Predicting Discharge Destination of Critically Ill Patients Using Machine Learning

Decision making about discharge destination for critically ill patients is a highly subjective and multidisciplinary process, heavily reliant on the ICU care team, patients and their caregivers' preferences, resource demand, staffing, and bed capacity. Timely identification of discharge disposition can be useful in care planning, and as a surrogate for functional status outcomes following critical illness. Although prior research has proposed methods to predict discharge destination in a critical care setting, they are limited in scope and in the generalizability of their findings. We proposed and implemented different machine learning architectures to determine the efficacy of the Acute Physiology and Chronic Health Evaluation (APACHE) IV score as well as the patient characteristics that comprise it to predict the discharge destination for critically ill patients within 24 hours of ICU admission. We conducted a retrospective study of ICU admissions within the eICU Collaborative Research Database (eICU-CRD) populated with de-identified clinical data from adult patients admitted to an ICU between 2014 and 2015. Machine learning models were developed to predict four discharge categories: death, home, nursing facility, and rehabilitation. These models were trained and tested on 115,248 unique ICU admissions. To mitigate class imbalance, we used synthetic minority over-sampling techniques. Hierarchical and ensemble classifiers were used to further study the impact of imbalanced testing set on the performance of our predictive models. Amongst all of the tested models, XGBoost provided the best discrimination performance with an area under the receiver operating characteristic curve of 90% (recall: 71%, F1: 70%). Our findings indicate that the variables used in the APACHE IV model for estimating patient severity of illness are better predictors of hospital discharge destination than the APACHE IV score alone. Incorporating these models into clinical decision support systems may assist patients, caregivers, and the ICU team to begin disposition planning as early as possible during the hospitalization.