Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 26;12(4):e056017.
doi: 10.1136/bmjopen-2021-056017.

Time-series cohort study to forecast emergency department visits in the city of Milan and predict high demand: a 2-day warning system

Rossella Murtas  1 , Sara Tunesi  1 , Anita Andreano  1 , Antonio Giampiero Russo  2
Affiliations

Time-series cohort study to forecast emergency department visits in the city of Milan and predict high demand: a 2-day warning system

Rossella Murtas et al. BMJ Open. .

Abstract

Objectives: 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.

Design: Time-series cohort study.

Setting: 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).

Primary outcome measures: Daily all-cause EDs visits.

Results: 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%.

Conclusions: 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.

Keywords: ACCIDENT & EMERGENCY MEDICINE; EPIDEMIOLOGY; QUALITATIVE RESEARCH; STATISTICS & RESEARCH METHODS.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Location of the five participating hospitals and of meteorological and air pollution monitoring stations in the city of Milan.
Figure 2
Figure 2
Hypothetical daily report received from a hospital on 5 January 2020. ED, emergency department.
See this image and copyright information in PMC

References

    1. Pines JM, Hilton JA, Weber EJ, et al. . International perspectives on emergency department crowding. Acad Emerg Med 2011;18:1358–70. 10.1111/j.1553-2712.2011.01235.x - DOI - PubMed
    1. Wargon M, Guidet B, Hoang TD, et al. . A systematic review of models for forecasting the number of emergency department visits. Emerg Med J 2009;26:395–9. 10.1136/emj.2008.062380 - DOI - PubMed
    1. Programma Nazionale Esiti - PNE . Home, 2018. Available: https://pne.agenas.it/index.php [Accessed Feb 18, 2020].
    1. Hwang U, McCarthy ML, Aronsky D, et al. . Measures of crowding in the emergency department: a systematic review. Acad Emerg Med 2011;18:527–38. 10.1111/j.1553-2712.2011.01054.x - DOI - PubMed
    1. Asplin BR. Measuring crowding: time for a paradigm shift. Acad Emerg Med 2006;13:459–61. 10.1197/j.aem.2006.01.004 - DOI - PubMed