Real-world Deployment and Evaluation of PErioperative AI CHatbot (PEACH) -- a Large Language Model Chatbot for Perioperative Medicine

Large Language Models (LLMs) are emerging as powerful tools in healthcare, particularly for complex, domain-specific tasks. This study describes the development and evaluation of the PErioperative AI CHatbot (PEACH), a secure LLM-based system integrated with local perioperative guidelines to support preoperative clinical decision-making. PEACH was embedded with 35 institutional perioperative protocols in the secure Claude 3.5 Sonet LLM framework within Pair Chat (developed by Singapore Government) and tested in a silent deployment with real-world data. Accuracy, safety, and usability were assessed. Deviations and hallucinations were categorized based on potential harm, and user feedback was evaluated using the Technology Acceptance Model (TAM). Updates were made after the initial silent deployment to amend one protocol. In 240 real-world clinical iterations, PEACH achieved a first-generation accuracy of 97.5% (78/80) and an overall accuracy of 96.7% (232/240) across three iterations. The updated PEACH demonstrated improved accuracy of 97.9% (235/240), with a statistically significant difference from the null hypothesis of 95% accuracy (p = 0.018, 95% CI: 0.952-0.991). Minimal hallucinations and deviations were observed (both 1/240 and 2/240, respectively). Clinicians reported that PEACH expedited decisions in 95% of cases, and inter-rater reliability ranged from kappa 0.772-0.893 within PEACH and 0.610-0.784 among attendings. PEACH is an accurate, adaptable tool that enhances consistency and efficiency in perioperative decision-making. Future research should explore its scalability across specialties and its impact on clinical outcomes.