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

Patient Discharge Cockpit

Anthony Boyd · Left leg cellulitis with abscess; IV vancomycin x10d (L03.116 + N18.32)
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MC
AB
Anthony Boyd
52 M · MRN-58401 · Left leg cellulitis with abscess; IV vancomycin x10d (L03.116 + N18.32)
PlanningUnit 5BMedicineSelf-pay (Medi-Cal application pending)LOS 4d
ComorbiditiesMajor depressive disorderAlcohol use disorderType 2 diabetes mellitus
Estimated discharge
Thursday 11:00 AM
HIGH delay risk
Six readiness dimensions

All six must align for discharge to actually happen

Open discharge map →
♡
Clinical readiness
75%Blocked
⚒
Functional & equipment readiness
75%Blocked
℞
Medication readiness
60%Blocked
$
Financial readiness
50%Blocked
▦
Care coordination readiness
50%In progress
✿
Patient agreement & support readiness
50%Blocked
Unified readiness model

Three axes → one “ready” verdict

Not ready · 6 blockers
Axis 1 · Feasibility
Can this disposition happen? (engine = authority)
2 blocker(s)
Target: HOME
Binding: Clinical acuity · VIOLATED
Axis 2 · Progress
How far along is the work? (tasks, not a score)
0/2 required
0% of execution tasks complete
Clinical readiness0/1
Medication readiness0/2 ●
Patient agreement & support readiness0/5 ●
Axis 3 · Execution-staging
Is the bed actually secured? (acceptance pipeline)
Awaiting bed
Stage: Referral Drafted
Facility-bound · not yet bed-confirmed (blocks completion).
  • ●2 engine constraint(s) violated: CLINICAL_ACUITY, SOCIAL_SDOH.
  • ●Acceptance pipeline not at Bed Confirmed (currently REFERRAL_DRAFTED).
  • ●T2 gate not cleared: Hospitalist 'medically ready' attestation on file.
  • ●T2 gate not cleared: Patient/family OOP acceptance documented (if residual cost).
  • ●2 required execution task(s) still open.
  • ●4 readiness gate(s) unmet: PT evaluation completed and documented; Prior auth approved for Naltrexone (Vivitrol); Real-time payer eligibility + benefit detail verified at admit; Prior auth status for Naltrexone (Vivitrol).
Scalars (display-only): clinical 74 · operational 22 — non-authoritative; feasibility + progress above are the truth.
30-d readmission risk
LACE+ + HOSPITAL · not HRRP-tracked
MODERATE

Drives pathway intensity tier — HIGH score adds Coleman / Naylor touchpoints automatically.

Active pathway

No matching pathway. Patient needs a confirmed disposition + service stack to assign a workflow.

Engine-derived barriers

Top blockers · with one-click playbooks

1 barrier
  • WatchApproaching SLAOwner: Financial counselor / CM· Open 0d
    Payer authorization

    Awaiting authorization; tracking against 7d bed-hold.

    via acceptance tracking (AWAITING_AUTH)

    → drafts go to HITL queue, not sent until approved
Execution layer · HITL queue

Pending actions · awaiting clinician approval

0 open

Drafted by playbooks / AI · NOT sent until you approve. Approve fires the integration mock + writes a Submission audit row.

No pending actions. Click Run playbook on a barrier to draft one.
From the family · patient portal

What the caregiver has told us

Not started
Recovery preferenceWants to talk it through
TransportNot sure — wants a call
Home supportNeeds extra help
Preferred pharmacy—
Preferred languageEnglish
Discharge teaching0/3 videos watched
Workflow swim lanes

Tasks by role · cross-functional discharge orchestration

4 tasks
Hospitalist1
In progress
Hospitalist 'medically ready' attestation on file
Nursing0
No active tasks
Pharmacy1
In progress
Discharge medication reconciliation completed by pharmacist
PT / OT1
In progress
PT evaluation completed and documented
Case manager1
Assigned
Resolve: Payer authorization
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.

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.

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.

Prior authorizations · M11

Each PA tracked Required → Submitted → Approved / Denied with the payer SLA clock. Runs concurrent with the referral, never serialized.

1 to submit
Naltrexone (Vivitrol)
380 mg · IM
Required
Self-pay (Medi-Cal application pending)· SLA 7d
→ Submit prior auth
SLA windows: 42 CFR §456.243 + CMS-0057-F. Synthetic demo data.
Demo data · no PHI · mocked Epic + payer endpoints