Stress-test a contrast shortage by proving that each hold window and restore rule can place unanswered contrast requests inside the planned lane, survive override pressure, and avoid trapping imaging teams inside a green inventory slide that hides long-lived soft holds.
Contrast shortages often list a substitution plan while leaving restore behavior, override authority, and abort ownership implicit. Those edges decide whether a late hold stays inside the contrast packet or leaves a broken modality path live under peak volume. The exercise should follow actual vial inventories, modality maps, and escalation paths rather than a clean pharmacy deck.
Map every contrast hold
List every contrast 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 contrast shortage incidents with raw timelines and any waivers. Include the source of truth for open vial 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 modalities are excluded from the shortage path and why.
Include the calendar of known events for the next two quarters: scanner freezes, vendor delays, and renal-risk spikes that shrink the usable response window. A contrast budget that ignores those dates will look calm until the week they land.
Drills that expose soft inventory
- A minority high-volume scanner keeps a side-channel while the aggregate contrast dashboard stays green.
- A restore has already left a modality without a trusted vial state.
- The primary contrast dashboard lags beyond the planned observation window.
- An operator skips a contrast gate because a schedule cutoff is near.
- Automated and human divert messages collide under the new shortage rule.
- Abort authority is unclear at week end and the update lands on the wrong amendment.
For each drill, identify detection time, modality impact, containment, and the authority to force a contrast shortage rollback. Require commands and dashboard links in the runbook.
Who owns the shortage after the window
Run the package in Pingpong with imaging ops, pharmacy, radiology nursing, and materials seats. Ask imaging ops which modality decision becomes unsafe first if holds still stick after the claimed window. Ask pharmacy whether substitution macros can absorb a forced override. Ask owners to show the exact contrast version or export used as the exit condition.
Related reviews include the imaging ops lead seat, a modality schedule freeze, an urgent read SLA, and an instrument tray shortage stress test. Browse the war-game decisions hub for adjacent controls.
Authorize the published contrast path only after a timed drill restores usable hold hygiene inside the documented budget without an undocumented manual step.