Dataset Information

Forecasting ICU Census by Combining Time Series and Survival Models.

ABSTRACT: Capacity planning of ICUs is essential for effective management of health safety, quality of patient care, and the allocation of ICU resources. Whereas ICU length of stay (LOS) may be estimated using patient information such as severity of illness scoring systems, ICU census is impacted by both patient LOS and arrival patterns. We set out to develop and evaluate an ICU census forecasting algorithm using the Multiple Organ Dysfunction Score (MODS) and the Nine Equivalents of Nursing Manpower Use Score (NEMS) for capacity planning purposes.

Design

Retrospective observational study.

Setting

We developed the algorithm using data from the Medical-Surgical ICU (MSICU) at University Hospital, London, Canada and validated using data from the Critical Care Trauma Centre (CCTC) at Victoria Hospital, London, Canada.

Patients

Adult patient admissions (7,434) to the MSICU and (9,075) to the CCTC from 2015 to 2021.

Interventions

None.

Measurements and main results

We developed an Autoregressive integrated moving average time series model that forecasts patients arriving in the ICU and a survival model using MODS, NEMS, and other factors to estimate patient LOS. The models were combined to create an algorithm that forecasts ICU census for planning horizons ranging from 1 to 7 days. We evaluated the algorithm quality using several fit metrics. The root mean squared error ranged from 2.055 to 2.890 beds/d and the mean absolute percentage error from 9.4% to 13.2%. We show that this forecasting algorithm provides a better fit when compared with a moving average or a time series model that directly forecasts ICU census. Additionally, we evaluated the performance of the algorithm using data during the global COVID-19 pandemic and found that the error of the forecasts increased proportionally with the number of COVID-19 patients in the ICU.

Conclusions

It is possible to develop accurate tools to forecast ICU census. This type of algorithm may be important to clinicians and managers when planning ICU capacity as well as staffing and surgical demand planning over a short time horizon.

SUBMITTER: Murray LL

PROVIDER: S-EPMC10166346 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Publications

Forecasting ICU Census by Combining Time Series and Survival Models.

Murray Lori L LL Wilson John G JG Rodrigues Felipe F FF Zaric Gregory S GS

Critical care explorations 20230505 5

Capacity planning of ICUs is essential for effective management of health safety, quality of patient care, and the allocation of ICU resources. Whereas ICU length of stay (LOS) may be estimated using patient information such as severity of illness scoring systems, ICU census is impacted by both patient LOS and arrival patterns. We set out to develop and evaluate an ICU census forecasting algorithm using the Multiple Organ Dysfunction Score (MODS) and the Nine Equivalents of Nursing Manpower Use ...[more]

PMID: 37168689

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Project description:In this paper, we introduce a novel model selection approach to time series forecasting. For linear stationary processes, such as AR processes, the direction of time is independent of the model parameters. By combining theoretical principles of time-reversibility in time series with conventional modeling approaches such as information criteria, we construct a criterion that employs the backwards prediction (backcast) as a proxy for the forecast. Hereby, we aim to adopt a theoretically grounded, data-driven approach to model selection. The novel criterion is named the backwards validated information criterion (BVIC). The BVIC identifies suitable models by trading off a measure of goodness-of-fit and a models ability to predict backwards. We test the performance of the BVIC by conducting experiments on synthetic and real data. In each experiment, the BVIC is examined in contrast to conventionally employed criteria. Our experimental results suggest that the BVIC has comparable performance as conventional information criteria. Specifically, in most of the experiments performed, we did not find statistically significant differences between the forecast error of the BVIC under certain parameterizations and that of the different information criteria. Nonetheless, it is worth emphasizing that the BVIC guarantees are established by design where the model order penalization term depends on strong mathematical properties of time-reversible time series forecasting properties and a finite data assessment. In particular, the penalization term is replaced by a weighted trade-off between functional dimensions pertaining to forecasting.That said, we observed that the BVIC recovered more accurately the real order of the underlying process than the other criteria, which rely on a static penalization of the model order. Lastly, leveraging the latter property we perform the assessment of the order model (or, memory) of time series pertaining to epileptic seizures recorded using electrocorticographic data. Our results provide converging evidence that the order of the model increases during the epileptic events.

Dataset Information

Forecasting ICU Census by Combining Time Series and Survival Models.

Design

Setting

Patients

Interventions

Measurements and main results

Conclusions

Publications

Forecasting ICU Census by Combining Time Series and Survival Models.

Similar Datasets

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