Predicting onward care needs at admission to reduce discharge delay using explainable machine learning

Early identification of patients who require onward referral to social care can prevent delays to discharge from hospital. We introduce an explainable machine learning (ML) model to identify potential social care needs at the first point of admission. This model was trained using routinely collected data on patient admissions, hospital spells and discharge at a large tertiary hospital in the UK between 2017 and 2023. The model performance (one-vs-rest AUROC = 0.915 [0.907 0.924] (95% confidence interval), is comparable to clinician's predictions of discharge care needs, despite working with only a subset of the information available to the clinician. We find that ML and clinicians perform better for identifying different types of care needs, highlighting the added value of a potential system supporting decision making. We also demonstrate the ability for ML to provide automated initial discharge need assessments, in the instance where initial clinical assessment is delayed and provide reasoning for the decision. Finally, we demonstrate that combining clinician and machine predictions, in a hybrid model, provides even more accurate early predictions of onward social care requirements (OVR AUROC = 0.936 [0.928 0.943]) and demonstrates the potential for human-in-the-loop decision support systems in clinical practice.