Patient no-shows and late cancellations for an appointment are common problems in healthcare, which adversely affect the financial performance and quality of service of healthcare organizations. A high rate of patient no-show and late cancellation in a clinic can significantly limit access to healthcare. In general, hospitals create predictive models to assess risk of no-show, and then assign overbooking appointments utilizing those risks. In this paper, by incorporating machine learning and optimization techniques, we proposed a predictive model to assist with the overbooking decision. The model consists of two phases. First, we utilized a metaheuristic optimization technique to explore the best subset of featuresknown as feature selection problemthat can significantly contribute to the prediction outcomes. Second, using the output of the first stage, we proposed a stacking model to improve the prediction performances further. Our extensive computations and comparisons across different classifiers show that formulating the feature selection problem as a multi-objective problem instead of a single-objective problem using random forest classifier yields better results. The proposed model will improve the overbooking at clinics, by increasing the patient access to care. We introduced important new features to the literature that can describe the no-show and late cancellation behavior.
Background
Overcrowding is a serious problem that impacts the ability to provide optimal level of care in a timely manner. High patient volume is known to increase the boarding time at the emergency department (ED), as well as at post-anesthesia care unit (PACU). Furthermore, the same high volume increases inpatient bed transfer times, which causes delays in elective surgeries, increases the probability of near misses, patient safety incidents, and adverse events.
Objective
The purpose of this study is to develop a Machine Learning (ML) based strategy to predict weekly forecasts of the inpatient bed demand in order to assist the resource planning for the ED and PACU, resulting in a more efficient utilization.
Methods
The data utilized included all adult inpatient encounters at Geisinger Medical Center (GMC) for the last 5 years. The variables considered were class of inpatient encounter, observation, or surgical overnight recovery (SORU) at the time of their discharge. The ML based strategy is built using the K-means clustering method and the Support Vector Machine Regression technique (K-SVR).
Results
The performance obtained by the K-SVR strategy in the retrospective cohort amounts to a mean absolute percentage error (MAPE) that ranges between 0.49 and 4.10% based on the test period. Additionally, results present a reduced variability, which translates into more stable forecasting results.
Conclusions
The results from this study demonstrate the capacity of ML techniques to forecast inpatient bed demand, particularly using K-SVR. It is expected that the implementation of this model in the workflow of bed capacity management will create efficiencies, which will translate in a more reliable, inexpensive and timely care for patients.
In logistic regression models predicting participation, the most important predictors of participation were having at least one physical examination (OR 1.46, 95%-CI 1.34-1.59) in Whites and long-term membership in Hispanics (OR 1.38, 95%-CI 1.11-1.69). None of the restrictions significantly predicted participation in Blacks (p for interaction with race <0.001). Conclusions: The application of restrictions based on longer membership and regular physical examinations may increase recruitment of non-Hispanic White and Hispanic men for biobank participation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.