MEET DORA: USER ACCEPTABILITY STUDY OF AUTOMATED TELEPHONE FOLLOW UP POST CATARACT SURGERY.

This study explores the patient experience and acceptability of undergoing routine follow up after cataract surgery with an automated telephone call using a natural language artificial intelligence (AI) assistant ‘Dora’.  The routine pathway of clinician delivered follow up is replaced by Dora who speaks to patients via a regular phone call and delivers a safety check as well as giving the patient the opportunity to ask questions.

This study takes place in the Ophthalmology outpatient department at Stoke Mandeville Hospital Buckinghamshire Healthcare NHS Trust.

This is a mixed-methods cohort study. Patients with planned telephone follow-up after uncomplicated cataract surgery were recruited during June-August 2021. Participants received an automated call between 2-4 weeks post-operatively. All calls were supervised by a human clinician.  As part of the conversation patients gave a Net Promoter Score (NPS) in answer to the question “on a scale of 1 to 10 how likely would you be to recommend this automated service to a friend or colleague?”
In addition, a randomly selected cohort of patients also underwent a remote semi-structured interview to assess their opinions about Dora’s usability, acceptability, satisfactoriness, and appropriateness. This included the validated Telephone Usability Questionnaire (TUQ) - a likert scale of 16 statements. The qualitative data from the interviews was assessed using thematic analysis.

184 calls were made with Dora (to 178 patients) with a mean age of 78 years. The median
NPS response was 9 out of 10, with a calculated NPS of 46%(number of scores of 9 or 10,
minus number of scores below 7, divided by total response number).21 patients had an additional interview. TUQ questions (out of 5) showed high rates of acceptability, with an overall mean of 4.0. Simplicity, time saving and ease of use scored the highest with a median of 5; whilst ‘speaking to Dora feels the same as speaking to a clinician’ scored a median of 3. Themes that emerged from interview data include convenience, ease of use and patients preference to speak to a clinician for human interaction, or if they were to have a complication.

Dora is an acceptable method of routine follow up post cataract surgery. Whilst many enjoy human interaction, patients appreciate that automation saves time and money for the NHS, and find automated telephone follow up simple and easy to use. Patient views are an integral part of the improvement in design and development of such innovation.  With high rates of patient acceptability, the use of automated AI assistants such as Dora has the potential for system wide increase in efficiency of high volume, low complexity care.