Summary
Objectives
Discharging patients from the Neonatal Intensive Care Unit (NICU) can be delayed for non-medical reasons including the procurement of home medical equipment, parental education, and the need for children’s services. We previously created a model to identify patients that will be medically ready for discharge in the subsequent 2–10 days. In this study we use Natural Language Processing to improve upon that model and discern why the model performed poorly on certain patients.
Methods
We retrospectively examined the text of the Assessment and Plan section from daily progress notes of 4,693 patients (103,206 patient-days) from the NICU of a large, academic children’s hospital. A matrix was constructed using words from NICU notes (single words and bigrams) to train a supervised machine learning algorithm to determine the most important words differentiating poorly performing patients compared to well performing patients in our original discharge prediction model.
Results
NLP using a bag of words (BOW) analysis revealed several cohorts that performed poorly in our original model. These included patients with surgical diagnoses, pulmonary hypertension, retinopathy of prematurity, and psychosocial issues.
Discussion
The BOW approach aided in cohort discovery and will allow further refinement of our original discharge model prediction. Adequately identifying patients discharged home on g-tube feeds alone could improve the AUC of our original model by 0.02. Additionally, this approach identified social issues as a major cause for delayed discharge.
Conclusion
A BOW analysis provides a method to improve and refine our NICU discharge prediction model and could potentially avoid over 900 (0.9%) hospital days.
Abbreviations
AUC – Area under the Curve, CART -- Classification And Regression Trees, DTD – Days to Dis- charge, GI – Gastrointestinal, LOS – Length of Stay, NICU – Neonatal Intensive Care Unit, NS – Neurosurgery, RF – Random Forest.
Keywords
Neonatal intensive care units - area under curve - patient discharge - ROC curve
