Optimization of patient throughput and wait time in emergency departments (ED) is an important task for hospital systems. For that reason, Emergency Severity Index (ESI) system for patient triage was introduced to help guide manual estimation of acuity levels, which is used by nurses to rank the patients and organize hospital resources. However, despite improvements that it brought to managing medical resources, such triage system greatly depends on nurse's subjective judgment and is thus prone to human errors. Here, we propose a novel deep model based on the word attention mechanism designed for predicting a number of resources an ED patient would need. Our approach incorporates routinely available continuous and nominal (structured) data with medical text (unstructured) data, including patient's chief complaint, past medical history, medication list, and nurse assessment collected for 338,500 ED visits over three years in a large urban hospital. Using both structured and unstructured data, the proposed approach achieves the AUC of @math for the task of identifying resource intensive patients (binary classification), and the accuracy of @math for predicting exact category of number of resources (multi-class classification task), giving an estimated lift over nurses' performance by 16 in accuracy. Furthermore, the attention mechanism of the proposed model provides interpretability by assigning attention scores for nurses' notes which is crucial for decision making and implementation of such approaches in the real systems working on human health.
Many advances in modeling sequence data were made in the field of natural language processing, where models for mathematical characterization of language were proposed. Namely, models for distributed low-dimensional representations of words or tokens were initially proposed in @cite_4 and were successfully applied more recently in @cite_5 . Distributed embedding approaches take advantage of word order, and follow the assumption of @math -gram language models that neighboring words are statistically more dependent.
@cite_5 @cite_4
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A goal of statistical language modeling is to learn the joint probability function of sequences of words in a language. This is intrinsically difficult because of the curse of dimensionality: a word sequence on which the model will be tested is likely to be different from all the word sequences seen during training. Traditional but very successful approaches based on n-grams obtain generalization by concatenating very short overlapping sequences seen in the training set. We propose to fight the curse of dimensionality by learning a distributed representation for words which allows each training sentence to inform the model about an exponential number of semantically neighboring sentences. The model learns simultaneously (1) a distributed representation for each word along with (2) the probability function for word sequences, expressed in terms of these representations. Generalization is obtained because a sequence of words that has never been seen before gets high probability if it is made of words that are similar (in the sense of having a nearby representation) to words forming an already seen sentence. Training such large models (with millions of parameters) within a reasonable time is itself a significant challenge. We report on experiments using neural networks for the probability function, showing on two text corpora that the proposed approach significantly improves on state-of-the-art n-gram models, and that the proposed approach allows to take advantage of longer contexts. We describe a new learning procedure, back-propagation, for networks of neurone-like units. The procedure repeatedly adjusts the weights of the connections in the network so as to minimize a measure of the difference between the actual output vector of the net and the desired output vector. As a result of the weight adjustments, internal ‘hidden’ units which are not part of the input or output come to represent important features of the task domain, and the regularities in the task are captured by the interactions of these units. The ability to create useful new features distinguishes back-propagation from earlier, simpler methods such as the perceptron-convergence procedure1.