  In this work, we show how real-time length-of-stay (LOS) predictions can be
used to divert outpatients from their assigned facility to other facilities
with lesser congestion. We illustrate the implementation of this diversion
mechanism for two primary health centers (PHCs), wherein we divert patients
from their assigned PHC to the other PHC based on their predicted LOSs in both
facilities. We develop a discrete-event simulation model of patient flow
operations at these two PHCs in an Indian district and observe significantly
longer LOSs at one of the PHCs due to disparities in the patient loads across
both PHCs. We first determine the expected LOS of the patient at the point in
time at which they are expected to arrive at a PHC using system state
information recorded at the current time at the PHC in question. The real-time
LOS predictions are generated by estimating patient wait times on a real-time
basis at the queueing subsystems within the PHC. We then divert the patient to
the appropriate PHC on the basis of the predicted LOS estimates at both PHCs,
and show through simulation that the proposed framework leads to more equitable
utilization of resources involved in provision of outpatient care.
