Stanford Med · Unit 5B Medicine·Day shift·Mon · 9:42 AM

Discharge Command Center

15 patients · Unit 5B / S4 / B6 · 09:42 AM
Switch role
MC
Expected discharges today
12
next 36h
Across all units
At-risk discharges
3
HIGH risk
Operational readiness < 55%
Projected avoidable days
10
this week
vs. CMS expected GMLOS
Pending authorizations
1
awaiting payer
SNF + medications + HH
Medication access issues
1
blocking
PA needed + pharmacy stock
SNF/HH placement blockers
2
active
Auth + bed + capacity

OpenBed AI · Live insights

Computed on unit census every 30s — narratives reviewed by CM before propagation.

Updated 09:42 · 4 insights
Predictive
8 patients likely clinically ready within 48 hours, but only 5 are operationally ready.

The gap is concentrated in SNF preferences, prior authorizations, and DME delivery windows. Recommend triggering caregiver intake + PA queue for the bottom-quartile readiness patients.

Open task board
System signal
Top system bottleneck: post-acute authorization and medication access.

2 active prior-auth blocks · 1 medication access blocks. Avg payer TAT 22h. Submitting today protects Wednesday discharges.

Open coverage matcher
Weekend forecaster
Fri→Mon risk: 1 patients exposed to weekend coverage gap.

Dispatching pre-staged tasks (caregiver coach, meds-to-beds, Sat speech eval) Friday morning typically saves 1.4 avoidable days per patient.

Pre-stage weekend prep
Action-ready
1 conditional-DC criteria met — awaiting MD order.

James Thompson (CHF, Echo signed 11:31). One-click discharge order ready.

Open patient cockpit

Patient census

Sorted by delay risk · click any row to open the discharge cockpit

Auto-refresh every 30s
PatientUnitServicePayerPredicted dispositionEDDClinicalOperationalDelay riskTop blockerOwnerNext best action
Michael Johnson
72 M · MRN-58231
5BCardiologyBlueShield MA Advantage HMOSNFalt: Home + HHTue 2:00 PM
81%
46%
HIGHSNF prefs + med PA
Maria Chen, RN
case manager
Send SNF preference form to caregiver
Linda Kowalski
68 F · MRN-58104
5BOrthoMedicare FFSSNFTue 11:00 AM
92%
38%
HIGHSNF auth denied — peer-to-peer pending
Maria Chen, RN
case manager
Schedule MD peer-to-peer with BlueShield
James Thompson
64 M · MRN-58332
5BCardiologyMedicare FFSHomeMon 5:00 PM
96%
88%
LOWEcho read signed 11:31 — DC order pending
Dr. Jordan Park
hospitalist
MD: place final DC order (conditional met)
Rosa Mendez
71 F · MRN-57990
S4StrokeMedicare FFSARUTue 3:00 PM
78%
60%
MEDSpeech eval + caregiver coaching pending
Maria Chen, RN
case manager
Fri→Mon prep: dispatch weekend tasks
Alma Singh
84 F · MRN-57810
5BMedicineMedicaid pendingSNFSat 12:00 PM
70%
22%
HIGHGuardianship + Medicaid pending
Tara Liu, MSW
social worker
Escalate to legal partner — pro bono guardianship
Carlos Rivera
58 M · MRN-58410
5BMedicineAetna PPOHome + HHTue 1:00 PM
74%
52%
MEDHome O₂ vendor ETA Wed
Maria Chen, RN
case manager
Confirm Lincare delivery window + backup
Patricia O'Brien
79 F · MRN-58025
5BCardiologyHumana MAHome + HHTue 4:00 PM
84%
64%
MEDEliquis PA + HH agency capacity
Maria Chen, RN
case manager
Submit Eliquis PA via CoverMyMeds
Raymond Park
67 M · MRN-58455
5BMedicineMedicare FFSHomeWed 12:00 PM
58%
70%
LOWAwaiting IV → PO conversion
Dr. Jordan Park
hospitalist
Pharmacy: convert ceftriaxone → cefpodoxime
Evelyn Baker
76 F · MRN-57890
B6BMTBlueCross MAHome + HHWed 11:00 AM
68%
54%
MEDInfusion pharmacy + caregiver education
Tara Liu, MSW
social worker
Coordinate Coram home infusion intake
George Wilson
82 M · MRN-58510
5BMedicineMedicare FFSSNFTue 10:00 AM
88%
71%
MEDSNF bed for Mon AM
Maria Chen, RN
case manager
Confirm Bayview SNF intake slot
Anita Gomez
54 F · MRN-58220
5BMedicineAnthem PPOHomeMon 6:00 PM
91%
76%
LOWInsulin pen teach-back + glucometer
Sara Khan, RN
nurse
Pharmacy meds-to-beds + 20-min teach
Frank DelaCruz
69 M · MRN-58118
5BCardiologyMedicare FFSHomeTue 12:00 PM
80%
80%
LOWCardiac rehab referral
Dr. Jordan Park
hospitalist
Submit Phase II rehab referral
Diane Hsu
75 F · MRN-58388
S4StrokeBlueShield MAHomeTue 9:00 AM
86%
82%
LOWAnticoag PA + neuro f/u
Maria Chen, RN
case manager
Submit Eliquis PA + book neuro 7 days
Henry Ford
60 M · MRN-58002
5BMedicineKaiser MAHomeTue 3:00 PM
72%
66%
MEDOutpatient nephrology slot
Maria Chen, RN
case manager
Book nephrology 48h via Kaiser referral desk
Rita Johnson
88 F · MRN-58444
5BMedicineMedicare FFSHome + HHTue 11:00 AM
76%
58%
MEDHome safety eval + walker
Liam Park, OT
ot
OT home safety + DME walker order
15 of 15 patientsExport CSV · Raw FHIR · Audit log
How this screen works
Auto-refreshes 30s · all numbers computed from live engine state
Inputs
What this screen reads
  • Epic FHIR R4 — Patient, Encounter, Observation, MedicationRequest (every 30s)
  • HL7 v2 ADT — real-time admit/discharge/transfer events
  • Internal task + barrier + brain-insight tables (in-memory engine state)
Engine
What it computes
  • Six-pillar readiness computed per patient
  • Brain detectors scored deterministically (4pm cliff, Fri→Mon, conditional-DC)
  • AI narrative copy generated only when CM opens detail
Outputs
What it writes / routes
  • Census table sorted by delay-risk + EDD
  • Six summary KPI tiles
  • AI insight cards with deep-link CTAs
  • Filter state in URL params (shareable)
Refresh trigger
When it updates
  • Any ADT event from EHR (real-time)
  • Any task completion (in-memory)
  • Any portal event (SSE push)
  • Scheduled brain tick (30s + 4pm + Fri AM crons)
Partners involved:Epic FHIR R4Availity (eligibility)Naviguide (SNF capacity)Internal Inngest workflows
Demo data · no PHI · mocked Epic + payer endpoints