Evaluation of Routine Clinical Deployment of an Autonomous Artificial Intelligence Assistant for Cataract Follow-Up in the National Health Service

Abstract

Aisling Higham,1,2 Anna Maria Sideri,3,4 Filip Tarcoveanu,4 Ernest J Lim,2 Lisette H G Bijma,2 Syeda S Imtiyaz,4 Louisa Katie Stacey,2 Sarah Khavandi,2,3 Nick de Pennington,2 James Thomas,2 Michael Adams,4 Sarah J Maling,4,5 Kikkeri S Arun,1 Rebecca Turner,1 Christopher King,4 Kanmin Xue1,6 1Department of Ophthalmology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; 2Ufonia Limited, Oxford, UK; 3Department of Ophthalmology, King’s College Hospital NHS Foundation Trust, London, UK; 4Department of Ophthalmology, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK; 5Royal College of Ophthalmologists, London, UK; 6Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UKCorrespondence: Kanmin Xue, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6 West Wing, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, United Kingdom, Email kanmin.xue@eye.ox.ac.ukPurpose: To understand the efficiency, safety, and patient acceptability of using an artificial intelligence-based conversational agent Dora R2 (Ufonia Limited, UK) in the cataract pathway.Patients and Methods: This mixed methods cohort-based service evaluation included both prospective and retrospective data collection from two UK public hospitals: Oxford University Hospitals National Health Service (NHS) Foundation Trust and Buckinghamshire Healthcare NHS Trust. Patients undergoing cataract surgery of mixed complexity were included. All patients who had postoperative calls with Dora R2 between October 2022 and April 2023 were included. Dora R2 calls patients three weeks after routine cataract surgery to assess symptoms and answer patient queries. Patient demographics and clinical outcomes were reviewed, and statistical analyses were performed to identify any differences based on age, gender and ethnicity.Results: Of 1580 eligible patients, 1269 (78%) completed the Dora R2 call. About 767 (63%) had “no clinical concerns” identified by Dora. The median patient age was 77 years, with 84% identifying as white. There were no significant differences in call outcomes based on demographic factors (at 5% significance level). The Net Promoter Score for patient acceptability was 47, indicating high satisfaction. Regarding safety, only 0.3% of patients required unplanned management changes within two weeks of a Dora call with a “no concerns identified” outcome.Conclusion: Dora R2 effectively supports postoperative follow-up for cataract surgery, demonstrating high efficiency, safety, and patient acceptability. The technology successfully supports clinicians in identifying uncomplicated cases, reduces the need for clinician-led consultations, and does not exacerbate digital inequalities, showing promise for broader implementation.Plain Language Summary: Cataract surgery is one of the most common operations worldwide. After surgery, patients typically need a follow-up appointment to check their recovery. However, with increasing demand for cataract surgery and limited National Health Service (NHS) resources, finding enough staff to conduct these follow-ups is challenging.We tested whether an automated telephone assistant called Dora could safely and effectively follow up patients after routine cataract surgery. Dora calls patients three weeks after their operation, asks about their symptoms and recovery, and answers common questions. Based on the conversation, Dora identifies patients who are recovering well and those who may need further assessment from a clinician.We studied 1636 patients across two NHS hospitals. Of those who spoke with Dora, 63% were recovering well with no concerns, meaning they did not need a follow-up call from clinical staff. Patients were highly satisfied with the service, giving it a recommendation score of 9 out of 10. Importantly, Dora worked equally well for patients of all ages, genders, and ethnic backgrounds – addressing concerns that digital healthcare tools might disadvantage certain groups.The system was also safe. Only 0.3% of patients identified as having “no concerns” later needed unexpected treatment.These findings suggest that automated telephone follow-up can help the NHS manage the growing demand for cataract surgery without compromising patient safety or experience. This frees up clinical staff to focus on patients who need more complex care, while ensuring all patients receive timely follow-up after their surgery.Keywords: post operative follow up, telemedicine, cataract surgery, digital health equity

Ähnliche Arbeiten