Estimating emergency department crowding with stochastic population models

Gil Parnass, Osnat Levtzion-Korach, Renana Peres*, Michael Assaf*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Environments such as shopping malls, airports, or hospital emergency-departments often experience crowding, with many people simultaneously requesting service. Crowding highly fluctuates, with sudden overcrowding "spikes". Past research has either focused on average behavior, used context-specific models with a large number of parameters, or machine-learning models that are hard to interpret. Here we show that a stochastic population model, previously applied to a broad range of natural phenomena, can aptly describe hospital emergency-department crowding. We test the model using data from five-year minute-by-minute emergency-department records. The model provides reliable forecasting of the crowding distribution. Overcrowding is highly sensitive to the patient arrival-flux and length-of-stay: a 10% increase in arrivals triples the probability of overcrowding events. Expediting patient exit-rate to shorten the typical length-of-stay by just 20 minutes (8.5%) cuts the probability of severe overcrowding events by 50%. Such forecasting is critical in prevention and mitigation of breakdown events. Our results demonstrate that despite its high volatility, crowding follows a dynamic behavior common to many systems in nature.

Original languageAmerican English
Article numbere0295130
JournalPLoS ONE
Issue number12 December
StatePublished - Dec 2023

Bibliographical note

Publisher Copyright:
© 2023 Parnass et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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