• Sam Tideman, Mauricio Santillana, Jonathan Bickel, and Ben Reis.
• Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA.
• J Am Med Inform Assoc. 2019 Dec 1; 26 (12): 1574-1583.

ObjectiveEmergency departments (EDs) are increasingly overcrowded. Forecasting patient visit volume is challenging. Reliable and accurate forecasting strategies may help improve resource allocation and mitigate the effects of overcrowding. Patterns related to weather, day of the week, season, and holidays have been previously used to forecast ED visits. Internet search activity has proven useful for predicting disease trends and offers a new opportunity to improve ED visit forecasting. This study tests whether Google search data and relevant statistical methods can improve the accuracy of ED volume forecasting compared with traditional data sources.Materials And MethodsSeven years of historical daily ED arrivals were collected from Boston Children's Hospital. We used data from the public school calendar, National Oceanic and Atmospheric Administration, and Google Trends. Multiple linear models using LASSO (least absolute shrinkage and selection operator) for variable selection were created. The models were trained on 5 years of data and out-of-sample accuracy was judged using multiple error metrics on the final 2 years.ResultsAll data sources added complementary predictive power. Our baseline day-of-the-week model recorded average percent errors of 10.99%. Autoregressive terms, calendar and weather data reduced errors to 7.71%. Search volume data reduced errors to 7.58% theoretically preventing 4 improperly staffed days.DiscussionThe predictive power provided by the search volume data may stem from the ability to capture population-level interaction with events, such as winter storms and infectious diseases, that traditional data sources alone miss.ConclusionsThis study demonstrates that search volume data can meaningfully improve forecasting of ED visit volume and could help improve quality and reduce cost.© The Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.

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