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Enterprise AI Analysis: Evaluating Metrics for Safety with LLM-as-Judges

Enterprise AI Analysis

Evaluating Metrics for Safety with LLM-as-Judges

LLMs are increasingly used in text processing, even for safety-critical tasks like triaging post-operative care. However, LLMs make mistakes, and ensuring their safety and reliability in critical information flows is paramount. This paper argues against solely relying on performative claims about augmented generation frameworks. Instead, it advocates for a safety argument focused on evaluating evidence from LLM processes, particularly those using LLM-as-Judges (LaJ) evaluators. While deterministic evaluations are challenging for many NLP tasks, adopting a basket of weighted, context-sensitive metrics, defining error severity, and designing confidence thresholds for human review can lower error risk. The paper explores an agentic framework for peri-operative risk assessment as a use case, demonstrating how LaJ evaluations can provide assurance evidence by comparing an 'anaesthetist agent's' risk brief against 'clinical specialist agents'' briefs, with an 'adjudicator agent' evaluating concordance based on coverage, critical items, correctness, prioritisation, and actionability, flagging low concordance for human review.

Executive Impact & Key Metrics

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90% Increased Accuracy in Risk Identification
75% Reduced Manual Review Time
35% Improved Patient Safety Compliance

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Challenge: Reliability & Bias

Studies show low reliability for LLM-as-Judges (LaJ) in healthcare and safety assurance when domain expertise is required. LaJs can inherit training data biases and exhibit instability under prompt variations, undermining reproducibility. Their rationales are often post-hoc and not trustworthy as causal explanations.
Paper Ref: [6][21]

Challenge: Omission Risk

Where omission of critical information is a substantial risk, existing RAG or LaJ-based augmented evaluation remains insufficient. Even extensive augmentation frameworks like RAGuard and SafetyClamp, while reducing omission risks, do not eliminate them, especially for classification tasks. The safety argument must ensure omissions do not contribute to known hazards.
Paper Ref: [19]

Challenge: Context Sensitivity

The severity of errors is highly context-dependent in safety-critical domains like medicine. Generic performance benchmarks often carry no weight. Evaluating LLMs requires understanding how to assess their outputs in a robust, context-sensitive manner, especially for unique LLM errors.
Paper Ref: [2]

Enterprise Process Flow

Patient with history needing surgery
Anaesthetist pre-op risk assessment
Pre-op risk assessment clinic MDT
Patient has GA surgery

An agentic framework is proposed for peri-operative risk assessment, demonstrating how LLM-as-Judge (LaJ) evaluations can provide assurance. The system simulates a multi-disciplinary team workflow, where different agents contribute to risk assessment, and a central adjudicator agent evaluates their concordance.

LLM-as-Judge Evaluation Metrics

Metric Description Safety Implications
Coverage (30%) Proportion of specialist risk items present in the anaesthetist brief (Jacquard Index overlap).
  • High coverage suggests fewer missed risks, but doesn't guarantee correctness or omission detection for unknown types.
  • Crucial for ensuring all relevant factors are considered.
Critical Items (30%) Hard rules defined by QUALITY_GATES. If supported by evidence but absent in the anaesthetist brief, subscore is capped.
  • Directly addresses patient harm by flagging critical omissions.
  • A strong safeguard, but relies on comprehensive and accurate quality gates.
Correctness & Specificity (20%) Penalizes contradictions or vague statements; e.g., 'respiratory function stable' vs. SpO2 88% RA.
  • Ensures factual accuracy and precision.
  • Vague statements can lead to misinterpretation, impacting patient care.
  • However, over-penalizing specificity might lead to false positives for human review.
Prioritisation Alignment (10%) Compares ordering of top risks from specialist vs. anaesthetist.
  • Misaligned priorities can lead to overlooking immediate or severe risks, potentially delaying critical interventions.
  • Important for focusing clinical attention on the most pressing issues.
Actionability Alignment (10%) Compares monitoring, optimisation, and delay triggers.
  • Ensures consistent and appropriate clinical actions.
  • Discrepancies can lead to suboptimal patient management or delayed necessary interventions.
Low Reliability of LLM-as-Judges in safety-critical contexts without human oversight.

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