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Progressive prediction of hospitalisation in the emergency department: uncovering hidden patterns to improve patient flow
  1. Yuval Barak-Corren1,2,
  2. Shlomo Hanan Israelit3,4,
  3. Ben Y Reis2,5
  1. 1 Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
  2. 2 Predictive Medicine Group, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, USA
  3. 3 Emergency Department, Rambam Healthcare Campus, Haifa, Israel
  4. 4 Elisha Hospital, Haifa, Israel
  5. 5 Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Yuval Barak-Corren, Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel; yuval.barakcorren{at}


Introduction One of the factors contributing to ED crowding is the lengthy delay in transferring an admitted patient from the ED to an inpatient department (ie, boarding time). An earlier start of the admission process using an automatic hospitalisation prediction model could potentially shorten these delays and reduce crowding.

Methods Clinical, operational and demographic data were retrospectively collected on 80 880 visits to the ED of Rambam Health Care Campus in Haifa, Israel, from January 2011 to January 2012. Using these data, a logistic regression model was developed to predict patient disposition (hospitalisation vs discharge) at three progressive time points throughout the ED visit: within the first 10 min, within an hour and within 2 hours. The algorithm was trained on 50% of the data (n=40 440) and tested on the remaining 50%.

Results During the study time period, 58 197 visits ended in discharge and 22 683 in hospitalisation. Within 1 hour of presentation, our model was able to predict hospitalisation with a specificity of 90%, sensitivity of 94% and an AUCof 0.97. Early clinical decisions such as testing for calcium levels were found to be highly predictive of hospitalisations. In the Rambam ED, the use of such a prediction system would have the potential to save more than 250 patient hours per day.

Conclusions Data collected by EDs in electronic medical records can be used within a progressive modelling framework to predict patient flow and improve clinical operations. This approach relies on commonly available data and can be applied across different healthcare settings.

  • emergency department management
  • hospitalisations
  • efficiency
  • communications
  • research
  • operational

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  • Contributors Study conception and design: YBC, SI, BYR. Acquisition of data: YBC, SI. Analysis and interpretation of data: YBC, SI, BYR. Drafting of manuscript: YBC, BYR. Critical revision: YBC, SI, BYR.

  • Funding This study was partially funded by the US National Library of Medicine, grant R01 LM009879.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.