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Description:
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ACORN is an expert system for advising on management of chest pain patients in the emergency room.
Medical audits determined that 38% of patients attending with acute ischaemic heart disease were sent home in error and the median time till CCU admission for the remainder was 115 minutes. ACORN was built for use by physicians and senior nurses to assist in the management of these patients. The system was in routine use at Accident & Emergency Department Westminster Hospital, London, from 1987 until 1990. In 1990 the mean usage rate per eligible case claimed by the 15 users was 77%, but when unequivocal evidence of use was looked for in the patient records, this was present in only 23% of eligible cases. There were approx. 15 eligible cases per week (= 750 per year), so this scales up to between 175 and 580 uses of ACORN per annum.
Evaluation: In a randomized controlled trial on 150 patients in 1987 the false negative rate in both control and ACORN cases fell to 20%; this may have been a carryover or Hawthorne effect. This trial also identified significant problems with ACORN, and it was subsequently revised and appeared to be effective at reducing the median time to CCU admission by 20 minutes, though this was an uncontrolled study.
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