Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy.
Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy
BMJ Open. 2022 Apr 26;12(4):e056017. doi: 10.1136/bmjopen-2021-056017.
The emergency department (ED) is one of the most critical areas in any hospital. Recently, many countries have seen a rise in the number of ED visits, with an increase in length of stay and a detrimental effect on quality of care. Being able to forecast future demands would be a valuable support for hospitals to prevent high demand, particularly in a system with limited resources where use of ED services for non-urgent visits is an important issue.
Time-series cohort study.
We collected all ED visits between January 2014 and December 2019 in the five larger hospitals in Milan. To predict daily volumes, we used a regression model with autoregressive integrated moving average errors. Predictors included were day of the week and year-round seasonality, meteorological and environmental variables, information on influenza epidemics and festivities. Accuracy of prediction was evaluated with the mean absolute percentage error (MAPE).
Daily all-cause EDs visits.
In the study period, we observed 2 223 479 visits. ED visits were most likely to occur on weekends for children and on Mondays for adults and seniors. Results confirmed the role of meteorological and environmental variables and the presence of day of the week and year-round seasonality effects. We found high correlation between observed and predicted values with a MAPE globally smaller than 8.1%.
Results were used to establish an ED warning system based on past observations and indicators of high demand. This is important in any health system that regularly faces scarcity of resources, and it is crucial in a system where use of ED services for non-urgent visits is still high.
急诊部（ED）是任何医院中最重要的区域之一。最近，许多国家的 ED 就诊人数都有所增加，住院时间延长，对护理质量产生了不利影响。能够预测未来的需求将是医院的宝贵支持，以防止高需求，特别是在资源有限的系统中，非紧急就诊使用 ED 服务是一个重要问题。
时间序列队列研究。
我们收集了 2014 年 1 月至 2019 年 12 月米兰五家较大医院的所有 ED 就诊记录。为了预测每日就诊量，我们使用了带有自回归综合移动平均误差的回归模型。预测因素包括星期几和全年季节性、气象和环境变量、流感疫情和节日信息。通过平均绝对百分比误差（MAPE）评估预测的准确性。
每日所有原因的 ED 就诊。
在研究期间，我们观察到 2223479 次就诊。儿童就诊最有可能发生在周末，而成年人和老年人则最有可能在周一就诊。结果证实了气象和环境变量的作用以及星期几和全年季节性效应的存在。我们发现观察值和预测值之间具有高度相关性，MAPE 总体小于 8.1%。
结果用于根据过去的观察结果和高需求指标建立 ED 预警系统。在任何经常面临资源短缺的卫生系统中，这都很重要，在 ED 服务仍用于非紧急就诊的系统中，这是至关重要的。
