Hold a live picture of beds, pending discharges and incoming demand, propose placements against configured unit and isolation rules, surface each discharge's barrier, and prepare transfer decisions — every one stays with a person.
A bed request arrives from the ED, OR or an accepting unit, with the live census and ADT feed.
02
Normalise unit, isolation flag, ratio configuration and stated arrival time across sources.
Reason
03
Read predicted discharges, current occupancy and the configured unit and isolation rules.
04
Apply the ratio limits and cohorting rules configured for each unit, never inferred.
05
Score candidate beds against the request and surface the barrier behind each pending discharge.
Decide
06
A transfer call comes in; flag what the picture shows and what it cannot confirm.
07
Route every placement and every transfer read to the house supervisor or charge nurse.
Out
08
Retain the census snapshot, the candidate beds, the barrier and the decision against the request.
09
Execute write actions only inside the approval boundaries agreed during implementation.
→Product statement
The agent proposes a placement or a transfer read; the house supervisor, charge nurse or physician decides, and a predicted date stays a planning signal, never a clinical conclusion.
Example workflow
One bed request, arrival to placement
AgentHuman
1Bed request receivedADT feed, ED board, OR schedule or transfer-centre call
2Picture assembledCensus, pending discharges, isolation flags, ratio configuration and unit rules
3Placement proposedCandidate bed, discharge barrier, transfer read and confidence
4Controls appliedRatio checks, isolation checks, staleness checks and confidence threshold
No human action required
Stages 1 to 4 run unaided, and no bed is held at any of them — the agent is proposing, and the human lane opens at the confidence gate.
5DecisionBranches at the confidence threshold
High confidence
Goes to the house supervisor or charge nurse to confirm.
Low confidence
Adds a capacity-manager read first.
Human confirmation
The placement is held with its candidate beds, the barrier and the confidence.
Confirm · Reassign · Escalate
Confirmed — bed board updated▼
6ADT and bed board updatedOnly where write access and approval policy allow it
7Outcome evaluatedPlacement accuracy, reassignments, escalations and time-to-placement
Reassignments
Every reassignment made in confirmation is counted in the evaluation.
What should not run autonomously
Human approval stays in control
Outside the boundary — human approval required8 items
Accepting or refusing a transfer request.
Deciding a patient is ready for discharge.
Overriding a configured nurse-to-patient ratio.
Determining medical necessity for admission.
Automation boundaryAgent acts unaided
✓Hold a live picture of beds, discharges and incoming demand.
✓Propose placements against configured unit and isolation rules.
✓Track the barrier behind each pending discharge.
✓Prepare the picture a transfer decision needs, and hold.
Any write happens inside the boundaries agreed at implementation, never ahead of a decision.
Predicting clinical deterioration or acuity.
Conducting the physician-to-physician transfer call.
Performing the discharge-planning evaluation.
Changes to unit, isolation or ratio configuration.
Example output
One bed request, annotated
Everything the agent proposes is attached to the request it was drawn from.
Placement output · single bed requestIllustrative example
Request
Proposed placement
Unit ratio
Candidate unit
Confidence
Isolation status
ED admit request
Bed 4B-12, single room, contact-precaution cohort
1:4
4B – Med-surg
88%
Contact precautions cleared
As receivedTaken from the ADT feed and the unit's configuration — nothing on this side is inferred by the agent.
Evidence usedADT bed-status feedUnit isolation flagConfigured ratio limit
Why this candidateThe ratio and isolation rule are configured for the unit, not decided for this one request.
ActionConfirmReassignEscalate
What the score decidesBelow the configured threshold the placement picks up a capacity-manager read.
Value
Where AI adds value
The same four claims, placed at the point in the workflow where each one applies.
Where the value landsValue 01 – 04
Every bed requestFrom the census and ADT feed
03Placement
Score against unit rules
Weigh the request against configured unit, isolation and ratio rules for each candidate bed.
01Approved path
Capacity is a legal statement
The rule that cleared a placement travels with it — the record is the deliverable, not just the bed.
02Human review
Point the supervisor at the tight cases
Ratio-tight units and low-confidence placements are marked, so the supervisor's read starts where the bed is hardest to place.
04Build an evidence trail
The placement, the constraint behind it and the charge nurse who accepted it stay on the bed request.
Integrations
Typical integrations
Five system groups connect to the same agent. Which of them are in scope is decided in discovery.
ADT and bed systemsEpic ADT · Cerner Millennium MEDITECH · HL7 ADT feeds
Bed-management platformsTeleTracking · central logistics Bed board and housekeeping
ED and OR schedulingEpic ASAP · ORMIS Perioperative and ED tracking boards
Agent
Capacity & patient-flow command centre
Reads the census Proposes the placement Holds for confirmation
Transfer centre and dischargeTeleTracking Transfer Center Case-management systems
A house-wide placement score hides the unit underneath it
A house-wide placement-rework rate can look acceptable while one unit or a single cohort absorbs most of the reassignments. Nestack reports the rate by slice, not only in total.
Slice performance — reported separately, not only in aggregateIllustrative example
Slice
Failure rate
Lift
Lift vs. threshold
Status
Isolation and cohorting requirements
7.5%
3.9×
Review
Off-service and overflow placements
5.4%
2.8×
Review
Predicted same-day discharges
3.3%
1.7×
Watch
Routine med-surg placements
1.9%
0.8×
Normal
Bar: placement-rework rate lift vs. the routine-med-surg baseline · scale 0–4.0× · tick marks the 2.0× review threshold2 of 4 slices over threshold
Evidence-linked improvement
The loop closes on the bed, not the metric
A cycle closes when the bad placement is a case the next release has to survive. That suite is what the next bed assigned is measured against.
Improvement cycle · five stagesSwitchback — the path turns at Improve and returns at Learn
01Detect
Placement-rework rate rises in a unit slice.
02Diagnose
The bed that showed as clean and was not is traced to the feed, the rule or the workflow that missed it.
03Improve
The fix ships against a version, with the placements that exposed it attached.
04Verify
Release is held until the affected placement cases pass again.
05Learn
The case joins the permanent suite and the placement rules move with it.
Learn → DetectThe return edge. The next census runs against a suite one placement case longer.
Typical build scope
Twelve workstreams across six weeks
The build scope read against the delivery timeline. Week structure follows the six-week plan — discovery, sources, placement workflow, evaluation, integration, then production validation and handover.
WorkstreamWeek 1Week 2Week 3Week 4Week 5Week 6
01Capacity workflow and boundary definition and it is logged..
02ADT and bed-system source assessment.
03Unit, isolation and ratio-rule mapping and rule mapping.
04Census ingestion and normalisation.
05Placement retrieval and scoring logic.
06Confidence scoring and escalation routing.
07Charge-nurse confirmation workflow.
08ADT and transfer-centre integration.
09Placement regression cases.
10Guardrails and escalation controls.
11Bed-trail instrumentation.
12Deployment, documentation and Agent Care handover.
12 workstreams · 6 weeks · bar shows the weeks a workstream is active — several run in parallelFinal scope and sequence confirmed in discovery
Engagement tiers
What each tier includes
Rows are the capabilities named in each tier's scope. Higher tiers include everything below them.
Capability✓ in scope · — not at this tierPilotOne unit, one campusProductionProduction ADT integrationAdvancedMultiple campuses / systems
Introduced at Pilot
Placement recommendations✓✓✓
Human confirmation✓✓✓
Placement-accuracy baseline✓✓✓
Introduced at Production
Reporting by unit—✓✓
Confirmation workflow in your systems—✓✓
Approved bed write-back—✓✓
ADT-system integration—✓✓
Introduced at Advanced
Multi-campus placement rules——✓
Multi-stage confirmation chains——✓
High placement volume——✓
Multi-campus capacity controls——✓
Build priceFrom $5,000From $8,000Custom quote
Final build priceConfirmed after discovery based on integrations, workflow complexity, transaction volume, approval controls and deployment requirements.
Separate from buildBuild pricing is separate from recurring Agent Care, which covers managed monitoring, evaluations, incidents and verified improvements after launch.
What we need from you
What you bring, and what we build with it
Each input maps to a piece of build scope and a week in the delivery timeline.
You bringWe build with it
01Your live census, ADT feed and bed-board layout→Census ingestion and bed-board mappingWeek 1
02Representative recent placements and transfers→Placement baseline and constraint extractionWeek 2
03Your unit, isolation and ratio rules→Unit, isolation and ratio-rule mappingWeek 1
04Access to relevant APIs, feeds or exports→ADT and transfer-centre assessment, then integration setupWeek 2
05Placements you would not want made→Transfer cases and failure-mode testingWeek 4
06What no placement may decide alone→Confidence scoring, escalation routing, guardrails and approval controlsWeek 3
07Named house supervisors and charge nurses to confirm→Charge-nurse confirmation workflow, then pilot and production validationWeeks 5–6
Nothing else is requiredDeployment, documentation and Agent Care handover are ours.
Delivery timeline
Four phases across six weeks
Each band covers the weeks the work really takes, which is why week 5 carries evaluation and pilot together.
PhaseW1W2W3W4W5W6
DiscoveryW1
BuildW2 – W3
EvaluateW4 – W5
Pilot & LaunchW5 – W6
Week focusW1Capacity workflow discovery, unit-rule mapping and boundaryW2ADT integration and the placement baselineW3Placement logic, confidence scoring and escalation controlsW4Evaluation suite, guardrails and failure-mode testingW5Transfer-centre integration, pilot placements and correctionsW6One census cycle run under the house supervisor, then Agent Care handover
Reading the bandA bar covers the weeks its work is named in, and nothing else. The week 5 overlap is real, not padding.
At the end of W6Validation closes on live placements, and Agent Care picks up monitoring.
DurationSix-week plan shown · typical delivery 4–6 weeks depending on scope confirmed in discovery.
Next step · Healthcare AI agent
Build a capacity and patient-flow agent around your bed board.
Show us your bed board, your unit and ratio rules, and who confirms a placement. If your census spans multiple units or a transfer centre, we'll map the workflow around it and name what stays with a person.
