Optimal discharge of patients from intensive care via a data-driven policy learning framework

Abstract

Clinical decision support tools rooted in machine learning and optimization can provide significant value to healthcare providers through better management of intensive care units. In particular, it is important that intensive care unit patient discharge decisions account for the nuanced trade-off between decreasing the length of stay and the risk of readmission or death after discharge of a patient. This work introduces a comprehensive framework (i.e., not geared towards any particular disease or condition) for capturing this trade-off and to recommend optimal discharge timing decisions given the electronic health records of a patient. A data-driven approach is used to derive a parsimonious, discrete state space representation to represent the physiological condition of a given patient. Based on this model and a given cost function, an infinite-horizon discounted Markov decision process is formulated and solved numerically to compute an optimal discharge policy, whose performance is assessed using off-policy evaluation strategies. Extensive numerical experiments are performed to validate the proposed framework using real-life intensive care unit patient data.