Machine Learning-Based Prediction of Emergency Department Prolonged Length of Stay: A Case Study from Italy

Overcrowding in Emergency Departments (EDs) is a pressing concern driven by high patient demand and limited resources. Prolonged Length of Stay (pLOS), a major contributor to this congestion, may lead to adverse outcomes, including patients leaving without being seen, suboptimal clinical care, increased mortality rates, provider burnout, and escalating healthcare costs. This study investigates the application of various Machine Learning (ML) algorithms to predict both LOS and pLOS. A retrospective analysis examined 32,967 accesses at a northern Italian hospital’s ED between 2022 and 2024. Twelve classification algorithms were evaluated in forecasting pLOS, using clinically relevant thresholds. Two data variants were employed for model comparison: one containing only structured data (e.g., demographics and clinical information), while a second one also including features extracted from free-text nursing notes. To enhance the accuracy of LOS prediction, novel queue-based variables capturing the real-time state of the ED were incorporated as additional dynamic predictors. Compared to single-algorithm models, ensemble models demonstrated superior robustness in forecasting both ED-LOS and ED-pLOS. These findings highlight the potential for integrating ML into EDs practices as auxiliary tools to provide valuable insights into patient flow. By identifying patients at high risk of pLOS, healthcare professionals can proactively implement strategies to expedite care, optimize resource allocation, and ultimately improve patient outcomes and ED efficiency, promoting a more effective and sustainable public healthcare delivery.