a comprehensive and coordinated approach to patient care.

The Triage Nurse agent is responsible for initial patient assessment using the KTAS scale, while the Emergency Physician agent conducts diagnostic evaluations and formulates treatment plans. The Pharmacist agent ensures medication safety by cross-referencing prescriptions with the RxNorm API for drug interactions and appropriate dosing. The ED Coordinator agent integrates data from the other agents to make final decisions regarding patient management, resource allocation, and treatment prioritization.

Evaluation Method

The effectiveness of the CDSS was validated using the Asclepius dataset, which includes a range of emergency scenarios. A clinical specialist in emergency medicine assessed the system's outputs, focusing on triage accuracy and the quality of clinical decision-making. The results reveal that the multi-agent CDSS outperformed a single-agent system in several metrics, such as KTAS classification accuracy and overall clinical decision quality. The multi-agent system demonstrated marked superiority in the precision of critical findings identification and resource allocation.

Key Findings and Implications

The paper provides compelling evidence that the multi-agent CDSS can significantly improve triage accuracy and support comprehensive care management in EDs. The model performed exceptionally well in high-priority cases (KTAS levels 1 and 2), indicating its potential effectiveness in urgent and life-threatening situations. Notably, the multi-agent approach resulted in more decisive and consistent outputs, reducing the ambiguity often witnessed in single-agent systems.

From a practical perspective, the CDSS could alleviate ED overcrowding by streamlining patient flow and improving the consistency and accuracy of initial assessments. This system could serve as an essential tool for reducing cognitive load on ED staff, enhancing decision-making efficiency, and potentially ameliorating patient outcomes.

Future Directions and Considerations

The paper suggests promising avenues for future research in AI applications in emergency medicine. Integrating the CDSS with real-time medical records and communication networks in hospitals could enhance its utility and seamless operation. Additionally, exploring the application of multi-agent LLMs in other medical domains could unveil further benefits and potentials.

However, the paper acknowledges certain limitations, chiefly related to data realism and the requirement for further refinement to manage lower-acuity cases consistently. Ethical considerations, particularly regarding data privacy and system transparency, also warrant attention as this technology progresses toward clinical integration.

In conclusion, the research reflects significant advancement in the domain of AI-driven decision support systems for emergency medicine. By incorporating LLMs into multi-agent architectures, the paper sets a substantial precedent for addressing the complexities of modern healthcare environments and improving triage processes in critical care settings.

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