Emergency Department Revisit Quality Review Screening: Exploring Human Decision-Making and Artificial Intelligence Support — Paper

Abstract

Background: Emergency Department (ED) return visits are commonly reviewed for quality assurance, but are often limited (e.g., to revisits within 48-72 hours) to increase actionable finding yield while minimizing chart review burden. Those limitations may lead to missed quality improvement opportunities. Methods: We conducted an exploratory, retrospective study of randomly selected ED visits to a multihospital health system having an ED revisit within 1-14 days to the same health system. Given only each visit's primary diagnosis, raters (2-3 clinicians and GPT-4 large language model [LLM]) assessed characteristics of the diagnosis pairs, including the "target": whether a pair warranted further assessment. Informed by rater response analyses, an algorithm leveraging an LLM-populated knowledge graph ("KGA") was created to automatically screen for potentially concerning pairs, then preliminarily assessed. Results: 99 diagnosis pairs were included. GPT-4 responses poorly correlated to clinician raters, rating nearly all (94%) pairs as warranting follow-up (4.4-13.3 times more than clinicians). However, prompt engineering was minimal. Among clinician raters, revisit medical gravity was consistently significantly associated with the target, while a differential diagnosis/complication composite was significantly associated on unadjusted, but not adjusted (though less powered) analysis. The KGA achieved 83-100% positive predictive value for at least one clinician rater determining further assessment was warranted based on the diagnosis pair. Conclusion: These results can inform next steps for improving screening with LLMs like ChatGPT. Further research is warranted to validate this preliminary work's finding that the KGA may enable enhancing the scope and yield of screening without substantially increasing reviewer workload.

Authors 8

Jonathan A. Handler, Marlene I. Robles-Granda, Jacob E. Mefford, Jeremy S. McGarvey, Gregory S. Podolej, Colleen J. Klein, Matthew D. Dalstrom, William F. Bond

Specification

Official page: arxiv.org/abs/2609.10421
Source:arXiv (Atom API + RSS)T1observed 4 h agohigh
Arxiv announce type: cross
Source:arXiv (Atom API + RSS)T1observed 4 h agohigh
arXiv id: 2609.10421
Source:arXiv (Atom API + RSS)T1observed 4 h agohigh
Categories: cs.CY, cs.AI
Source:arXiv (Atom API + RSS)T1observed 4 h agohigh
PDF: arxiv.org/pdf/2609.10421
Source:arXiv (Atom API + RSS)T1observed 4 h agohigh
Primary category: cs.CY
Source:arXiv (Atom API + RSS)T1observed 4 h agohigh
Published: 11 Sept 2026
Source:arXiv (Atom API + RSS)T1observed 4 h agohigh

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Provenance

Attributed facts

9

Source tiers

T19

Freshest observation

4 h ago

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None

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Authors: Jonathan A. Handler, Marlene I. Robles-Granda, Jacob E. Mefford

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Claim history for Authors
Value	Valid from → to	Status	Source	Confidence	Extractor
Jonathan A. Handler, Marlene I. Robles-Granda, Jacob E. Mefford, Jeremy S. McGarvey, Gregory S. Podolej, Colleen J. Klein, Matthew D. Dalstrom, William F. Bond	11 Sept 2026 21:03 UTC → current	current	arXiv (Atom API + RSS)T1	high	deterministic

Claims are temporal and append-only: a new observation closes the previous claim (valid_to) instead of overwriting it. Conflicting claims from different sources are kept side by side and flagged — never averaged. Methodology →

11 Sept 2026
New paperPaperEmergency Department Revisit Quality Review Screening: Exploring Human Decision-Making and Artificial Intelligence Support
New paper: Emergency Department Revisit Quality Review Screening: Exploring Human Decision-Making and Artificial Intelligence Support
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Source documents
Source	Document	Type	Tier	Last observed	Snapshots
arXiv (Atom API + RSS)	rss.arxiv.org/rss/cs.AI	feed	T1· Official	2 h ago	1

Tier 1 = official/primary, 2 = quality secondary, 3 = community, 4 = unverified. Every snapshot is archived; see all sources and the methodology.