Computerised triage in a prostate assessment clinic.

Area of Science:

• Urology
• Health Informatics
• Medical Software Development

Background:

• Effective management of prostate outpatients requires accurate assessment of symptoms, history, and laboratory results.
• Current clinical workflows can be time-consuming and may benefit from automated decision support systems.
• Standardized scoring systems like the International Prostate Symptom Score (IPSS) are crucial for consistent evaluation.

Purpose of the Study:

• To develop and evaluate a user-friendly MS Office package for scoring IPSS, patient history, and guiding interim management in prostate outpatients.
• To compare computer-generated management decisions with those of a consultant urologist.
• To assess the system's potential for improving efficiency and accuracy in outpatient urological care.

Main Methods:

• Development of an MS Office package using Excel and Visual Basic for data input (IPSS, history, lab results) and management rule implementation.
• Patient interaction via a touch screen for IPSS and medical history input, stored in Excel spreadsheets.
• Comparison of computer-driven management decisions against a consultant urologist's decisions for 139 patients.

Main Results:

• The system achieved agreement with consultant urologist decisions in 106 out of 139 patients (76%).
• Disagreements (33 patients) were primarily due to the computer's oversensitivity to uroflow results (21 cases).
• In 12 cases, the urologist deviated from the system's rules when single variables were slightly abnormal.

Conclusions:

• The developed software system demonstrates significant potential for user-friendly management of prostate outpatients.
• The system effectively integrates patient data and established management rules to support clinical decision-making.
• Further refinement, particularly regarding uroflowmetry interpretation, is needed to optimize performance, with artificial neural networks being investigated.