ArticlemedRxiv : the preprint server for health sciences2026
PAUSE-Agents: A Clinician-in-the-Loop Multi-Agent AI Pipeline for ICU-to-Ward Handoff Briefs.
Saki Amagai, Wan-Ting Liao, Caleb Murphy, Courtney Reamer, Yupeng Liu, Bhavana Ambil, Glenn Fernandes, Lekshmi Santhosh, Patrick G Lyons, Neil Jordan and 5 more
Abstract readPreprint
In one paragraphArticle in medRxiv : the preprint server for health sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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2 · The registryThe trial behind it
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4 · The recordCorrections and comments
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5 · Who and what moneyAuthors and funding
15 authors.
Saki AmagaiDepartment of Preventive Medicine, Division of Biostatistics and Informatics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.ORCID 0000-0002-2825-4219 Wan-Ting LiaoDivision of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.ORCID 0009-0001-5070-5610 Caleb MurphyDivision of Hospital Medicine, Northwestern University, Chicago, IL, USA.
Courtney ReamerDepartment of Medicine, Northwestern University, Chicago, IL, USA.
Yupeng LiuDepartment of Medicine, Northwestern University, Chicago, IL, USA.
Bhavana AmbilDepartment of Medicine, Northwestern University, Chicago, IL, USA.
Glenn FernandesDepartment of Computer Science, Northwestern University, Chicago, IL, USA.
Lekshmi SanthoshDepartment of Medicine, Division of Pulmonary/Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA.ORCID 0000-0002-9897-3462 Patrick G LyonsDepartment of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health & Science University, Portland, OR, USA.ORCID 0000-0002-1557-2787 Neil JordanDepartments of Psychiatry & Behavioral Sciences, Preventive Medicine, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.ORCID 0000-0001-8467-822X David LiebovitzDepartment of Surgery & Electrical and Computer Engineering, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.ORCID 0000-0002-2518-5940 Adrienne KlineCenter for Artificial Intelligence, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, USA.ORCID 0000-0002-0052-0685 Juan C RojasDivision of Pulmonary, Critical Care, and Sleep Medicine, Rush University, Chicago, IL, USA.
Yuan LuoDepartment of Preventive Medicine, Division of Biostatistics and Informatics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Catherine A GaoDivision of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.ORCID 0000-0001-5576-3943 Funding
Data Driven Strategies for Substance Misuse Identification in Hospitalized PatientsR01DA051464 · NIDA · UNIVERSITY OF WISCONSIN-MADISON · PI Majid Afshar · 2020 to 2026
$4.5MSPOT-IT: Sepsis Prediction in Oncology Through Implementation Science and TechnologyK08CA270383 · NCI · OREGON HEALTH & SCIENCE UNIVERSITY · PI Patrick G Lyons · 2024 to 2026
$851kMachine learning to predict cure in severe pneumonia episodesK23HL169815 · NHLBI · NORTHWESTERN UNIVERSITY AT CHICAGO · PI Catherine A. Gao · 2024 to 2026
$501kNCI NIH HHS K08 CA270383NHLBI NIH HHS K23 HL169815NIDA NIH HHS R01 DA051464
6 · The paper itselfAbstract
ICU-to-ward transfers are high-risk transitions marked by information loss and burdensome handoff preparation. We developed PAUSE-Agents, a clinician-in-the-loop multi-agent LLM pipeline that drafts source-attributed handoff briefs from structured ICU data and clinical notes using the clinician-developed ICU-PAUSE template. Mirroring ICU team structure, PAUSE-Agents routes each record through a scribe extractor, 6 role-specialized agents, explicit conflict surfacing, and deterministic safety checks before synthesis, producing an editable first draft rather than an autonomous note. In a single-center medical ICU cohort, 5 physicians completed 100 reviews of 84 agent-drafted briefs. Among adjudicable claims, 98.8% were verified and 1.2% were incorrect; 88% of briefs had no pertinent omission, and mean PDSQI-9 quality was 4.20/5. PAUSE-Agents surfaced 118 conflict warnings and 421 safety flags, making documentation inconsistencies visible before handoff. An o4-mini PDSQI-9 judge showed limited case-level discrimination but supported aggregate monitoring. We release PAUSE-Agents and its clinician evaluation application.
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PMID42528499
PMCPMC13409233
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