Novel Dynamic Prediction of Daily Patient Discharge in Acute and Critical Care

Determining when a patient can be discharged from a care setting is critical to optimize the utilization and delivery of timely care. Furthermore, timely discharge can lead to better clinical outcomes by effectively mitigating the prolonged length of stay in a care environment. This paper presents a novel algorithm for the prediction of likelihood of patient discharge within the next 24 or 48 hours from acute or critical care environments on a daily basis. Continuous patient monitoring and health data obtained from acute hospital at home environment (n=303 patients) and a critical care unit environment (n=9,520 patients) are retrospectively used to train, validate and test numerous machine learning models for dynamic daily predictions of patients discharge. In the acute hospital at home environment, the area under the receiver operating characteristic (AUROC) curve performance of a top XGBoost model was 0.816 ± 0.025 and 0.758 ± 0.029 for daily discharge prediction within 24 hours and 48 hours respectively. Similar independent prediction models from the critical care environment resulted in relatively a lower AUROC for likewise predicting daily patient discharge. Overall, the results demonstrate the efficacy and utility of our novel algorithm for dynamic predictions of daily patient discharge in both acute– and critical care healthcare settings.