Prediction-Driven Surge Planning with Application in the Emergency Department

Determining emergency department (ED) nurse staffing decisions to balance the quality of service and staffing cost can be extremely challenging, especially when there is a high level of uncertainty in patient-demand. Increasing data availability and continuing advancements in predictive analytics provide an opportunity to mitigate demand uncertainty by utilizing demand forecasts. In this work, we study a two-stage predictiondriven staffing framework where the prediction models are integrated with the base (made weeks in advance) and surge (made nearly real-time) staffing decisions in the ED. We quantify the benefit of having the ability to use the more expensive surge staffing and identify the importance of balancing demand uncertainty versus demand stochasticity. We also propose a near-optimal two-stage staffing policy that is straightforward to interpret and implement. Lastly, we develop a unified framework that combines parameter estimation, realtime demand forecasts, and capacity sizing in the ED. High-fidelity simulation experiments for the ED demonstrate that the proposed framework can reduce annual staffing costs by 11%–16% ($2 M–$3 M) while guaranteeing timely access to care.