• Farah Z Dadabhoy, Lachlan Driver, Dustin S McEvoy, Ronelle Stevens, David Rubins, and Sayon Dutta.
• Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
• Ann Emerg Med. 2023 Jun 1; 81 (6): 738748738-748.

Study ObjectiveEarly notification of admissions from the emergency department (ED) may allow hospitals to plan for inpatient bed demand. This study aimed to assess Epic's ED Likelihood to Occupy an Inpatient Bed predictive model and its application in improving hospital bed planning workflows.MethodsAll ED adult (18 years and older) visits from September 2021 to August 2022 at a large regional health care system were included. The primary outcome was inpatient admission. The predictive model is a random forest algorithm that uses demographic and clinical features. The model was implemented prospectively, with scores generated every 15 minutes. The area under the receiver operator curves (AUROC) and precision-recall curves (AUPRC) were calculated using the maximum score prior to the outcome and for each prediction independently. Test characteristics and lead time were calculated over a range of model score thresholds.ResultsOver 11 months, 329,194 encounters were evaluated, with an incidence of inpatient admission of 25.4%. The encounter-level AUROC was 0.849 (95% confidence interval [CI], 0.848 to 0.851), and the AUPRC was 0.643 (95% CI, 0.640 to 0.647). With a prediction horizon of 6 hours, the AUROC was 0.758 (95% CI, 0.758 to 0.759,) and the AUPRC was 0.470 (95% CI, 0.469 to 0.471). At a predictive model threshold of 40, the sensitivity was 0.49, the positive predictive value was 0.65, and the median lead-time warning was 127 minutes before the inpatient bed request.ConclusionThe Epic ED Likelihood to Occupy an Inpatient Bed model may improve hospital bed planning workflows. Further study is needed to determine its operational effect.Copyright © 2022 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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