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NINA is Responding With Irrelevant Clinical Questions Unrelated to the Patient's Issue

Purpose of Document

When NINA presents a patient with clinical questions that have nothing to do with what they asked, it creates immediate confusion and distrust. The patient may abandon the session, call the surgery instead, or complain to reception. Support staff must understand what causes this, how to identify the source, and how to fix or escalate it correctly.

Background: How NINA Routes Patient Intent

NINA is QuantumLoop AI's website-based AI chatbot. It sits on the surgery's website and handles patient queries, guides patients to the correct consultation tool, and processes common requests without the patient needing to call the surgery.

NINA uses intent detection to understand what a patient is asking and route them to the correct flow. When a patient types a message, NINA assesses whether the intent is:

  • Informational: the patient wants to know something such as opening hours, how to register, or what services are available
  • Action-oriented: the patient wants to do something such as submit a medical request, request a sick note, or book a test

Based on this intent assessment, NINA routes the patient to the correct agent or flow. If intent detection fails or context from a previous interaction bleeds into the current session, NINA may route the patient to the wrong flow and present irrelevant clinical questions.

Common Causes and What to Check

1. Context bleed from a previous consultation tool session (RapidHealth, March 2026 fix)

This was the most significant and widespread cause of irrelevant clinical question complaints. In RapidHealth, if a patient used any consultation tool before navigating to the Questions About Surgery flow, context from the previous session could persist and bleed into the General Enquiries flow. This caused NINA to return incorrect, stale, or irrelevant information and occasionally route the patient into the wrong clinical flow entirely.

Additionally, raw system data was occasionally surfacing in the chatbot interface, which was visible to patients and caused significant confusion.

This was resolved on 25 March 2026. The General Enquiries agent now operates with a fully isolated session for each request. Context from previous consultation tool interactions cannot affect subsequent responses. All chatbot responses now pass through a validation layer before being presented to the patient.

What to do:

  • Confirm whether the complaint predates 25 March 2026
  • If before that date, this was a known issue now resolved
  • If after that date and context bleed is still occurring, escalate to engineering with the surgery ODS code, consultation tool used, and a description of what the patient saw

2. Intent misidentification: informational query routed into action flow

Before the March 2026 fix, registration queries were incorrectly routing patients into the registration flow rather than answering their query directly. For example, a patient asking "how do I register at this surgery?" was being sent into a registration action flow rather than receiving a plain-language answer to their question.

This has been improved through enhanced intent handling that now distinguishes between informational and action-oriented requests. Informational queries are answered directly without triggering flow navigation.

What to do:

  • Confirm whether the complaint involves a patient being taken into a consultation flow when they only wanted information
  • Check whether the complaint predates 25 March 2026
  • If occurring after that date, review the specific query the patient typed and assess whether the intent was genuinely ambiguous
  • If intent was clear and NINA still misrouted, escalate to engineering with the specific patient message and surgery ODS code

3. Patient typed a query in a way that matched clinical flow keywords

NINA uses keyword and intent matching. Some patient messages contain words that match clinical flow triggers even when the patient's actual intent is different. For example, a patient asking "I have a sore throat, when is the surgery open today?" may trigger a clinical pathway for sore throat queries rather than providing surgery hours information.

What to do:

  • Review the specific message the patient typed
  • Assess whether the patient's phrasing contained clinical keywords that could reasonably have triggered the wrong flow
  • If the phrasing was genuinely ambiguous, explain this to the practice and advise patients to phrase their requests clearly
  • If the phrasing was unambiguous and NINA still misrouted, escalate to engineering

4. A patient navigated between multiple consultation tools in one session

If a patient uses one consultation tool (for example Accurx) and then navigates back and tries another tool (for example Anima) in the same session, context from the first session may still be present. This is the context bleed issue specific to multi-tool navigation.

After the March 2026 fix, sessions are fully isolated. However, if a surgery has custom configurations applied to multiple tools, there may be edge cases where session isolation does not fully apply.

What to do:

  • Confirm whether the surgery has multiple consultation tools active on NINA
  • Confirm whether the patient was navigating between tools within the same session
  • If after March 2026 and context bleed is occurring on a multi-tool session, escalate to engineering

5. NINA is showing raw system output or unformatted data to patients

Before the March 2026 fix, raw system data was occasionally appearing in the chatbot interface. This is not clinical questions per se, but it is deeply confusing for patients and has the same practical effect as an irrelevant response.

All chatbot responses now pass through a validation layer that prevents unformatted data from being presented to patients.

What to do:

  • If a practice reports patients seeing raw system data or unformatted output in NINA after 25 March 2026, escalate to engineering immediately with a screenshot or description of what was displayed
  • This should not be occurring after the March 2026 fix

Step-by-Step Triage Process

  1. Ask the practice or patient to describe exactly what happened. What did the patient type? What did NINA respond with?
  2. Confirm the consultation tool the surgery uses (RapidHealth, Accurx, Anima, AskMyGP, System Connect).
  3. Check whether the complaint predates 25 March 2026.
  4. Assess whether the patient's message contained clinical keywords that could have triggered the wrong flow.
  5. Check whether the patient was navigating between multiple consultation tools in the same session.
  6. If the cause is clear and predates 25 March 2026, reassure the practice the issue has been resolved.
  7. If the issue is occurring after 25 March 2026 and cannot be explained by ambiguous patient phrasing, escalate to engineering.

What to Tell the Practice

Example wording when the complaint predates the March 2026 fix:

"This was a known issue where context from one consultation tool session could carry over into subsequent sessions, causing NINA to present irrelevant responses or wrong flows. We resolved this in March 2026 through a session isolation update. Each session is now fully isolated, preventing this from happening. If you are still seeing this after March 2026, please let us know and we will investigate immediately."

Example wording when patient phrasing may have caused the misroute:

"NINA identifies what a patient needs based on what they type. If a patient's message contains clinical keywords alongside a different intent, NINA may occasionally route to the clinical flow first. We can review the specific message to understand what happened. In the meantime, patients can reduce this by typing their request as simply as possible, for example typing 'opening hours' rather than 'I have a sore throat, what are your opening hours?'"

Common Mistakes

  • Treating all irrelevant clinical question complaints as current bugs without first checking whether they predate 25 March 2026
  • Not reviewing the specific message the patient typed before concluding NINA misrouted
  • Not checking whether the surgery has multiple consultation tools active and whether the patient was switching between them
  • Not knowing that the registration query misrouting issue was also part of the March 2026 fix
  • Not escalating raw system output appearing in NINA immediately

Escalation Guidance

Escalate to engineering if:

  • Context bleed or irrelevant clinical flows are occurring after 25 March 2026 and the patient's message was unambiguous
  • Raw system data or unformatted output is visible to patients in NINA after 25 March 2026
  • Multiple patients at the same surgery are consistently being misrouted after 25 March 2026
  • NINA is presenting clinical questions to patients who have not made any clinical request

When escalating, always include:

  • Surgery name and ODS code
  • Consultation tool used
  • Exact message the patient typed
  • Description of what NINA responded with
  • Whether the patient was switching between consultation tools
  • Whether the incident predates or postdates 25 March 2026
  • Screenshot of the NINA interface if available

Last Reviewed: May 2026 Owner: Support and Customer Success