Sustainable Use of Resources in Hospitals: A Machine Learning-Based Approach to Predict Prolonged Length of Stay at the Time of Admission

Introduction. Length of Stay (LOS) and Prolonged Length of Stay (pLOS) are critical indicators of hospital efficiency. Reducing pLOS is crucial for patient safety, autonomy, and bed allocation. This study investigates different machine learning (ML) models to predict LOS and pLOS. Methods. We analyzed a dataset of patients discharged from a northern Italian hospital between 2022 and 2023 as a retrospective cohort study. We compared sixteen regression algorithms and twelve classification methods for predicting LOS as either a continuous or multi-class variable (1-3 days, 4-10 days, >10 days). We also evaluated pLOS prediction using the same models, having pLOS defined as any hospitalization with LOS longer than 8 days. We further analyzed all models using two versions of the same dataset: one containing only structured data (e.g. demographics and clinical information), whereas the second one also containing features extracted from free-text diagnosis. Results. Our results indicate that ensemble models achieved the highest prediction accuracy for both LOS and pLOS, outperforming traditional single-algorithm models, particularly when using both structured and unstructured data extracted from diagnoses. Discussion. The integration of ML, particularly ensemble models, can significantly improve LOS prediction and identify patients at increased risk of pLOS. This information can guide healthcare professionals and bed managers in making informed decisions to enhance patient care and optimize resource allocation.