Background: Off-Shift Administration (OSA) supports the senior leadership by overseeing clinical operations for both inpatient and outpatient areas at MD Anderson. Our team is responsible for resolving and/or managing issues that could impede patient care, particularly when unsuccessful at the departmental level. This project focuses on streamlining inpatient discharge activities. Data reports from December 2010 to February 2011 revealed that OSA received 1,923 assistance requests institution-wide of which 13% were case management related. A taskforce familiar with patient care and case management processes ultimately resolved to decrease the number of calls made to Off-Shift Administration requesting case management services by 50% by June 2011. Methods: The pilot period began March 1, 2011 and ended May 31, 2011. The earliest intervention was to re-route after hours case management requests directly to the case manager on-call. In the new process, the RN paged the case manager on-call directly who would then escalate calls to OSA as deemed necessary for internal support. A staff education plan complemented the intervention. The education plan entailed in-services with nursing staff, discharge planning teams and nurse leaders for each unit. Education by way of posters was delivered on select units. Piloted areas were also surveyed to assess their knowledge of case management processes and wait time experiences. Results: Outcomes were favorable. OSA experienced an 80% reduction in call volume from the piloted areas. Survey results showed educational efforts yielded a positive practice change and increased awareness of case management protocol. Survey results also revealed a 20-minute reduction in wait time for case management assistance. Certainly, of greatest benefit were the reduced wait times and more expedient patient care and customer service for staff. Conclusions: The project was successful and knowledge gained was be used to implement permanently and within all patient care settings. This project also serves as a useful paradigm of Clinical Operations’ improved ability to distinguish operational trends requiring attention, thereby increasing operational efficiency and customer satisfaction.