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

Discharge Map

The OpenBed operating model · six dimensions, one operating layer
Why this exists

Hospitals don't have a discharge execution system.

They have an EHR, messages, rounds, referrals, and humans chasing tasks. Length of stay grows when clinical readiness arrives before operational readiness. OpenBed AI synchronizes clinical readiness, patient needs, coverage, resources, ownership, and execution before the patient is medically ready — turning discharge from a communication problem into an executable operating process.

6 dimensions, parallelOwner per rowAuditable state machineNo more sticky notes
Discharge map · how OpenBed AI synchronizes the six readiness dimensions

Patient → readiness pillars → disposition route → logistics → discharge

PATIENTSIX READINESS DIMENSIONSDISPOSITION ROUTELOGISTICSDISCHARGEPatientadmit + EHR Medical readinessIs the patient clinically safe to leave the inpatient setting? Functional readinessCan the patient safely perform the activities the next setting… Medication readinessWill the patient actually take the right medications at home, … Payer / authorization readinessIs everything the patient needs after discharge pre-authorized… Resource availabilityDoes the post-acute setting + DME + transport actually exist? Patient + caregiver agreementHave the patient and family seen the plan and said 'yes, that …HomeHome + HH / InfusionSNF / ARU / LTACHospice / Memory Care / RespiteFamily pickupRideshare / NEMTAmbulance / CCTShelter / transit voucherDischargeaudited event
Every patient passes through all six pillars in parallel — not in sequence. OpenBed AI maintains the alignment in real time, so when the last pillar turns green, the disposition + logistics path is already booked. The audit trail records the entire convergence.

Live snapshot · Michael Johnson

CHF · Medicare Advantage · Day 3 · EDD Tue 14:00

Open patient cockpit →
Medical readiness
Is the patient clinically safe to leave the inpatient setting?
Blocked
Readiness92%

Medical readiness 92% · 0 criteria failing (1 blocking). Patient not yet medically dischargeable.

Functional readiness
Can the patient safely perform the activities the next setting requires?
Blocked
Readiness42%

Functional readiness 42% · 2 criteria failing (1 blocking). Patient not yet functionally dischargeable to proposed setting.

Medication readiness
Will the patient actually take the right medications at home, on time, today?
Blocked
Readiness79%

Medication readiness 79% · 0 criteria failing (2 blocking). Patient not yet medication-safe for discharge.

Payer / authorization readiness
Is everything the patient needs after discharge pre-authorized and in-network?
Blocked
Readiness83%

Payer / auth readiness 83% · 0 failing (1 blocking). Friday-afternoon SNF auth at-risk if not escalated.

Resource availability
Does the post-acute setting + DME + transport actually exist?
Ready
Readiness94%

Resource readiness 94% · top match booked, backup warmed, DME/transport/pharmacy in place.

Patient + caregiver agreement
Have the patient and family seen the plan and said 'yes, that works'?
Blocked
Readiness50%

Patient + caregiver agreement 50% · preference form not yet returned. Disposition slip risk until family responds.

Each dimension · why it's needed, logic, inputs

Medical readiness
Is the patient clinically safe to leave the inpatient setting?
Why it matters

Premature discharge → readmission. Late discharge → avoidable bed days. Today this is the only readiness most teams track — and it's the one that arrives earliest.

If this slips

Patient stays in bed waiting on a lab, an order, or a confirmation that's already in the chart.

Inputs (what flows in)
  • Vitals + labs (EHR observation feed)
  • Active diagnoses + comorbidities
  • Sign-off checklist per service line
  • Hospitalist note ('medically ready' attestation)
Workflow (how OpenBed runs it)
  1. 1.Hospitalist evaluates daily on rounds
  2. 2.Service-line criteria checked against EHR data (CHF: diuresis target, weight stable 24h, BNP trend)
  3. 3.OpenBed surfaces gaps in real time, doesn't wait for daily huddle
  4. 4.Attestation generates a 'medically ready' timestamp — clock starts on operational readiness
HospitalistAPP
Functional readiness
Can the patient safely perform the activities the next setting requires?
Why it matters

ADL/mobility gaps drive 30% of SNF rejections and most avoidable readmits. PT/OT evals frequently arrive 24–72h after clinical readiness.

If this slips

SNF refuses the referral packet because mobility/cognition wasn't documented in time.

Inputs (what flows in)
  • PT/OT consult notes + TUG / FIM scores
  • Speech eval (stroke / dysphagia)
  • Home environment assessment
  • Caregiver capacity assessment
Workflow (how OpenBed runs it)
  1. 1.OpenBed auto-orders PT eval when admit dx implies mobility risk (e.g. CHF, stroke, ortho)
  2. 2.PT slot booked against unit calendar, not as-available
  3. 3.Result feeds the dispatcher: which disposition is even possible
  4. 4.If SNF, eval doubles as the SNF intake document
PTOTSLPNursing
Medication readiness
Will the patient actually take the right medications at home, on time, today?
Why it matters

Med rec gaps and pharmacy stock-outs trigger ED return within 7 days. Meds-to-beds + same-day fill is the leverage point.

If this slips

Patient is discharged with a prescription they can't fill until tomorrow — sometimes Monday.

Inputs (what flows in)
  • Discharge med list + reconciliation
  • Formulary + prior auth status
  • Patient's pharmacy + stock
  • Affordability (copay + supplemental)
Workflow (how OpenBed runs it)
  1. 1.Pharmacist runs reconciliation on day-of-discharge eve
  2. 2.OpenBed checks formulary tier + pharmacy stock + PA status concurrently
  3. 3.If PA needed → AI drafts packet → pharmacist reviews → submits in <10 min
  4. 4.Meds-to-beds program delivers to room before transport leaves
PharmacyPharm Tech
Payer / authorization readiness
Is everything the patient needs after discharge pre-authorized and in-network?
Why it matters

Prior auth + denial cycles add a median 22h per discharge. They are the single largest avoidable-day driver in our census.

If this slips

Patient stays the weekend because Friday-afternoon SNF auth missed the payer's intake window.

Inputs (what flows in)
  • Payer plan rules (live formulary, SNF benefit, HH benefit)
  • Eligibility check (real-time via X12 270/271)
  • Auth submission status + SLA
  • Denials + peer-to-peer queue
Workflow (how OpenBed runs it)
  1. 1.OpenBed loads the payer-rules library on patient admit
  2. 2.Engine pre-validates every downstream need against the plan
  3. 3.Auth packets auto-drafted; pharmacist / CM reviews + submits
  4. 4.Denial → peer-to-peer queued with the right MD
Case ManagerPharmacyMD (peer-to-peer)
Resource availability
Does the post-acute setting + DME + transport actually exist?
Why it matters

A SNF bed, an oxygen tank, a wheelchair van. None of these book themselves — and any one of them gates the entire discharge.

If this slips

No SNF bed Monday, no walker in stock, no NEMT slot — and nobody knew until Friday afternoon.

Inputs (what flows in)
  • Resource Hub directory (SNF, HH, ARU, LTAC, hospice, memory care, community, charity)
  • Vendor capacity feed (where available)
  • DME inventory + delivery ETA
  • Transport availability + insurance benefit
Workflow (how OpenBed runs it)
  1. 1.Resource matcher queries the Hub with payer + distance + capability constraints
  2. 2.Ranks by fit; books top match + warms backup proactively
  3. 3.Voice-agent (or human) confirms with vendor
  4. 4.Outcome writes to ResourceMatch + flips the matching barrier state
Case ManagerSocial WorkerAI Agent
Patient + caregiver agreement
Have the patient and family seen the plan and said 'yes, that works'?
Why it matters

Family decision lag is the #1 quietly-tolerated avoidable-day driver. SNF refusals, transport surprises, and pickup no-shows all start here.

If this slips

Family hasn't picked a SNF, the chosen SNF is full by Monday, and the discharge slips another 48h.

Inputs (what flows in)
  • Care plan + disposition options surfaced in the patient portal
  • SNF preference ranking + tour requests
  • Transport + pharmacy choice
  • Education completion + ack
  • Consent capture
Workflow (how OpenBed runs it)
  1. 1.Care team pushes preference form via portal (SMS + email) within 24h of admit
  2. 2.Family ranks SNFs, confirms transport, picks pharmacy
  3. 3.Portal-translator agent re-renders clinical updates into 6th-grade plain language
  4. 4.Acks flip barriers in real time; CM sees the change within 2s
Patient / CaregiverCase ManagerSocial Worker
How this screen works
The conceptual map · explains the operating model to non-CM audiences
Inputs
What this screen reads
  • PILLARS definition (src/lib/library/pillars.ts)
  • pillarStatusFor(patient) — live computed per patient
  • Cross-references to route + logistics + needs + resources libraries
Engine
What it computes
  • Renders Patient → 6 pillars → 4 route categories → 4 logistics → Discharge SVG flow
  • Computes per-patient pillar snapshot (Michael Johnson default)
  • No outbound action — strategy + explainer
Outputs
What it writes / routes
  • Deep links into Cockpit + all library pages
  • Investor-facing explainer of operating model
Refresh trigger
When it updates
  • Edits to pillar definitions or status mapping
  • Strategy refresh per design partner
Demo data · no PHI · mocked Epic + payer endpoints