Abstract

Emergency departments (ED) in hospitals usually suffer from crowdedness and long waiting times for treatment. The complexity of the patient’s path flows and their controls come from the patient’s diverse acute level, personalized treatment process, and interconnected medical staff and resources. One of the factors, which has been controlled, is the dynamic situation change such as the patient’s composition and resources’ availability. The patient’s scheduling is thus complicated in consideration of various factors to achieve ED efficiency. To address this issue, a deep reinforcement learning (RL) is designed and applied in an ED patients’ scheduling process. Before applying the deep RL, the mathematical model and the Markov decision process (MDP) for the ED is presented and formulated. Then, the algorithm of the RL based on deep -networks (DQN) is designed to determine the optimal policy for scheduling patients. To evaluate the performance of the deep RL, it is compared with the dispatching rules presented in the study. The deep RL is shown to outperform the dispatching rules in terms of minimizing the weighted waiting time of the patients and the penalty of emergent patients in the suggested scenarios. This study demonstrates the successful implementation of the deep RL for ED applications, particularly in assisting decision-makers under the dynamic environment of an ED.

Highlights

  • An emergency department (ED) is a complicated system due to many factors, such as the limitation of medical resources and the patient’s clinical condition, which are interrelated

  • The result presented in this study indicates that the reinforcement learning (RL) method assists decision-makers in making proper decisions in crowed situations

  • Crowding in ED is regarded as a critical problem because it leads to the long waiting time of patients and affects the level of the satisfaction of services

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Summary

Introduction

Sufficient medical resources cannot be prepared in advance Because of such complexity and unforeseeable situations, errors by decision-makers are highly possible, which may adversely affect the patient’s treatment sequence. One wrong decision could increase the waiting time of patients, leading to crowdedness in the ED. If the waiting time of patients in the ED is increased, their medical conditions may deteriorate, which may lead to significant adverse effects. The increased waiting time may not worsen their clinical conditions, the delay in treatment can cause dissatisfaction in patients with low acuity levels, which can negatively affect the reputation of the hospital. Deep reinforcement learning (RL) is employed to schedule patients who visit an ED with limited medical resources under a dynamic environment.

Improving Emergency Department Efficiency
Patient Scheduling
Emergency Department Model
Mathematical Modeling
Markov Decision Process Framework
State Formulation
Reward Formulation
Deep Q-Network
Deep RL Algorithm for ED
21: Perform a gradient decent regarding weights θ
Architecture
Patient
Patient Treatment Pattern
Evaluation
Result
Discussion
Conclusions

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