Emergency crowding gets a six-hour warning: proactive capacity protocols cut time over threshold by up to about a fifth in simulation
Full Capacity Protocols in emergency departments usually start only after crowding thresholds are crossed, yet hallway beds, temporary nurses and transfer restrictions take time to arrange. A discrete-event simulation evaluation embedded a machine learning model forecasting waiting-room counts six hours ahead into the emergency flow and used those forecasts to trigger the protocol early. Over a simulated year, early activation significantly shortened time above the crowding threshold and average protocol duration at all three threshold settings, while changes in average emergency length of stay and wait time were not statistically significant.