This study implemented and evaluated a prediction-driven nurse staffing framework in a large adult emergency department. The framework leveraged a two-stage prediction model that forecasted patient volume and guided staffing decisions. Using a pre-post study design, we compared patient throughput (measured by door-to-evaluation time, active treatment time, boarding time, length of stay, and left-without-being-seen rate) and cost outcomes (measured as hourly nurse staffing costs) before and after implementation. The model achieved an RMSE of 11.261 and MAPE of 13.414% at the base stage, and an RMSE of 9.973 and MAPE of 12.126% at the surge stage. The framework reduced hourly staffing costs by $162.04 without negatively affecting throughput. Reducing one nurse per hour from the recommended level increased wait times by two minutes, with an additional 2.3-min increase when staffing dropped below 20% of recommendations. These findings highlight the potential of prediction-driven staffing to reduce costs while maintaining patient throughput.
