Emergency Departments (EDs) are critical access points in healthcare systems, yet they face persistent pressure from unpredictable patient demand, seasonal surges, and non-urgent visits. Effective ED planning requires forecasts at multiple decision-making levels: hospitals need local demand estimates for staffing and bed management, regions require forecasts to coordinate healthcare units, and national authorities need system-wide projections for capacity planning. However, most existing approaches forecast ED demand independently at a single level, ignoring the hierarchy linking hospitals, regions, and national systems. This can produce incoherent predictions, where hospital-level forecasts do not aggregate consistently to regional or national demand. We propose HierSTT, a hierarchical Transformer-based framework for coherent multi-level ED forecasting. HierSTT jointly predicts hospital, regional, and national level demand in a single end-to-end model. A Temporal Fusion Transformer captures national dynamics, while spatio-temporal Transformer encoder-decoder modules model regional and hospital demand conditioned on higher-level forecasts. A coherence-aware loss penalizes cross-level inconsistencies during training. We further introduce a nationwide Portuguese ED dataset covering 81 hospitals across 5 regional health administrations, with heterogeneous covariates at each level. Experiments show that HierSTT reduces average WAPE by 32% relative to the best non-hierarchical deep learning baseline and outperforms all classical hierarchical reconciliation methods, while producing near-coherent predictions across levels. Additional resources associated with this work are available at https://github.com/FilipaLino/HierSTT.
Overcrowding in emergency departments (ED) remains a persistent operational challenge worldwide, causing delays in care delivery and downstream congestion. ED boarding time, defined as the duration admitted patients remain in the ED while awaiting inpatient bed placement, is a key indicator of this congestion. Predicting ED boarding time in advance enables proactive operational decision making before congestion escalates. We developed and evaluated a multi-horizon time series forecasting framework to predict ED boarding time at 6, 8, 10, 12, and 24-hour horizons. Real-world data from a university-affiliated urban hospital in the United States were utilized and integrated with external contextual data sources, including weather, holidays, and major local events. Decomposition-based Linear (DLinear) and Normalization-based Linear (NLinear) time series forecasting deep learning models showed superior performance across multiple horizons. Models were also evaluated under extreme congestion scenarios characterized by elevated boarding times. In addition, a Machine Learning Operations (MLOps) web application prototype was developed to support translation of the forecasting framework into practice through integrated data ingestion, forecast visualization, experimentation, and retraining.
Accurate disease trajectory prediction is critical for early intervention, resource allocation, and improving long-term outcomes. While electronic health records (EHRs) provide a rich longitudinal view of patient health in clinical environments, models trained on curated research cohorts may not reflect routine deployment settings, and those trained on single-hospital datasets capture only fragments of each patient's trajectory. This highlights the importance of leveraging large, multi-hospital health systems for training and validation to better reflect real-world clinical complexity. In this work, we develop DT-Transformer, a foundation model trained on 57.1M structured EHR entries over 1.7M patients from Mass General Brigham (MGB), spanning 11 hospitals and a broad network of outpatient clinics. DT-Transformer achieves strong discrimination in both held-out and prospective validation settings. Next-event prediction achieves a median age- and sex-stratified AUC of 0.871 across 896 disease categories, with all categories exceeding AUC 0.5. These results support health system-scale training as a path toward foundation models suited to real-world clinical forecasting.
Yunying Zhu, Andrew R Weckstein, Kueiyu Joshua Lin +1
In many real-world applications, such as retail sales, energy usage, and supply chain planning, forecasting is performed across hierarchical structures. These structures often represent aggregations (e.g., products to categories to regions), where forecasts must not only be accurate but also coherent, meaning that lower-level predictions sum correctly to higher-level forecasts. Traditional statistical methods, such as Bottom-Up and MinT, enforce coherence through post-processing but fail to model complex nonlinear temporal dependencies and covariate interactions. We propose Hierarchical Temporal Fusion (HTF), a novel extension of the Temporal Fusion Transformer (TFT) that integrates structured hierarchical embeddings with a coherence-aware loss function to ensure consistent forecasts across all levels of a hierarchy. Rather than applying reconciliation after forecasting, HTF embeds coherence directly into the training objective. The coherence loss penalizes the difference between aggregated child forecasts and their corresponding parent forecasts during training, enabling the model to learn both temporal dynamics and structural consistency simultaneously. We evaluate HTF on two publicly available benchmark datasets: the M5 Walmart forecasting dataset and a publicly available hierarchical energy consumption dataset. Results demonstrate that HTF substantially reduces forecast incoherence while improving forecasting accuracy compared with classical reconciliation methods and deep learning baselines. In addition, attention visualization and embedding analysis provide insight into how temporal and structural information contribute to hierarchical forecasting performance.