Post cases against block time, room, equipment and staffing rules, estimate duration from your own history and chase what each case needs — clinical priority and any bump stay with the surgeon and anaesthesia.
Take postings, add-on requests, cancellations and block releases from OR scheduling, the offices and pre-op.
02
Read the block grid, room and equipment constraints, preference cards, roster and pre-op requirement lists.
Reason
03
Estimate case duration from this surgeon's own history for this procedure, and carry how wide that estimate is.
04
Check the room, trays, implants, vendor cover and the anaesthesia and nursing staffing the case needs that day.
05
Check clearance, anaesthesia review, authorisation and patient instructions against the requirement list the case carries.
Decide
06
Detect a case that will not fit the block, a requirement not met or a constraint it cannot meet — hold for a person.
07
Detect anything that would move, bump or reorder a case, and route it to surgeon, anaesthesia and charge nurse.
Out
08
Post, move and release inside the rules, then publish the day's list, the open time and what is outstanding.
09
Retain the estimate and its basis, the constraint applied, the release decision and every scheduler change.
→Product statement
The agent proposes a schedule inside rules a person set. Clinical priority, case order and any bump stay with the surgeon, anaesthesia and the OR charge nurse.
Example workflow
One case posting, end to end
AgentHuman
1Posting receivedBooking request, add-on, cancellation or a block release from a surgeon's office
2Rules readBlock grid, room and equipment constraints, preference card, staffing roster and requirement list
3Duration estimatedThis surgeon's own history for this procedure, with the spread the estimate carries
4Constraints checkedRoom, trays, implants, vendor cover, staffing, clearance and authorisation — each in place or named as missing
No human action required
Stages 1 to 4 run without a person in the loop — the rules are read, the duration estimated and the constraints checked before anyone is asked to look. Anything that would move a booked case ends that stretch on the spot.
5DecisionSplits on block fit and constraint completeness
Fits the block, nothing outstanding
Posts on the approved path.
Will not fit, or something is missing
Goes to the OR scheduler, or to the surgeon and anaesthesia.
Scheduler or charge nurse
Sees the estimate and what it was built from, the constraint that blocked the posting and what is still missing, then posts it, overrides the constraint or takes it to the surgeon.
Post · Override the constraint · Take it to the surgeon
Posted — handed back▼
6Posted to the scheduleWritten only where write access and scheduling policy allow it; no booked case is moved
7Day reconciled and evaluatedActual against estimated, on-time starts, turnover, day-of cancellations and released block, by service line
Corrections
Cases a scheduler re-times or moves by hand are counted in the evaluation.
What should not run autonomously
Human approval stays in control
Outside the boundary — human approval required8 items
Deciding which case takes priority over another.
Bumping, moving or reordering a booked case.
Setting or changing a case's clinical urgency.
Booking into another surgeon's block without release.
Automation boundaryAgent acts unaided
✓Post, move and confirm cases inside the block, room and equipment rules.
✓Estimate case duration from your own history and show how wide it is.
✓Chase clearance, authorisation, trays, implants, vendor cover and staffing.
✓Release unused block on the agreed clock and report what came back.
Write actions run only inside the approval boundaries agreed during implementation. Clinical priority and bumping are not among them.
Overriding a staffing or anaesthesia coverage rule.
Posting a case before clearance or authorisation.
Changing block allocation, release clocks or targets.
Waiving an instrument, implant or vendor hold.
Example output
One case posting, annotated
Everything the agent proposes is attached to the posting and the rules it was read against.
Scheduling output · single postingIllustrative example
Posting
Surgeon booked
Block remaining
Estimated duration
Confidence
Case priority
Robotic case, Tuesday block
120 min
135 min
155 min
91%
As the surgeon set it
As receivedThe posting, the time the surgeon asked for and the block as it stands, kept as sent — nothing on this side is re-decided.
Evidence usedPrior cases, same surgeonPreference-card tray statusAnaesthesia cover that day
Why it did not postThe estimate runs past what is left in the block by more than the day can absorb, so the posting is held.
ActionPostOverride the constraintTake it to the surgeon
What the score decidesConfidence decides whether a scheduler checks the posting, not which case goes first. The surgeon decides that.
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 posting and add-onOR scheduling, surgeons' offices and pre-op
03Fit & constraints
Apply the client's own scheduling rules
Use the block grid, room and equipment constraints, preference cards, staffing roster and requirement lists already on file.
01Approved path
Take the chasing off the OR schedulers
Durations, trays, implants, vendor cover, clearance and authorisation are worked without someone holding a list and a phone.
02Human review
Put the conflicts in front of a person
A case that will not fit, a requirement not yet met and anything that would move a booked case reach a person before the day.
04Build an evidence trail
Retain the estimate and its basis, the constraint applied, the release decision, the chasing done and the scheduler's correction — on both paths.
Integrations
Typical integrations
Five system groups connect to the same agent. Which of them are in scope is decided in discovery.
OR scheduling & blockEpic OpTime · Oracle Health · MEDITECH Block grid · release and add-on rules
Anaesthesia & staffingAnaesthesia record · pre-op clinic Rostering · call and cover rules
Aggregate utilisation can look healthy while a small number of case cohorts carry most of the overruns, most of the day-of cancellations and most of the bumping. Nestack reports performance by slice, not only in total.
Slice performance — reported separately, not only in aggregateIllustrative example
Slice
Failure rate
Lift
Lift vs. threshold
Status
Long, high-variance procedures
5.9%
3.7×
Review
Add-on and emergency insertion
4.4%
2.8×
Review
Surgeons without regular block
3.1%
1.9×
Watch
Routine short cases
1.0%
0.6×
Normal
Bar: lift vs. routine short-case baseline · scale 0–4.0× · tick marks the 2.0× review threshold2 of 4 slices over threshold
Evidence-linked improvement
Every estimate you change moves someone else's case
An overrun is not closed by re-timing one case. The fix lands in a duration basis, a constraint rule or a release clock — and each decides which cases fit.
Improvement cycle · five stagesSwitchback — the path turns at Improve and returns at Learn
01Detect
Overruns, day-of cancellations or bumping move in a cohort.
02Diagnose
Traced to the estimate, the constraint read, the chase or the release clock.
03Improve
The duration basis, constraint rule or release clock is re-approved and version-linked.
04Verify
Re-run against held-out postings from the affected cohort, including the ones that failed.
05Learn
That case becomes a regression case and the changed rule enters the block policy.
Learn → DetectThe return edge. A release clock or a duration basis is an access decision, so the next cycle is read by service line and by who was bumped, not only by utilisation.
Typical build scope
Twelve workstreams across six weeks
The build scope read against the delivery timeline. Week structure follows the six-week plan — discovery, block rules and durations, constraints and chasing, evaluation, integration, then production validation and handover.
WorkstreamWeek 1Week 2Week 3Week 4Week 5Week 6
01Workflow discovery and automation-boundary definition.
02Scheduling and block APIs, and access scope.
03Block grid, release clock and add-on rules.
04Case-duration basis from your own history.
05Room, equipment and staffing constraints.
06Preference-card and implant checks.
07Pre-op clearance and authorisation lists.
08Bump, add-on and escalation routing rules.
09Evaluation suite, parity slices and regression cases.
10Utilisation, release and day-of reporting.
11Scheduling write-back and reconciliation.
12Observability, deployment 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 service lineProductionProduction OR integrationAdvancedMulti-site / multi-service
Introduced at Pilot
Rule-checked case posting✓✓✓
Block, room and equipment rules✓✓✓
Surgeon-owned priority and case order✓✓✓
Baseline evaluation✓✓✓
Introduced at Production
Duration estimates from your history—✓✓
Pre-op, clearance and authorisation chasing—✓✓
Preference-card and implant checks—✓✓
Block release on the agreed clock—✓✓
Observability and evaluation—✓✓
Introduced at Advanced
Add-on and emergency routing controls——✓
Utilisation reporting with access parity——✓
Build priceFrom $5,000From $8,000Custom quote
Final build priceConfirmed after discovery based on scheduling and block-management integrations, service-line complexity, case volume, staffing and materials systems, minimum-necessary access scope, 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 block grid, release clock and add-on rules→Block, release and add-on rule configurationWeek 1
02Case history for the procedures in scope→Case-duration basis built from your own historyWeek 2
03Access to OR scheduling, block and staffing APIs→API assessment, access scope and integration setupWeek 2
04Room, equipment, tray and staffing constraints→Room, equipment and staffing constraint modelWeek 3
05Preference cards and what each case needs beforehand→Preference-card, implant and pre-op requirement checksWeek 3
06Cases that overran, were bumped or cancelled on the day→Evaluation suite, parity slices and regression casesWeek 4
07Named schedulers, and who owns priority and bumping→Escalation routing, then pilot posting and production validationWeeks 5–6
Nothing else is requiredDeployment, documentation and Agent Care handover are ours.
Delivery timeline
Four phases across six weeks
Phases are drawn over the weeks they actually occupy. Week 5 runs the duration basis against live postings while the evaluation is still open.
PhaseW1W2W3W4W5W6
DiscoveryW1
BuildW2 – W3
EvaluateW4 – W5
Pilot & LaunchW5 – W6
Week focusW1Block grid, release clock and add-on rules read into the modelW2Scheduling and staffing integration, then the duration basisW3Constraint checks, preference cards and requirement listsW4Evaluation suite, parity slices and escalation routingW5Scheduling write-back, supervised posting and targeted correctionsW6A full block cycle posted beside the existing process, then handover
Reading the bandThe duration basis is built in week 2 but is not trusted until week 5 measures it against real days, which is why Evaluate and Pilot overlap.
At the end of W6Posting has run alongside the existing process for a full block cycle and the day-of numbers have been read by service line, then Agent Care takes over monitoring.
DurationSix-week plan shown · typical delivery 4–6 weeks depending on scope confirmed in discovery.
Next step · Healthcare AI agent
Build a surgical-scheduling agent around your block rules.
Show us your block grid, your release and add-on rules, and what each case needs before it can go ahead. We'll rebuild your duration estimates from your own case history and replay a past block week.
