⚠ Official Notice: www.ijisrt.com is the official website of the International Journal of Innovative Science and Research Technology (IJISRT) Journal for research paper submission and publication. Please beware of fake or duplicate websites using the IJISRT name.



Predictive Modeling Techniques for Forecasting Emergency Department Overcrowding and Resource Needs in United States Public Hospitals


Authors : Sesi Mensah Gidisu; Millicent Naa Oye Boadu; Joseph Kobi

Volume/Issue : Volume 11 - 2026, Issue 9 - September


Google Scholar : https://tinyurl.com/45jykxbp

DOI : https://doi.org/10.38124/ijisrt/26sep1244

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.


Abstract : In the United States, emergency department congestion stealthily undermines the safety net of public hospitals for uninsured, underinsured, and medically complex populations, and the use of forecasting tools is limited where it is desired most. This research article proposes and tests a set of predictive modeling techniques for predicting the volume of patients in the emergency department (ED) and downstream hospital resource use for the next day or multiple days within public hospitals in the United States, based on 4 years of anonymized encounter data and calendar, weather, epidemiology, and hospital operational data. Different models, including naive, seasonal autoregressive integrated moving average with exogenous regressors (SARIMAX), Prophet, random forest, extreme gradient boosting (XGBoost), long short-term memory (LSTM), and attention-based transformer architectures were trained and evaluated using 1-day, 7-day, and 14-day forecasting horizons, and the results were converted to a discrete-event simulation of staffing and bed management.

Keywords : Emergency Department Overcrowding, Predictive Analytics, Machine Learning, Public Hospitals, Resource Allocation, Time-Series Forecasting.

References :

  1. Afilal, M., Yalaoui, F., Dugardin, F., Amodeo, L., Laplanche, D., & Blua, P. (2016). Forecasting the emergency department patients flow. Journal of Medical Systems, 40(7), 175. https://doi.org/10.1007/s10916-016-0527-1
  2. Alvarez-Chaves, H., Maseda-Zurdo, I., Munoz, P., & R-Moreno, M. D. (2024). Evaluating the impact of exogenous variables for patients forecasting in an emergency department using attention neural networks. Expert Systems with Applications, 240, 122496. https://doi.org/10.1016/j.eswa.2023.122496
  3. Antwarg, L., Miller, R. M., Shapira, B., & Rokach, L. (2021). Explaining anomalies detected by autoencoders using Shapley Additive Explanations. Expert Systems with Applications, 186, 115736. https://doi.org/10.1016/j.eswa.2021.115736
  4. Araz, O. M., Bentley, D., & Muelleman, R. L. (2014). Using Google Flu Trends data in forecasting influenza-like-illness related ED visits in Omaha, Nebraska. American Journal of Emergency Medicine, 32(9), 1016-1023. https://doi.org/10.1016/j.ajem.2014.05.052
  5. Asplin, B. R., Magid, D. J., Rhodes, K. V., Solberg, L. I., Lurie, N., & Camargo, C. A. (2003). A conceptual model of emergency department crowding. Annals of Emergency Medicine, 42(2), 173-180. https://doi.org/10.1067/mem.2003.302
  6. Bernstein, S. L., Aronsky, D., Duseja, R., Epstein, S., Handel, D., Hwang, U., McCarthy, M., John McConnell, K., Pines, J. M., Rathlev, N., Schafermeyer, R., Zwemer, F., Schull, M., & Asplin, B. R. (2009). The effect of emergency department crowding on clinically oriented outcomes. Academic Emergency Medicine, 16(1), 1-10. https://doi.org/10.1111/j.1553-2712.2008.00295.x
  7. Boyle, J., Jessup, M., Crilly, J., Green, D., Lind, J., Wallis, M., & Fitzgerald, G. (2012). Predicting emergency department admissions. Emergency Medicine Journal, 29(5), 358-365. https://doi.org/10.1136/emj.2010.103531
  8. Capp, R., Rooks, S. P., Wiler, J. L., Zane, R. D., & Ginde, A. A. (2016). National study of health insurance type and reasons for emergency department use. Journal of General Internal Medicine, 31(6), 610-616. https://doi.org/10.1007/s11606-016-3646-3
  9. Carvalho-Silva, M., Monteiro, M. T. T., de Sa-Soares, F., & Doria-Nobrega, S. (2018). Assessment of forecasting models for patients arrival at emergency department. Operations Research for Health Care, 18, 112-118. https://doi.org/10.1016/j.orhc.2017.05.001
  10. Challener, D. W., Dowdy, S. C., & O'Horo, J. C. (2020). Analytics and prediction modeling during the COVID-19 pandemic. Mayo Clinic Proceedings, 95(9), S8-S10. https://doi.org/10.1016/j.mayocp.2020.06.043
  11. Champion, R., Kinsman, L. D., Lee, G. A., Masman, K. A., May, E. A., Mills, T. M., Taylor, M. D., Thomas, P. R., & Williams, R. J. (2007). Forecasting emergency department presentations. Australian Health Review, 31(1), 83-90. https://doi.org/10.1071/AH070083
  12. Chen, T., & Guestrin, C. (2016). XGBoost: A scalable tree boosting system. Proceedings of the 22nd ACM SIGKDD International Conference on Knowledge Discovery and Data Mining, 785-794. https://doi.org/10.1145/2939672.2939785
  13. Cunningham, P. J. (2011). Nonurgent use of hospital emergency departments. JAMA, 306(11), 1257-1258. https://doi.org/10.1001/jama.2011.1319
  14. Derlet, R. W., & Richards, J. R. (2000). Overcrowding in the nation's emergency departments: Complex causes and disturbing effects. Annals of Emergency Medicine, 35(1), 63-68. https://doi.org/10.1016/S0196-0644(00)70105-3
  15. Duarte, D., Walshaw, C., & Ramesh, N. (2021). A comparison of time-series predictions for healthcare emergency department indicators and the impact of COVID-19. Applied Sciences, 11(8), 3561. https://doi.org/10.3390/app11083561
  16. Dugas, A. F., Hsieh, Y. H., Levin, S. R., Pines, J. M., Mareiniss, D. P., Mohareb, A., & Rothman, R. E. (2013). Google Flu Trends: Correlation with emergency department influenza rates and crowding metrics. Clinical Infectious Diseases, 54(4), 463-469. https://doi.org/10.1093/cid/cir883
  17. Etu, E. E., Monplaisir, L., Masoud, S., Arslanturk, S., Emakhu, J., Tenebe, I., Miller, J. B., Hagerman, T., Jourdan, D., & Krupp, S. (2022). A comparison of univariate and multivariate forecasting models predicting emergency department patient arrivals during the COVID-19 pandemic. Healthcare, 10(6), 1120. https://doi.org/10.3390/healthcare10061120
  18. Fan, B., Peng, J., Guo, H., Gu, H., Xu, K., & Wu, T. (2022). Accurate forecasting of emergency department arrivals with internet search index and machine learning models: Model development and performance evaluation. JMIR Medical Informatics, 10(7), e34504. https://doi.org/10.2196/34504
  19. Fan, Z., Song, W., Ke, Y., Jia, L., Li, S., Li, J. J., & Wang, B. (2024). XGBoost-SHAP-based interpretable diagnostic framework for knee osteoarthritis: A population-based retrospective cohort study. Arthritis Research & Therapy, 26(1), 213. https://doi.org/10.1186/s13075-024-03439-6
  20. Green, L. V., Soares, J., Giglio, J. F., & Green, R. A. (2006). Using queueing theory to increase the effectiveness of emergency department provider staffing. Academic Emergency Medicine, 13(1), 61-68. https://doi.org/10.1197/j.aem.2005.07.034
  21. Guan, G., & Engelhardt, B. E. (2019). Predicting sick patient volume in a pediatric outpatient setting using time series analysis. Machine Learning for Healthcare Conference, 106, 271-287.
  22. Guarnieri, M., & Balmes, J. R. (2014). Outdoor air pollution and asthma. The Lancet, 383(9928), 1581-1592. https://doi.org/10.1016/S0140-6736(14)60617-6
  23. Guttmann, A., Schull, M. J., Vermeulen, M. J., & Stukel, T. A. (2011). Association between waiting times and short term mortality and hospital admission after departure from emergency department: Population based cohort study from Ontario, Canada. BMJ, 342, d2983. https://doi.org/10.1136/bmj.d2983
  24. Hoot, N. R., & Aronsky, D. (2008). Systematic review of emergency department crowding: Causes, effects, and solutions. Annals of Emergency Medicine, 52(2), 126-136. https://doi.org/10.1016/j.annemergmed.2008.03.014
  25. Hwang, U., McCarthy, M. L., Aronsky, D., Asplin, B., Crane, P. W., Craven, C. K., Epstein, S. K., Fee, C., Handel, D. A., Pines, J. M., Rathlev, N. K., Schafermeyer, R. W., Zwemer, F. L., & Bernstein, S. L. (2011). Measures of crowding in the emergency department: A systematic review. Academic Emergency Medicine, 18(5), 527-538. https://doi.org/10.1111/j.1553-2712.2011.01054.x
  26. Institute of Medicine. (2007). Hospital-based emergency care: At the breaking point. National Academies Press.
  27. Jones, S. S., Thomas, A., Evans, R. S., Welch, S. J., Haug, P. J., & Snow, G. L. (2008). Forecasting daily patient volumes in the emergency department. Academic Emergency Medicine, 15(2), 159-170. https://doi.org/10.1111/j.1553-2712.2007.00032.x
  28. Kadri, F., & Harrou, F. (2021). A data-driven framework for forecasting emergency department visits using machine learning models. Health Systems, 10(1), 1-14. https://doi.org/10.1080/20476965.2020.1741009
  29. Kadri, F., Harrou, F., Chaabane, S., & Tahon, C. (2014). Time series modelling and forecasting of emergency department overcrowding. Journal of Medical Systems, 38(9), 107. https://doi.org/10.1007/s10916-014-0107-0
  30. Kandula, S., Pei, S., & Shaman, J. (2019). Improved forecasts of influenza-associated hospitalization rates with Google search trends. Journal of the Royal Society Interface, 16(155), 20190080. https://doi.org/10.1098/rsif.2019.0080
  31. Kelen, G. D., Wolfe, R., D'Onofrio, G., Mills, A. M., Diercks, D., Stern, S. A., Wadman, M. C., & Sokolove, P. E. (2021). Emergency department crowding: The canary in the health care system. NEJM Catalyst Innovations in Care Delivery, 2(5). https://doi.org/10.1056/CAT.21.0217
  32. Kellermann, A. L. (2020). Crisis in the emergency department. New England Journal of Medicine, 355(13), 1300-1303. https://doi.org/10.1056/NEJMp068194
  33. Li, Y., Mamouei, M., Salimi-Khorshidi, G., Rao, S., Hassaine, A., Canoy, D., Lukasiewicz, T., & Rahimi, K. (2023). Hi-BEHRT: Hierarchical transformer-based model for accurate prediction of clinical events using multimodal longitudinal electronic health records. IEEE Journal of Biomedical and Health Informatics, 27(2), 1106-1117. https://doi.org/10.1109/JBHI.2022.3224727
  34. Lundberg, S. M., & Lee, S. I. (2017). A unified approach to interpreting model predictions. Advances in Neural Information Processing Systems, 30, 4765-4774.
  35. Morley, C., Unwin, M., Peterson, G. M., Stankovich, J., & Kinsman, L. (2018). Emergency department crowding: A systematic review of causes, consequences and solutions. PLOS ONE, 13(8), e0203316. https://doi.org/10.1371/journal.pone.0203316
  36. Nohara, Y., Matsumoto, K., Soejima, H., & Nakashima, N. (2022). Explanation of machine learning models using Shapley Additive Explanation and application for real data in hospital. Computer Methods and Programs in Biomedicine, 214, 106584. https://doi.org/10.1016/j.cmpb.2021.106584
  37. Orellano, P., Quaranta, N., Reynoso, J., Balbi, B., & Vasquez, J. (2017). Effect of outdoor air pollution on asthma exacerbations in children and adults: Systematic review and multilevel meta-analysis. PLOS ONE, 12(3), e0174050. https://doi.org/10.1371/journal.pone.0174050
  38. Park, J. C., Chang, B. P., & Mok, N. (2019). Time series analysis and forecasting daily emergency department visits utilizing Facebook's Prophet method. Annals of Emergency Medicine, 74(4), S57. https://doi.org/10.1016/j.annemergmed.2019.08.135
  39. Pines, J. M., Hilton, J. A., Weber, E. J., Alkemade, A. J., Al Shabanah, H., Anderson, P. D., & Schull, M. J. (2011). International perspectives on emergency department crowding. Academic Emergency Medicine, 18(12), 1358-1370. https://doi.org/10.1111/j.1553-2712.2011.01235.x
  40. Porto, B. M., & Fogliatto, F. S. (2024). Enhanced forecasting of emergency department patient arrivals using feature engineering approach and machine learning. BMC Medical Informatics and Decision Making, 24(1), 377. https://doi.org/10.1186/s12911-024-02785-5
  41. Rathlev, N. K., Visintainer, P., Schmidt, J., Hettler, J., Albert, V., & Li, H. (2013). Patient characteristics and clinical process predictors of patients leaving without being seen from the emergency department. Western Journal of Emergency Medicine, 14(4), 316-323. https://doi.org/10.5811/westjem.2012.10.14051
  42. Reis, J., & Shaman, J. (2016). Retrospective parameter estimation and forecast of respiratory syncytial virus in the United States. PLOS Computational Biology, 12(10), e1005133. https://doi.org/10.1371/journal.pcbi.1005133
  43. Rocha, C. N., & Rodrigues, F. (2021). Forecasting emergency department admissions. Intelligent Data Analysis, 25(6), 1579-1601. https://doi.org/10.3233/IDA-205433
  44. Sprivulis, P. C., Da Silva, J. A., Jacobs, I. G., Frazer, A. R., & Jelinek, G. A. (2006). The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Medical Journal of Australia, 184(5), 208-212. https://doi.org/10.5694/j.1326-5377.2006.tb00203.x
  45. Studnek, J. R., Artho, M. R., Garner, C. L., & Jones, A. E. (2012). The impact of emergency department crowding on EMS response times. Prehospital Emergency Care, 16(3), 316-322. https://doi.org/10.3109/10903127.2011.633481
  46. Sun, B. C., Hsia, R. Y., Weiss, R. E., Zingmond, D., Liang, L. J., Han, W., McCreath, H., & Asch, S. M. (2013). Effect of emergency department crowding on outcomes of admitted patients. Annals of Emergency Medicine, 61(6), 605-611.e6. https://doi.org/10.1016/j.annemergmed.2012.10.026
  47. Sun, Y., Heng, B. H., Tay, S. Y., & Seow, E. (2009). Forecasting daily attendances at an emergency department to aid resource planning. BMC Emergency Medicine, 9, 1. https://doi.org/10.1186/1471-227X-9-1
  48. Tideman, S., Santillana, M., Bickel, J., & Reis, B. (2019). Internet search query data improve forecasts of daily emergency department volume. Journal of the American Medical Informatics Association, 26(12), 1574-1583. https://doi.org/10.1093/jamia/ocz154
  49. Tuominen, J., Lomio, F., Oksala, N., Palomaki, A., Peltonen, J., Huttunen, H., & Roine, A. (2022). Forecasting daily emergency department arrivals using high-dimensional multivariate data: A feature selection approach. BMC Medical Informatics and Decision Making, 22(1), 134. https://doi.org/10.1186/s12911-022-01878-3
  50. Vaswani, A., Shazeer, N., Parmar, N., Uszkoreit, J., Jones, L., Gomez, A. N., Kaiser, L., & Polosukhin, I. (2017). Attention is all you need. Advances in Neural Information Processing Systems, 30, 5998-6008.
  51. Vollmer, M. A., Glampson, B., Mellan, T., Mishra, S., Mercuri, L., Costello, C., & Bhatt, S. (2021). A unified machine learning approach to time series forecasting applied to demand at emergency departments. BMC Emergency Medicine, 21(1), 9. https://doi.org/10.1186/s12873-020-00395-y
  52. Weiss, A. J., Wier, L. M., Stocks, C., & Blanchard, J. (2019). Overview of emergency department visits in the United States, 2011. Statistical Brief #174. Agency for Healthcare Research and Quality.
  53. Whitt, W., & Zhang, X. (2019). A data-driven model of an emergency department. Operations Research for Health Care, 21, 1-16. https://doi.org/10.1016/j.orhc.2019.01.002
  54. Wiler, J. L., Griffey, R. T., & Olsen, T. (2013). Review of modeling approaches for emergency department patient flow and crowding research. Academic Emergency Medicine, 18(12), 1371-1379. https://doi.org/10.1111/j.1553-2712.2011.01135.x
  55. Zhang, Y., Zhang, J., Tao, M., Shu, J., & Zhu, D. (2022). Forecasting patient arrivals at emergency department using calendar and meteorological information. Applied Intelligence, 52(10), 11232-11243. https://doi.org/10.1007/s10489-021-03084-3
  56. Zhao, X., Lai, J. W., Ho, A. F. W., Liu, N., Ong, M. E. H., & Cheong, K. H. (2022). Predicting hospital emergency department visits with deep learning approaches. Biocybernetics and Biomedical Engineering, 42(3), 1051-1065. https://doi.org/10.1016/j.bbe.2022.08.005
  57. Zibulewsky, J. (2001). The Emergency Medical Treatment and Active Labor Act (EMTALA): What it is and what it means for physicians. Baylor University Medical Center Proceedings, 14(4), 339-346. https://doi.org/10.1080/08998280.2001.11927785.

In the United States, emergency department congestion stealthily undermines the safety net of public hospitals for uninsured, underinsured, and medically complex populations, and the use of forecasting tools is limited where it is desired most. This research article proposes and tests a set of predictive modeling techniques for predicting the volume of patients in the emergency department (ED) and downstream hospital resource use for the next day or multiple days within public hospitals in the United States, based on 4 years of anonymized encounter data and calendar, weather, epidemiology, and hospital operational data. Different models, including naive, seasonal autoregressive integrated moving average with exogenous regressors (SARIMAX), Prophet, random forest, extreme gradient boosting (XGBoost), long short-term memory (LSTM), and attention-based transformer architectures were trained and evaluated using 1-day, 7-day, and 14-day forecasting horizons, and the results were converted to a discrete-event simulation of staffing and bed management.

Keywords : Emergency Department Overcrowding, Predictive Analytics, Machine Learning, Public Hospitals, Resource Allocation, Time-Series Forecasting.

Paper Submission Last Date
31 - October - 2026

SUBMIT YOUR PAPER CALL FOR PAPERS
Video Explanation for Published paper

Never miss an update from Papermashup

Get notified about the latest tutorials and downloads.

Subscribe by Email

Get alerts directly into your inbox after each post and stay updated.
Subscribe
OR

Subscribe by RSS

Add our RSS to your feedreader to get regular updates from us.
Subscribe