Nursing documentation in intensive care units (ICUs) provides essential clinical intelligence but often suffers from inconsistent terminology, informal styles, and lack of standardization, challenges that are particularly critical in heart failure care. This study applies Direct Preference Optimization (DPO) to adapt Mistral-7B, a locally deployable language model, using 8,838 heart failure nursing notes from the MIMIC-III database and 21,210 preference pairs derived from expert-verified GPT outputs, model generations, and original notes. Evaluation across BLEU, ROUGE, BERTScore, Perplexity, and expert qualitative assessments demonstrates that DPO markedly enhances documentation quality. Specifically, BLEU increased by 84% (0.173 to 0.318), BERTScore improved by 7.6% (0.828 to 0.891), and expert ratings rose across accuracy (+14.4 points), completeness (+14.5 points), logical consistency (+14.1 points), readability (+11.1 points), and structural clarity (+6.0 points). These results indicate that DPO can align lightweight clinical language models with expert standards, supporting privacy-preserving, AI-assisted documentation within electronic health record systems to reduce administrative burden and improve ICU patient safety.

Nursing notes, an important component of Electronic Health Records (EHRs), keep track of the progression of a patient's health status during a care episode. Distilling the key information in nursing notes through text summarization techniques can improve clinicians' efficiency in understanding patients' conditions when reviewing nursing notes. However, existing abstractive summarization methods in the clinical setting have often overlooked nursing notes and require the creation of reference summaries for supervision signals, which is time-consuming. In this work, we introduce QGSumm, a query-guided self-supervised domain adaptation framework for nursing note summarization. Using patient-related clinical queries as guidance, our approach generates high-quality, patient-centered summaries without relying on reference summaries for training. Through automatic and manual evaluation by an expert clinician, we demonstrate the strengths of our approach compared to the state-of-the-art Large Language Models (LLMs) in both zero-shot and few-shot settings. Ultimately, our approach provides a new perspective on conditional text summarization, tailored to the specific interests of clinical personnel.

Recent advances in large language models have led to renewed interest in natural language processing in healthcare using the free text of clinical notes. One distinguishing characteristic of clinical notes is their long time span over multiple long documents. The unique structure of clinical notes creates a new design choice: when the context length for a language model predictor is limited, which part of clinical notes should we choose as the input? Existing studies either choose the inputs with domain knowledge or simply truncate them. We propose a framework to analyze the sections with high predictive power. Using MIMIC-III, we show that: 1) predictive power distribution is different between nursing notes and discharge notes and 2) combining different types of notes could improve performance when the context length is large. Our findings suggest that a carefully selected sampling function could enable more efficient information extraction from clinical notes.

Hospital discharge documentation is among the most essential, yet time-consuming documents written by medical practitioners. The objective of this study was to automatically generate hospital discharge summaries using neural network summarization models. We studied various data preparation and neural network training techniques that generate discharge summaries. Using nursing notes and discharge summaries from the MIMIC-III dataset, we studied the viability of the automatic generation of various sections of a discharge summary using four state-of-the-art neural network summarization models (BART, T5, Longformer and FLAN-T5). Our experiments indicated that training environments including nursing notes as the source, and discrete sections of the discharge summary as the target output (e.g. "History of Present Illness") improve language model efficiency and text quality. According to our findings, the fine-tuned BART model improved its ROUGE F1 score by 43.6% against its standard off-the-shelf version. We also found that fine-tuning the baseline BART model with other setups caused different degrees of improvement (up to 80% relative improvement). We also observed that a fine-tuned T5 generally achieves higher ROUGE F1 scores than other fine-tuned models and a fine-tuned FLAN-T5 achieves the highest ROUGE score overall, i.e., 45.6. For majority of the fine-tuned language models, summarizing discharge summary report sections separately outperformed the summarization the entire report quantitatively. On the other hand, fine-tuning language models that were previously instruction fine-tuned showed better performance in summarizing entire reports. This study concludes that a focused dataset designed for the automatic generation of discharge summaries by a language model can produce coherent Discharge Summary sections.

Clinical notes are becoming an increasingly important data source for machine learning (ML) applications in healthcare. Prior research has shown that deploying ML models can perpetuate existing biases against racial minorities, as bias can be implicitly embedded in data. In this study, we investigate the level of implicit race information available to ML models and human experts and the implications of model-detectable differences in clinical notes. Our work makes three key contributions. First, we find that models can identify patient self-reported race from clinical notes even when the notes are stripped of explicit indicators of race. Second, we determine that human experts are not able to accurately predict patient race from the same redacted clinical notes. Finally, we demonstrate the potential harm of this implicit information in a simulation study, and show that models trained on these race-redacted clinical notes can still perpetuate existing biases in clinical treatment decisions.

Machine learning models depend on the quality of input data. As electronic health records are widely adopted, the amount of data in health care is growing, along with complaints about the quality of medical notes. We use two prediction tasks, readmission prediction and in-hospital mortality prediction, to characterize the value of information in medical notes. We show that as a whole, medical notes only provide additional predictive power over structured information in readmission prediction. We further propose a probing framework to select parts of notes that enable more accurate predictions than using all notes, despite that the selected information leads to a distribution shift from the training data ("all notes"). Finally, we demonstrate that models trained on the selected valuable information achieve even better predictive performance, with only 6.8% of all the tokens for readmission prediction.

Their importance has been highlighted in recent times, when ICUs around the world have been overrun by the COVID-19 pandemic [1, 2]. It is in times like these when research into ways to adequately manage scarce critical care resources must be even more vigorously pursued, in order to offer additional tools that support medical decisions and allow for the effective benchmark of clinical practice. The issue of mortality prediction in the ICU has been approached from a statistical standpoint by means of risk prediction models like APACHE, SAPS, MODS, among others [3]. These models use a set of physiological predictors, demographic factors, and the occurrence of certain chronic conditions, to estimate a score that serves as a proxy for the likelihood of death of ICU patients. Because of the relatively straightforward way of interpreting results, simple statistical approaches such as logistic regression are the go-to modeling techniques used to estimate mortality probability and the importance of the predictors involved. On the other hand, the simplicity of the models also mean that their limited expressiveness may not accurately represent the possibly nonlinear dynamics of mortality prediction. Given this, high-capacity machine learning models might be useful to increase predictive performance.