SHAKED LLM decision support fell to 30% adoption in emergency department trial

Trial covered 1,138 patients over 4 weeks with no adverse events; expert review rated 99 of 100 outputs clinically appropriate. Disengagement tracked shift workload (OR 0.72); radiology consults drove use (OR 2.98). Authors conclude clinician engagement, not accuracy, is the key barrier to emergency-department adoption.