Exploring Hospital Overcrowding with an Explainable Time-to-Event Machine Learning Approach

Emergency department (ED) overcrowding is a complex problem that is intricately linked with the operations of other hospital departments. Leveraging ED real-world production data provides a unique opportunity to comprehend this multifaceted problem holistically. This paper introduces a novel approach to analyse healthcare production data, treating the length of stay of patients, and the follow up decision regarding discharge or admission to the hospital as a time-to-event analysis problem. Our methodology employs traditional survival estimators and machine learning models, and Shapley additive explanations values to interpret the model outcomes. The most relevant features influencing length of stay were whether the patient received a scan at the ED, emergency room urgent visit, age, triage level, and the medical alarm unit category. The clinical insights derived from the explanation of the models holds promise for increase understanding of the overcrowding from the data. Our work demonstrates that a time-to-event approach to the over- crowding serves as a valuable initial to uncover crucial insights for further investigation and policy design.