Bunyamin Ozaydin

Orhun Vural, Abdulaziz Ahmed, Ferhat Zengul et al.

Overcrowding in emergency departments (ED) remains a persistent operational challenge worldwide, causing delays in care delivery and downstream congestion. ED boarding time, defined as the duration admitted patients remain in the ED while awaiting inpatient bed placement, is a key indicator of this congestion. Predicting ED boarding time in advance enables proactive operational decision making before congestion escalates. We developed and evaluated a multi-horizon time series forecasting framework to predict ED boarding time at 6, 8, 10, 12, and 24-hour horizons. Real-world data from a university-affiliated urban hospital in the United States were utilized and integrated with external contextual data sources, including weather, holidays, and major local events. Decomposition-based Linear (DLinear) and Normalization-based Linear (NLinear) time series forecasting deep learning models showed superior performance across multiple horizons. Models were also evaluated under extreme congestion scenarios characterized by elevated boarding times. In addition, a Machine Learning Operations (MLOps) web application prototype was developed to support translation of the forecasting framework into practice through integrated data ingestion, forecast visualization, experimentation, and retraining.

Orhun Vural, Bunyamin Ozaydin, Khalid Y. Aram et al.

Background: Emergency department (ED) overcrowding remains a major challenge, causing delays in care and increased operational strain. Hospital management often reacts to congestion after it occurs. Machine learning predictive modeling offers a proactive approach by forecasting patient flow metrics, such as waiting count, to improve resource planning and hospital efficiency. Objective: This study develops machine learning models to predict ED waiting room occupancy at two time scales. The hourly model forecasts the waiting count six hours ahead (e.g., a 1 PM prediction for 7 PM), while the daily model estimates the average waiting count for the next 24 hours (e.g., a 5 PM prediction for the following day's average). These tools support staffing decisions and enable earlier interventions to reduce overcrowding. Methods: Data from a partner hospital's ED in the southeastern United States were used, integrating internal metrics and external features. Eleven machine learning algorithms, including traditional and deep learning models, were trained and evaluated. Feature combinations were optimized, and performance was assessed across varying patient volumes and hours. Results: TSiTPlus achieved the best hourly prediction (MAE: 4.19, MSE: 29.32). The mean hourly waiting count was 18.11, with a standard deviation of 9.77. Accuracy varied by hour, with MAEs ranging from 2.45 (11 PM) to 5.45 (8 PM). Extreme case analysis at one, two, and three standard deviations above the mean showed MAEs of 6.16, 10.16, and 15.59, respectively. For daily predictions, XCMPlus performed best (MAE: 2.00, MSE: 6.64), with a daily mean of 18.11 and standard deviation of 4.51. Conclusions: These models accurately forecast ED waiting room occupancy and support proactive resource allocation. Their implementation has the potential to improve patient flow and reduce overcrowding in emergency care settings.

Orhun Vural, Bunyamin Ozaydin, James Booth et al.

This study presents a deep learning-based framework for predicting emergency department (ED) boarding counts six hours in advance using only operational and contextual data, without patient-level information. Data from ED tracking systems, inpatient census, weather, holidays, and local events were aggregated hourly and processed with comprehensive feature engineering. The mean ED boarding count was 28.7 (standard deviation = 11.2). Multiple deep learning models, including ResNetPlus, TSTPlus, and TSiTPlus, were trained and optimized using Optuna, with TSTPlus achieving the best results (mean absolute error = 4.30, mean squared error = 29.47, R2 = 0.79). The framework accurately forecasted boarding counts, including during extreme periods, and demonstrated that broader input features improve predictive accuracy. This approach supports proactive hospital management and offers a practical method for mitigating ED overcrowding.