Stress-test a boarding crisis by proving that each hold window and restore rule can place unanswered boarding patients inside the planned lane, survive override pressure, and avoid trapping ED teams inside a green throughput slide that hides long-lived soft holds.
Boarding crises often list a surge plan while leaving restore behavior, override authority, and abort ownership implicit. Those edges decide whether a late hold stays inside the throughput packet or leaves a broken boarding path live under peak volume. The exercise should follow actual bed timelines, pod maps, and escalation paths rather than a clean boarding deck.
Trace the boarding path
List every hold class with its response window, waive rule, override behavior, owners, and notification channels. Mark paths that cannot reverse without a manual amendment. Attach the last three boarding crisis incidents with raw timelines and any waivers. Include the source of truth for open hold counts during the observation window.
Define the phases for detect, hold, divert, abort, and restore. Each phase needs an owner and an exit condition. Write the point after which a stuck hold would require a different procedure, then review whether that action is still permitted. Capture maximum acceptable dwell in measurable units, including which pods are excluded from the boarding path and why.
Include the calendar of known events for the next two quarters: census freezes, ICU capacity cuts, and staffing gaps that shrink the usable response window. A boarding budget that ignores those dates will look calm until the week they land.
Crisis drills that matter
- A minority high-acuity pod keeps a side-channel while the aggregate boarding dashboard stays green.
- A restore has already left a hallway without a trusted hold state.
- The primary boarding dashboard lags beyond the planned observation window.
- An operator skips a boarding gate because a bed cutoff is near.
- Automated and human divert messages collide under the new boarding rule.
- Abort authority is unclear at week end and the update lands on the wrong amendment.
For each drill, identify detection time, pod impact, containment, and the authority to force a boarding rollback. Require commands and dashboard links in the runbook.
Ownership after the crisis window
Run the package in Pingpong with ED ops, ICU ops, bed management, and nursing seats. Ask ED ops which pod decision becomes unsafe first if holds still stick after the claimed window. Ask ICU whether bed macros can absorb a forced override. Ask owners to show the exact boarding version or export used as the exit condition.
Related reviews include the ED ops lead seat, a left-without-being-seen ladder, a bed flow huddle rule, and the ICU ops lead seat. Browse the war-game decisions hub for adjacent controls.
Authorize the published boarding path only after a timed drill restores usable hold hygiene inside the documented budget without an undocumented manual step.