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AI tool cuts unexpected deaths in hospital by 26%, Canadian study finds
- SketchySeaBeast 2y agoImportant to note that the timing of this means that it's dedicated, specific AI, not "throw a wrapper and a specific prompt in front of ChatGPT" AI. Of course it's all muddied now.
- Tobani 2y agoTest results are already reported from testing equipment a value and expected range (to account for a specific machine/reagant's calibration). Notifying when out of range hardly seems like a AI, but it certainly might be marketed as such. Maybe there is some nuance for things like a patient in for liver issues where their liver enzymes are expected to be abnormal, but identifying when it is abnormal for them.
- SketchySeaBeast 2y agoYeah, I'm not sure how this qualifies as AI outside of marketing, but wanted to get ahead of the people whose opinions would be biased by the current en vogue LLMs.
- lambdadelirium 2y ago"While the nursing team usually checked blood work around noon, the technology flagged incoming results several hours beforehand" So they're understaffed and could just look into the results more, oh wow what an use of computational power.
- FeepingCreature 2y agoIf it keeps me alive, I don't care if the hospital I'm in "should" have just hired a lot more people.
- rscho 2y agoWell, maybe it would be even more efficient to have enough staff to keep you alive...
- taeric 2y agoI mean... this is a perfectly legitimate use of computational power? What is the downside? I suppose there is a risk they will downsize more. But this is like thinking cameras were bad because they reduced the number of security guards needed to secure an area. No?
- rscho 2y agoWell, calling this AI seems like a long shot. What seems causal here is 'warn early', and indeed I'm sure it would work even better if you outputted a warning displayed full screen on the nurse's phone. It's quite possible you could have the same effect with trivial thresholds instead of a stat model. Still, I'd say it's indeed a good use of computers in general to produce targeted warnings.
- taeric 2y agoOh, fair. To an extent, at least. If they had said these were ML processed samples, would you balk as hard at it? That is, I'm willing to chalk up use of "AI" as a descriptor being an editorial choice. Agreed that it isn't impressive just because it is AI, but it does still seem to be a good use of computational power.
- rscho 2y agoWhy 'balking hard'? Just saying that this is trivial use of statistics, but for once it's intelligent use. Still, if the false positive rate is too high, the effect won't last long.
- taeric 2y agoApologies, I thought you were the GP. I took your tone to be a bit of push back on this being a good use of compute.
- unsupp0rted 2y agoIn Canada they're dangerously understaffed. And the staff are burnt out and lack qualities like: attention to detail, common sense and basic human empathy. Or at least I hope it's because they're burnt out and not because the hospital regularly hires amoral robots, which is also a possibility.
- Der_Einzige 2y agoEither you go with America and get bankrupted by medical care if you don’t have excellent insurance, or you go to Canada or Europe where the average doctor is paid 1/3rd as much and there are significant waiting periods for non immediately necessary procedures. Heads I lose, tails you win. People wonder why folks hate doctors or get “white coat” syndrome. Same shit from dentists wondering why everyone hates them.
- diggan 2y ago> Europe where the average doctor is paid 1/3rd as much and there are significant waiting periods for non immediately necessary procedures I'm not sure where exactly you evaluated this based on (personal experience I suppose?) but this hasn't been true for me in Spain with either public healthcare nor private. Don't remember it being like that in Sweden (public healthcare) either, and I'm sure there are plenty of other European countries where the waiting time isn't significant either, and you also get great care. Some countries seems to just have figured out how to make healthcare costs manageable, with great care, well educated doctors/nurses and also relatively low waiting times. I'd probably still say they're underpaid, because they're literally saving people's lives, but I guess that's true for everywhere, even the US.
- BeetleB 2y agoCanadian doctors earn decently well: https://www.dr-bill.ca/blog/career-advice/doctor-salary-us-vs-canada https://www.dr-bill.ca/blog/career-advice/doctor-salary-us-v... Sure, there's the exchange rate, but it's still quite good. The disparity for tech workers is much greater.
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- readthenotes1 2y agoWe could view the patient as a process under control, with all the sensors we have, and simply apply process control technology to that without waiting for a human to interpret the data many hours after it's relevant.
- rscho 2y agoVisit a hospital and see how measurement samples are taken. Your idea might be applicable with 10x the budget.
- readthenotes1 2y agoI've been there. They take the physical samples to minimize patient sleep. Otherwise, you're hooked up to monitoring equipment...
- rscho 2y ago... that beeps and boops nonstop. Yes, but on top of that the error rate in measurements is staggering. It's difficult even to get reliable vital signs. Also, much of the stuff we're measuring is of unclear purpose. We don't have a solid understanding of what the measurements actually mean for the patient.
- readthenotes1 2y agoI talked with some doctors. They said they already have alert fatigue, mostly from so many false alarms built into the systems they already have.
- falcor84 2y agoThat is literally what AI means - the ability of a computer to perform a task that would otherwise require human reasoning.
- syndicatedjelly 2y agoWhat is an example of a computer that doesn't employ AI, by this definition?
- falcor84 2y agoThe way I see it, AI is about the tasks a system handles, rather than the computer itself. I would say that AI encompasses the set of tasks where the computer system is in some way better than its user not just by having access to more computational resources, but by actually "reasoning" better. As a simple example, I'd argue that a basic spell-checker which works via dictionary lookup doesn't employ AI, but an extensive modern grammar checker does, as it can "reason" about the English language better than I (and most people) can. Another way of thinking about it is that non-AI systems must always perform a task correctly, or we'd say that they have a bug. Conversely, an AI system performs tasks in situations where there is some measure of uncertainty or subjectivity, and they might arrive at a way of performing the task that is suboptimal, or even entirely inappropriate, without being buggy - for these systems we'd say that they did their best given the circumstances. In the case of this hospital study, if they had used a simple "beep if measure goes above X" system, that wouldn't have been AI, but they used an ML model which integrates many interdependent factors over time [0] and while it has a significant ratio of false positive triggers (and as such is often wrong), it applies what would absolutely count as "reasoning" in trained human nurses. [0] "The deterioration prediction model was a time-aware multivariate adaptive regression spline (MARS) model (Appendix, Sections 1–4). The model is made time-aware by incorporating risk score predictions from earlier in the encounter, the change in risk score since the previous assessment, and summaries of changes in the risk score over time." https://www.cmaj.ca/content/196/30/E1027 https://www.cmaj.ca/content/196/30/E1027
- lambdadelirium 2y agoMuh AI shill
- freilanzer 2y ago> So they're understaffed and could just look into the results more, oh wow what an use of computational power. How is this not a good use of compute?
- tensor 2y agoContinuous monitoring will always be better than manual checks. Also this is not an LLM and uses less power than your email software.
- qsort 2y ago"The deterioration prediction model was a time-aware multivariate adaptive regression spline (MARS) model" https://doi.org/10.1503/cmaj.240132 https://doi.org/10.1503/cmaj.240132
- tantalor 2y agoThanks for posting this! Much better source than CBC article. I found this interesting: > 1 truly alerted patient for every 2 falsely alerted patients was deemed an acceptable number of false alarms
- shadowgovt 2y agoInteresting, and I think it makes sense. In an ideal world, the nurse to patient ratio would be high enough that patients could be seen on regular rotation frequently. I've never been in a hospital where this was the case. So a system that can correctly prioritize resources for critical cases even if it's pulling resources away from non-critical cases will probably result in a net improved outcome.
- rscho 2y agoWith such a false positive rate, I expect the staff on site to find ways to negate the effect pretty quickly.
- Tostino 2y agoI don't know...If every 3rd time I was alerted it was some relatively serious issue, vs how often there is a serious issue when just doing rounds that you stumble upon, I'd think that would be a pretty good alert rate compared to the norm. But then again, I'm not in healthcare.
- rscho 2y agoEssentially, it depends on workplace integration, i.e. how much effort it takes to discover the alert trigger. From personal experience, I'd say the upper limit of inconvenience is 'click the alert' on mobile, and 'move mouse on alert label to see tooltip' on desktop. Anything more will be quickly discarded, especially if it involves a popup or opens a new window.
- tantalor 2y agoUnclear what "AI" brings to the table here. Sounds like traditional automation & monitoring could do the job here. No mention of how the model works, or what kind of training is involved. > white blood cell count was "really, really high" You don't need AI for this. I wish they would provide a more compelling example.
- byteknight 2y agoI am beyond tired of the "It made a decision on a if-statement, that's AI!"
- robertlagrant 2y agoI heard AI is just if-statements, so perhaps the reverse is true.
- janalsncm 2y agoYou could build a transformer from if statements if you wanted to.
- patapong 2y agoI am tired of people redefining AI to exclude fully viable and useful technologies in favour of the latest hype. AI should be a functional concept, not defined by technological choices.
- kenjackson 2y agoMost modern AI does even less. It simply flows values through a graph. No decision is ever made. The consumer of the network interprets the result and makes a decision.
- charlie0 2y agoYou do have to wonder though, if traditional automation could do the job, why wasn't that done already?
- apwell23 2y ago" A difference-in-differences comparison between GIM and subspecialty units demonstrated no statistically significant difference in outcomes"
- larsiusprime 2y agoWe have the term “GOFAI” to distinguish “modern” AI from the older stuff (big bag of if statements, behavior trees, etc., but do we need a new term now to distinguish pre-LLM / Diffusion models (neural networks and tree based models)? Everyone thinks “ChatGPT” when they hear AI now but surely this is something more like XGBoost or a neural network under the hood.
- swyx 2y agocan you elaborate how XGBoost could be used for a time series type thing like Chartwatch seems to be doing?
- tensor 2y agoNo, we don't use GOFAI, we call it machine learning. LLMs are a subset of the field, and if you want to refer to them just use the term LLM. We don't need new terms when we already have easy to use precise language. Marketing will abuse any term they get their hands on, and certainly "AI" has been abused, but in the field it usually the umbrella term for all areas of research into making "intelligent" behaviour. Be it expert systems, logic systems, machine learning, statistical machine learning, or otherwise.
- marcosdumay 2y agoWhy all that need to distinguish it? If you want the details, call it a regression model. If not, why insisting on communicating the details?
- gyutff 2y agoIn my experience the best thing to have in a hospital is an advocate. If a loved one is in the hospital, stay with them as long as the hospital will allow you to.
- resource_waste 2y agoIts incredible that this is needed. Medical isnt science, and its frightening. The weirdest thing I've experienced as a patient is that Physicians will urge you against second opinions or having multiple doctors. Hope telemedicine becomes more mainstream, I'd like to avoid US physicians as much as possible.
- rscho 2y agoMedicine isn't science because science is not as advanced as many would think. The lack of workplace integration is also a big factor. I don't think we discourage second opinions, except maybe in some for-profit structures. The bad idea is to have multiple people making decisions in parallel. I'm not in the US, though. Regarding advocacy, I don't think it's so crazy. It's very good to have a valid interlocutor when the patient is diminished. Also, hospitals are big systems with limited personalization. If someone's there to call out the system when it's trying to shoehorn too hard, it's also very good.
- ndarray 2y agoEnjoy the privilege of seeing multiple doctors as long as you still can. With steady cost reduction (AI, automation, less effort per patient) and increase in medical authoritarianism ("expert said so") that privilege is on thin ice. In the UK it's already normal to have a single area-designated doctor you're allowed to go to, and that doctor is also a gatekeeper to refer you to specialists. Hope he likes you! Beyond that, AI diagnosis would likely require an extensive medical online profile of you. Such e-med profiles obviously already exist in various countries, as opt-out features. In the name of cost reduction through automation, I'll be so free and call it: These profiles will become mandatory over the next ten years. Either way, good luck getting a second opinion once a false diagnosis ended up in your file or once AI continuously misidentifies a pattern present there.
- delichon 2y agoThere's a thriller plot hidden in here where the medicos ask an AI to reduce unexpected deaths so it manipulates both predictions and deaths to optimize the statistic. When they can manipulate the world we'll have to treat prompts as if they were wish fulfillment demands to a hostile djinn.
- nisten 2y agoNo there isn't, this is a 4 year old project that likely started before back-n-forth prompts were really a thing.
- DiscourseFan 2y agoWell, personally I'd like to read that novel!
- bearjaws 2y agoThis is a great example of "classic AI" being more than good enough. Using AI to find patterns in patients and intervene was something I worked on in my last job in Specialty Pharma. Theres many red flags on patients long before they even start treatment, sadly income is one of the largest red flags here in the States. We were able to perform interventions earlier and improve outcomes with a simple regression model that tried to determined the number of missed doses.
- resource_waste 2y agoThese studies are the only way AI will be implemented in Medical. This stuff will not happen because its good technology that can save lives. Rather, the public pressure from AI performing better at saving lives that humans. The anecdotes of 'oh it was wrong that one time', will pale in comparison to success. Maybe Insurance companies will be the winners and be our advocate. I've already seen medical professionals use 'that one time it was wrong' as a way to ignore technology.
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- JumpCrisscross 2y ago“While the nursing team usually checked blood work around noon, the technology flagged incoming results several hours beforehand” So the blood was collected and labs done but it wasn’t scheduled to be reviewed until later? Seems like a win-win. For those saying you don’t need AI, the alternative would be either across-the-board thresholds for flags for each line item (too many false positives) or manually setting it for each patient (too intensive).
- rscho 2y agoAcross the board thresholds is exactly what we usually have. I'm not so sure about the false positives being so high. I expect most of the effect to result from additional nurse whipping (sorry, 'targeted warning').
- JumpCrisscross 2y ago> Across the board thresholds is exactly what we usually have. I'm not so sure about the false positives being so high The article would have been stronger with those numbers. But I wouldn’t be convinced that a high WBC count for an average ER visitor would have been sensitive enough to trigger an alarm. The prior knowledge that it’s a cat bite is important.
- rscho 2y agoAgreed. Adaptive thresholds are better than average thresholds.
- jmward01 2y agoThe question is will this lead to better care or a reduction in resources? Technology allows companies to become 'just good enough'. Any better than 'just good enough' and resources are withdrawn. If there is a 26% improvement in x and x was 'just good enough' before then the only 'rational' move by administration is to reduce other resources until x hits 'just good enough' again. That being said, I think the improvements are coming so rapidly in healthcare that we have a real chance of causing the entire system to shift into a new dynamic so maybe we will actually capture some of these gains for patients.
- zooq_ai 2y agoThis scenario exists only in progressive and HNers heads. Companies make money and Capitalism works by offering more services not fewer. Are there companies that does short-term thinking? Yes. But overall, our standard of living and quality of services has always improved
- jmward01 2y agoThat was a rational capitalist argument. If a company has an opportunity to make money, they will. Any better than 'good enough' isn't rational and the people running that company should be fired. In the long term the entire industry will slowly adopt this and the standard of care may rise slightly as these gains are used for competitive advantage instead of pure profit but that will take a while at best and relies on a true free market, which healthcare definitely isn't.
- SteveNuts 2y ago> relies on a true free market, which healthcare definitely isn't. I think this is the part that people miss the most. When a purchasing decision is made based on something like "who has the best quality shoes in price range X", competition can occur. When the buying decision is "will I live or die", there's not really any choice made there. Couple that with the complete lack of transparency for how much a give procedure will cost, and you've strayed so far away from a free market that it's not even recognizable. I mean, even the hospital can't even remotely accurately tell you how much something will cost before you actually get a bill...
- fabiospampinato 2y agoClosing hospitals would cut deaths in hospitals by 100%. Like I'm not sure what this measure means, it's not like 26% of people that would die in the hospital would be made immortal or something.
- Oarch 2y agoThe real weasel word here is "unexpected". If the AI is going around terminating patients and this counts as expected behaviour... technically correct!
- inglor_cz 2y agoI don't think it is weasel word. It is just a qualification. Nobody really expects AI to save terminal cancer patients or 90-y.o. cardiacs. Unexpected deaths, on the other hand, are really nasty, both for the next of kin and the doctors themselves. If an apparently viable patient suddenly drops dead, everyone asks what went wrong. Reducing such deaths by one fourth is a good job.
- Kalanos 2y ago"their white blood cell count was high" that's just an alert, not ai
- magicmicah85 2y agoStuff like this is not exactly new but it’s great it’s receiving desired outcomes. The company I work for developed a sepsis alert back in 2010 that helped inform clinicians to possible sepsis in patients by analyzing lab results. Lot of success stories but of course false positives. Tools like this are very useful when they are one of many factors driving a clinician’s decision and not the only reason.
- loeg 2y agoYou have two levers for reducing unexpected deaths, right? Hopefully this didn't increase the number of expected deaths to substitute.
- botanical 2y agoI really dislike how AI is used for everything. To me, AI means a dumb LLM spewing out half-truth and whole lies. But in this instant, it's machine learning in the form of regression analysis: Multivariate adaptive regression spline
- esoleyman 2y agoI don’t like relative risk and relative risk reduction because it tends to overestimate the effectiveness of the intervention. In this case, the absolute risk when measuring for death in the GIM pre-intervention and GIM post-intervention are 0.0215 (2.15%) and 0.0146 (1.46%) with an absolute risk reduction of 0.0069 (.69%). While the relative risk is 26% across the pre- and post-intervention, the absolute risk reduction is only 0.69% with a NNT (number needed to treat) of 1/156. Which means that 1 patient in 156 was helped by this intervention. In addition, they had 2 false alarms for each true alarm and could suggest that interventions were performed in patients who did not require it — more tests, medications and possibly increased risk from said interventions. This shows that the CHARTwatch ML/AI is not helping at all that much clinically.
- swyx 2y agothis was excellent and necessary context on all fluff pieces like the OP. how can we automate this kind of analysis?
- esoleyman 2y agoYou can't automate it. You have to look at the data and charts to figure out the specifics you want and then you plug and chug. I haven't looked deeply at this though but whenever researchers use relative risk and it shows a profound effect, I always calculate the absolute risk to make sure that the intervention is effective. Many researchers go to relative risk because it shows better results!
- netruk44 2y agoI know everyone hates "I asked ChatGPT" comments but...I feel it's relevant here. It came to roughly the same conclusion as the gp comment when provided with the study PDF. https://chatgpt.com/share/66eb09e3-7a74-8008-afa8-3b60161d2497 https://chatgpt.com/share/66eb09e3-7a74-8008-afa8-3b60161d24... (Though obviously this approach still requires you to go and look at the PDF yourself to make sure it isn't making anything up)
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- pknerd 2y agoDon't judge me. I am not an ML expert. I am just wondering how this is an AI or ML thing. Is it not match the threshold of WBC in the body, if it is above or below the range, generate an alert. Can any ML guy tell me how this system is actually working?
- kenjackson 2y agoI don't know the details, but I suspect its a bit more. Probably takes as input all of the factors over a time series and then determines based on these inputs over time there is a higher likelihood of Y. When that likelihood reaches some threshold it sends an alert to the nurse. It's almost certainly not as simple as temperature at 105 -> alert (although a temp of 105, would certainly signal a problem).
- daft_pink 2y agoThis is really awesome. As someone that has entered an emergency room in severe pain and is shocked at how long it takes to see a physician. I hope this system can monitor people waiting to be admitted as well.
- renonce 2y ago> That warning showed the patient's white blood cell count was "really, really high," recalled Bell, the clinical nurse educator for the hospital's general medicine program. I’m not sure how an alarm for “high white cell count” should have had so much impact. Here in China once the doctor prescribes a finger blood test, we sample finger blood after lining up for 15 minutes, and the result is available within 30 minutes. The patient prints the results from a kiosk and any patient who cares enough about their own health will see the exceptionally high white cell count and request an urgent appointment with the doctor for diagnosis right away. Even in normal cases we usually have the doctor see the report within two hours. Why wait several hours? > While the nursing team usually checked blood work around noon, the technology flagged incoming results several hours beforehand. > But in health care, he stressed, these tools have immense potential to combat the staff shortages plaguing Canada's health-care system by supplementing traditional bedside care. This sounds like the deaths prevented by this tech are caused by delays and staff shortage and what this tech does is to prioritize patients with serious issues? While I appreciate using new tools to cut deaths, it looks like the elephant in the room is staff shortage?
- wolfi1 2y agoimagine how much they could reduce when the barest safety rules regarding hygiene were met
- AStonesThrow 2y agoI am thankful that we can expect fewer unexpected events now. Today I was saved from death at least five times because an automated traffic signal alerted me to machines hurtling dangerously in the wrong direction. I was able to push commands that halted my conveyance until the risk of death had plummeted. I am also reminded of Dilbert's PHB decreeing that all future unplanned outages must be announced at least 48 hours in advance.