Leveraging machine learning and rule extraction for enhanced transparency in emergency department length of stay prediction

This study aims to address the critical issue of emergency department (ED) overcrowding, which negatively affects patient outcomes, wait times, and resource efficiency. Accurate prediction of ED length of stay (LOS) can streamline operations and improve care delivery. We utilized the MIMIC IV-ED dataset, comprising over 400,000 patient records, to classify ED LOS into short (<= 4.5 hours) and long (>4.5 hours) categories. Using machine learning models, including Gradient Boosting (GB), Random Forest (RF), Logistic Regression (LR), and Multilayer Perceptron (MLP), we identified GB as the best performing model outperforming the other models with an AUC of 0.730, accuracy of 69.93%, sensitivity of 88.20%, and specificity of 40.95% on the original dataset. In the balanced dataset, GB had an AUC of 0.729, accuracy of 68.86%, sensitivity of 75.39%, and specificity of 58.59%. To enhance interpretability, a novel rule extraction method for GB model was implemented using relevant important predictors, such as triage acuity, comorbidity scores, and arrival methods. By combining predictive analytics with interpretable rule-based methods, this research provides actionable insights for optimizing patient flow and resource allocation. The findings highlight the importance of transparency in machine learning applications for healthcare, paving the way for future improvements in model performance and clinical adoption.