A Hybrid Modelling Approach Using Forecasting and Real-Time Simulation to Prevent Emergency Department Overcrowding

摘要

Emergency Department (ED) overcrowding is a pervasive problem worldwide, which impacts on both performance and safety. Staff are required to react and adapt to changes in demand in real-time, while continuing to treat patients. These decisions and actions may be supported by enhanced system knowledge. This is an application of a hybrid modelling approach for short-term decision support in urgent and emergency healthcare. It uses seasonal ARIMA time-series forecasting to predict ED overcrowding in a near-future moving-window (1-4 hours) using data downloaded from a digital platform (NHSquicker). NHSquicker delivers real-time wait-times from multiple centers of urgent care in the South-West of England. Alongside historical distributions, this data loads the operational state of a real-time discrete-event simulation model at initialization. The ARIMA forecasts trigger simulation experimentation of ED scenarios including proactive diversion of low-acuity patients to alternative facilities in the urgent-care network, supporting short-term decision-making toward reducing overcrowding in near real-time.