Machine Intelligence-Driven Forecasting for ED Triage and Dynamic Hospital Patient Routing

Overcrowding of emergency departments (ED) is now a problem of global health care concern due to the increase in patients. Triage systems have been established for a considerable period. However, their reliability in choosing the appropriate patient and the level of service has undergone much scrutiny. In this paper, we describe a comprehensive machine learning framework aimed at predicting critical emergency department outcomes and enabling dynamic routing decisions. Through the MIMIC-IV-ED database, which comprises more than 440,000 emergency visits, we design and assess varied predictive models, which include classical clinical scores, interpretable ML systems, classical algorithms, and deep learning architectures. We investigate three significant outcomes: hospitalization post-ED visit, critical deterioration (ICU transfer/death within 12 hours), 72-hour re-attendance in ED. The results indicate that gradient boosting algorithms can make better predictions with AUROCs of 0.820, 0.881, and 0.699 as compared to standard clinical scoring systems and complex deep learning models. The interpretable AutoScore framework which combines clinical performance with clinical transparency. We also study patterns of feature importance across prediction tasks. Moreover, we talk about how these can be implemented in real-time clinical workflows. This study builds a reproducible benchmarking platform for ED prediction research. In addition, it presents evidence-based recommendations for intelligent patient routing systems that can help enhance emergency care efficiency and resource utilization while improving patient outcomes in a high-pressure environment.