IoT-ClinXAI: Explainable Recovery Prediction in Smart Wards with Consensus Feature Selection and Snake Optimization

Patient recovery prediction and hospital length of stay estimation remain critical challenges in healthcare resource allocation and clinical decision-making. Inaccurate discharge planning drives substantial avoidable hospital costs, while existing machine learning models remain limited by narrow, single-domain data that fail to capture the multimodal complexity of modern smart ward environments. This study proposes IoT-ClinXAI, an explainable multimodal framework that fuses IoT environmental data, wearable physiological signals, and clinical records for accurate and transparent patient recovery prediction in smart hospital wards. A Multi-domain Hierarchical Consensus Feature-Selection method groups features into structured domains, applies Borda–Kemeny weighted consensus within each domain, and reduces cross-domain redundancy while preserving complementary information. A Snake Optimization–tuned Random Forest Regressor optimizes predictive performance through adaptive hyperparameter search, while a multi-scale SHAP framework provides global and patient-level explanations for transparent clinical inference. Experiments were conducted on a real-world IoT-enabled smart ward dataset comprising patient data and recovery duration. The proposed framework achieved strong predictive performance on the held-out test set, with R2 of 0.964, RMSE of 0.476 days, MAE of 0.342 days, and MAPE of 3.13%, yielding a 23.3% RMSE reduction over the unselected baseline and outperforming all feature-selection methods by 10.9–17.6% in RMSE. Statistical superiority was consistently confirmed across all pairwise comparisons using Wilcoxon signed-rank tests with Bonferroni correction (p<0.001). SHAP analysis identified ward allocation, respiratory rate, and oxygen saturation as the dominant recovery predictors, while environmental IoT variables showed minimal predictive contribution. These results highlight IoT-ClinXAI as a reliable and useful framework for supporting bed management, discharge planning, and hospital resource optimization in resource-constrained healthcare settings.