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

Patient Discharge Cockpit

Linda Kowalski · Hip fx, POD-3 (S72.001A)
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MC
LK
Linda Kowalski
68 F · MRN-58104 · Hip fx, POD-3 (S72.001A)
Unit 5BOrthoMedicare FFSLOS 5d
ComorbiditiesAtrial fibrillationCOPDType 2 diabetes mellitusPersonal history of TIA/cerebral infarction
Estimated discharge
Tuesday 11:00 AM
HIGH delay risk
Comorbidity profile · multi-condition interactions

4 comorbid conditions · 2 active interactions

Coded conditions (ICD-10-CM)
Primary: Hip fx, POD-3 (S72.001A)I48.91Atrial fibrillation, unspecifiedJ44.9COPD, unspecifiedE11.9Type 2 diabetes mellitusZ86.73Personal history of TIA/cerebral infarction
Active interactions · cited registry
  • AFib + Prior TIA/CVA
    cite: 2018 ACC/AHA/HRS Stroke Prevention in AFib + 2023 AFib Guideline
    Watch-out: DOAC PA must clear before discharge or bridge with enoxaparin + warfarin — never discharge without anticoag plan.
    Additional needs unlocked
    specialty pharmacyeducation
    Outpatient follow-up
    • · Neurology ≤ 14d
    • · Cardiology or PCP ≤ 14d
    1 contraindication & education modules
    Contraindications
    • · CHA2DS2-VASc with prior CVA = 2 points — anticoagulation mandatory absent bleeding contraindication
    Education modules
    • · Anticoagulation adherence + stroke warning signs (FAST)
    • · Bleeding precautions + when to call (head trauma → ED immediately)
  • Hip fracture (post-op) + COPD
    cite: GOLD 2024 + ACC/AHA Peri-op Cardiovascular 2014 + CHEST 2024
    Watch-out: VTE prophylaxis x35d AND incentive spirometry — neither alone is sufficient. Both must be in the SNF transfer packet.
    Additional needs unlocked
    nebulizereducationdme mobility
    Outpatient follow-up
    • · Orthopedics ≤ 14d
    • · Pulmonology or PCP ≤ 14d
    2 contraindications & education modules
    Contraindications
    • · Opioid analgesia risks post-op pulmonary complications — multimodal regimen preferred
    • · PCA pumps require respiratory monitoring
    Education modules
    • · Incentive spirometry q1h while awake post-op
    • · Inhaler technique re-check before discharge (typical inhaler error rate > 70%)
Contraindications
3
Follow-ups required
4
Earliest follow-up
14d
Six readiness dimensions

All six must align for discharge to actually happen

Open discharge map →
♡
Medical readiness
Ready
Readiness100%
⚒
Functional readiness
In progress
Readiness50%
℞
Medication readiness
Blocked
Readiness79%
✓
Payer / authorization readiness
Blocked
Readiness70%
▦
Resource availability
Blocked
Readiness50%
✿
Patient + caregiver agreement
Blocked
Readiness50%
Discharge readiness
92%
Clinical
MD criteria, labs, vitals
38%
Operational
Auth, PT, transport, prefs
Operational readiness lifts as tasks complete. Goal: both ≥ 80% by 15:00 today to release tomorrow's discharge.
Predicted disposition
Skilled Nursing Facility
0.76 conf.
Rationale: prior CHF admission 2025-11, NYHA III, frailty score 0.43, caregiver POA available. Primary tilt → SNF for 7-day cardiac reconditioning; viable HH path if caregiver capacity confirmed.
Discharge timeline
Event simulator · demo only

Fire a realistic event to watch the engine recompute

src/lib/engine/dispatcher.ts
Event feed · dynamic engine

What moved the pillars

0 total
No events yet. Use the simulator below to fire a payer decision, FHIR observation, or vendor callback and watch the pillars move.
Decision engine

Needs × Coverage × Resources

3 mismatches
Needs
Clinical + functional set
Coverage
PA pending
Resources
Vendor / SNF gap
3 edges red-dashed — fallback path warming
  • · Needs ↔ Coverage: medication / auth gap blocks the disposition match
  • · Needs ↔ Resources: caregiver / clinical need has no booked resource yet
  • · Coverage ↔ Resources: payer + vendor cannot be aligned in time — backup queued
PaCHE barriers

Top blockers

1 barriers
  • E — ExternalActively blockingOwner: case manager
    Prior auth — SNF

    BlueShield denied SNF auth. Peer-to-peer requested.

Next best actions

Recommended by OpenBed AI

4 ranked
  • Before 2:00 PM
    Request PT mobility evaluation

    Required before SNF accepts; slot before 2:00 PM.

    via Internal · Rehab Services

  • Today
    Send patient/caregiver SNF preference form

    Push portal form to Carla (daughter, POA).

    via Patient Portal · SMS + email

  • Now
    Check medication coverage & pharmacy availability

    Verify Entresto formulary tier + CVS Mission St stock + PA TAT.

    via BlueShield MA · CoverMyMeds · CVS

  • Submit by 10:30 AM
    Start SNF authorization packet

    Submit prior auth via BlueShield MA. Avg TAT 22h — submit today.

    via BlueShield MA · CoverMyMeds

Active tasks

For this patient

Open full task board →
  • Waiting externalSchedule MD peer-to-peer (SNF denial)Maria Chen, RN
Workflow swim lanes

Tasks by role · cross-functional discharge orchestration

1 tasks
Hospitalist0
No active tasks
Nursing0
No active tasks
Pharmacy0
No active tasks
PT / OT0
No active tasks
Case manager1
Waiting
Schedule MD peer-to-peer (SNF denial)
Maria Chen, RN

AI chart summary · live via Anthropic Claude

Runs through runAgent · writes an AgentInference audit row with cost, latency, prompt hash.

Click Run chart summary to call Claude Sonnet 4.6 on this patient's record. The audit row will be visible in Neon's AgentInference table within ~3s.

Medical readiness · deterministic rule engine

Reads cited criteria from src/lib/discharge/compliance.ts · scores deterministically · no AI involvement in severity.

100%
READY

Medical readiness 100% · all 4 criteria pass or pending non-blocking finalization.

Functional readiness · deterministic rule engine

Reads cited criteria from src/lib/discharge/functional-criteria.ts · scores deterministically · no AI involvement in severity.

50%
WIP

Functional readiness 50% · 2 pass · 2 pending · 2 fail. Score lifts as PT/OT and dysphagia results land.

Medication readiness · deterministic rule engine

Reads cited criteria from src/lib/discharge/medication-criteria.ts · scores deterministically · no AI involvement in severity.

79%
BLOCKED

Medication readiness 79% · 0 criteria failing (1 blocking). Patient not yet medication-safe for discharge.

Prior auth drafter · Claude → HITL → CoverMyMeds

Draft → review → approve → submit

Live wire

Drafts via src/lib/ai/agents/prior-auth-drafter.ts → submits via src/lib/integrations/cmm.ts (mock-contract). Both write audit rows.

⚙How this screen works
Cockpit is the single-pane view of one patient's six-pillar state
Inputs
What this screen reads
  • Epic FHIR encounter + clinical signals + medications
  • Cross-references to barriers, tasks, resource matches, portal state
  • Six-pillar engine snapshot for this patient
Engine
What it computes
  • Re-computes pillars whenever an event tied to this patient lands
  • Re-ranks Next-Best-Actions based on current barriers + readiness
  • Triggers chart-summarizer agent (Claude) on demand for the summary refresh
Outputs
What it writes / routes
  • Action buttons dispatch into the task orchestrator
  • 'Send preference form' pushes to portal via SSE
  • 'Start prior auth' fires CoverMyMeds submission + writes Submission row
  • Every approved action writes an AgentInference + Submission audit pair
Refresh trigger
When it updates
  • Any new FHIR observation on this patient
  • Any task completion that mentions this patientId
  • Any payer webhook for this patient's auths
  • Any portal event from caregiver
Partners involved:Anthropic Claude (via runAgent)CoverMyMeds (PA submission)Naviguide (SNF referral)ModivCare (NEMT booking)
Demo data · no PHI · mocked Epic + payer endpoints