Forecasting mortality associated emergency department crowding

Emergency department (ED) crowding is a global public health issue that has been repeatedly associated with increased mortality. Predicting future service demand would enable preventative measures aiming to eliminate crowding along with it's detrimental effects. Recent findings in our ED indicate that occupancy ratios exceeding 90% are associated with increased 10-day mortality. In this paper, we aim to predict these crisis periods using retrospective data from a large Nordic ED with a LightGBM model. We provide predictions for the whole ED and individually for it's different operational sections. We demonstrate that afternoon crowding can be predicted at 11 a.m. with an AUC of 0.82 (95% CI 0.78-0.86) and at 8 a.m. with an AUC up to 0.79 (95% CI 0.75-0.83). Consequently we show that forecasting mortality-associated crowding using anonymous administrative data is feasible.

Forecasting Emergency Department Crowding with Advanced Machine Learning Models and Multivariable Input

Emergency department (ED) crowding is a significant threat to patient safety and it has been repeatedly associated with increased mortality. Forecasting future service demand has the potential patient outcomes. Despite active research on the subject, several gaps remain: 1) proposed forecasting models have become outdated due to quick influx of advanced machine learning models (ML), 2) amount of multivariable input data has been limited and 3) discrete performance metrics have been rarely reported. In this study, we document the performance of a set of advanced ML models in forecasting ED occupancy 24 hours ahead. We use electronic health record data from a large, combined ED with an extensive set of explanatory variables, including the availability of beds in catchment area hospitals, traffic data from local observation stations, weather variables, etc. We show that N-BEATS and LightGBM outpeform benchmarks with 11 % and 9 % respective improvements and that DeepAR predicts next day crowding with an AUC of 0.76 (95 % CI 0.69-0.84). To the best of our knowledge, this is the first study to document the superiority of LightGBM and N-BEATS over statistical benchmarks in the context of ED forecasting.