The Impact of Cultural Embeddedness on the Implementation of an Artificial Intelligence Program at Triage: A Qualitative Study

Abstract

Introduction: Triage requires rapid determination of acuity and resources. Current modalities allow for individual judgment, with varied application of algorithmic rules. Although artificial intelligence can improve triage accuracy, gaps remain in understanding implementation facilitators and barriers, especially those related to the cultural understandings by nurses of emergency department presentations. The purpose of this study was to explore the cultural and technological elements of the implementation of an artificial intelligence clinical decision support aid (i.e., KATE) in an emergency nursing triage process in an urban community hospital on the West Coast of the United States. Method: An exploratory qualitative study using semi-structured small group and individual interviews and constant comparison analysis strategies. The sample comprised 13 emergency department triage nurses at one site. Campinha-Bacote’s theory of cultural competence framed the study. Results: Responses yielded the overall theme of We know these people and we know these things. Supporting categories included the problem of aire; just another checkbox; gut trumps data; higher acuity with no resources; and technology as a safety net. Participants reported reliance on clinical experience and cultural knowledge to assign acuity. Discussion: The implementation of an artificial intelligence program was initially received skeptically due to the acontextual nature of AI, but grew to be perceived as a safety net for triage decision making among emergency nurses.