Thomson Hospital Kota Damansara

Esther May Cheam Sue San

Artificial intelligence (AI) is the hottest topic in the technological advancement. We hear and read daily about AI in every industry worldwide and have it discussed in many dialogues across the globe. How important is AI then to the Critical Care world? Let’s have a glimpse of AI in theIntensive Care Unit (ICU).

In 2021, Peine A et al. mentioned in their journal that VentAI, a reinforcement learning algorithm, was used in mechanically ventilated patients and improved adjustments in tidal volume and positive end-expiratory pressure with target outcomes of 90-day and ICU mortality. During the pandemic in 2022, Elhazmi et al. used a machine learning (ML) method called decision tree (DT) to identify the predictors of 28-day ICU mortality in 1468 critically ill COVID-19 patients from 14 hospitals in Saudi Arabia. Their findings showed that a decision tree could be a useful tool to identify critically ill COVID-19 patients who were at high risk of 28-day ICU mortality. Nevertheless, future validation is still necessary, as nothing is worse than inaccurate results. More recently, in 2023, Kessler et al. sought to develop an AI model that predicted cardiovascular ICU readmission. They used the open-access Medical Information Mart for Intensive Care (MIMIC-III) dataset to develop an AI modeling approach that was superior to ML approaches. So many useful tools can be attained from using AI in the ICU to improve patients’ outcomes – reducing the length of stay, reducing mortality rates, improving turn-around time in ICU bed occupancy, and ensuring patient safety is prioritized. This would then translate to generating higher revenue and inflating more businesses for the hospital. Furthermore, Softarex Technologies agreed that ICU provides an ideal environment for the implementation of AI technologies because ICU generates a large volume of patient data, which is very useful in predictive analytics, faster rates being generated for prediction, alleviating workload demands to prevent burn-out of staffs and optimize patient care. A small controlled trial of 142 patients demonstrated that incorporation of AI technology into existing EHR-based sepsis identification systems was associated with decreased hospital length of stay and mortality reductions.

The emergence of generative AI in healthcare has recently propelled the revolutionary advancement of AI technologies. Generative AI seems promising for Critical Care in systematically analyzing patients’ data real-time and generating individual personalized reports in a robust manner. Some stellar examples of AI-powered healthcare solutions include Corti, Nuance, Hippocratic AI, Google Bard and Ellen AI. With so much being done around AI in Critical Care, what will be the future of Nursing?

"The basic human touch in critical care is the ultimate need for any healthcare facility."

Nurses are the entire backbone of the healthcare industry. Without nurses, it is relatively impossible to run a healthcare facility. As AI is steadily seeping into the healthcare system and restructuring the architecture of Critical Care, nurses must know that the significance of soft skills in handling human beings can never be replaced nor underestimated. While AI’s logic functions are governed by various codes, data and algorithms, human touch is forever irreplicable and irreplaceable. The ability to process emotions and maintain ethical practices can only be garnered by nurses who are physically attending to patients’ needs, be present to hold patients’ hands when they take their last breaths or empathize and console when a child has sensory processing issues such as having meltdowns or overreacting to bright lights.

Albeit the myths of AI taking over the workforce would seem extravagantly surreal, there is still a known prevailing fact that critical thinking and problem-solving abilities are non-automatable skills.

 According to Polymer Search, the number of jobs replaced by AI by 2030 largely depends on the industry and is more susceptible to automation than others. Likewise, PwC did a study to show that 30% of jobs could be at risk of automation by early 2030. Would anyone ever be willing to be operated by AI then? Would you prefer to have AI deliver your firstborn? Or having the AI present when you take your last breath on the ICU bed? Of course not.

Nurses play a fundamental role in healthcare, more so especially in Critical Care. Their job requires a blend of clinical plus critical knowledge, a strong sense of empathy, and great communication skills that are truly difficult for AI to emulate. Moreover, ICU nurses must adapt to each individualized patient's needs and respond aptly to every single change in their condition, tasks that require human intuition and appropriate judgment. An example can be depicted from a child in critical care. “These technologies will only reflect the quality of the data they receive — they won’t serveeveryone unless the health care system does a better job of creating fair, equitable, representative medical data first,” says Dr. Sezgin, who specializes in analyzing the health care applications of AI and recently published in The Lancet Child & Adolescent Health on its ethical use in pediatrics.

Therefore, the basic human touch in critical care is the ultimate need for any healthcare facility. Hospitals must be brave enough to empower nurses to some point as nurses still supersede AI in aspects like values, ethical decision-making, critical thinking, curiosity or inquisitiveness and emotional intelligence.

Having said that, we will definitely still want to live with the revolutionary great technologies AI has to offer in critical care settings. Consequently, nurses in complex care situations and AI must gel together to bring out the most beneficial outcomes for the best interest of patients and their safety when they are in their most vulnerable states. The yin and yang of AI and Nursing will continue to accelerate and be integrated in the coming decades whilst ensuring patient-centered care stays at the forefront. AshishSukhadeve highlighted in Forbes (2021) the positives of living in a world where AI and humans collaborate instead of competing against each other as well as striving for the right balance between human intelligence and AI. A hybrid AI-human workflow for palliative care in improving efficacy, as mentioned by Chua, I.S. et al. (2022), has shown positive traits to embark on.

In conclusion, adaptation is the significant driving force behind human intelligence. In order for adaptation to take place, we need to change in tandem with the restructuring of critical care medicine so that meaningful changes do take place profoundly with the ever-evolving world of AI. Being a positive change agent will definitely impact a culture change in healthcare organizations globally. As BrandenNeish asserted in Medical Economics (2023), AI has the ability to bridge the gap between patients and providers with thoughtful and ethical implementation.