From Clinical Risk Prediction to Operational Decisions: An Uncertainty-Aware Framework for ICU Staffing
Abstract: Advances in electronic health records (EHR) and large-scale critical care databases have enabled the development of machine learning models for the early detection of patient deterioration. While these models often achieve strong predictive performance for outcomes such as sepsis and mortality, most studies evaluate them purely on discrimination metrics. This leaves a critical gap: how to systematically translate probabilistic clinical risk estimates into downstream operational decisions under real-world constraints, such as shift rigidity and hiring delays. This study proposes an uncertainty-aware anticipatory staffing framework that bridges short-term patient risk prediction and staff planning without altering the upstream predictive model. Instead of relying on naive deterministic aggregation or fixed safety buffers, the framework explicitly models dynamic predictive uncertainty and evaluates extreme shortage exposure using Conditional Value-at-Risk (CVaR). These aggregated, risk-calibrated demand signals are then embedded into an hourly rolling-horizon scheduling policy to generate delay-constrained staffing decisions. Evaluated on realistic trajectories from the MIMIC-IV database, the proposed framework demonstrates a favorable cost-shortage trade-off compared to deterministic and purely reactive baselines. Pareto frontier analysis illustrates how uncertainty-aware demand construction changes resource allocation under varying safety preferences, while stress testing confirms the framework's operational robustness even when subjected to systematic predictive bias in the form of calibration drift. By formalizing this translation layer, this work provides a principled, transparent pathway for safely integrating probabilistic AI outputs into high-stakes healthcare operational systems.