Stress-test a ventilator capacity cut by proving that each hold window and restore rule can place unanswered vent requests inside the planned lane, survive override pressure, and avoid trapping ICU teams inside a green capacity slide that hides long-lived soft holds.
Ventilator capacity cuts 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 capacity packet or leaves a broken vent path live under peak volume. The exercise should follow actual device inventories, unit maps, and escalation paths rather than a clean vent deck.
Map every vent hold
List every vent 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 ventilator capacity incidents with raw timelines and any waivers. Include the source of truth for open vent 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 units are excluded from the cut path and why.
Include the calendar of known events for the next two quarters: census freezes, transfer surges, and staffing gaps that shrink the usable response window. A vent budget that ignores those dates will look calm until the week they land.
Drills that expose soft capacity
- A minority high-acuity unit keeps a side-channel while the aggregate vent dashboard stays green.
- A restore has already left a floor without a trusted vent state.
- The primary vent dashboard lags beyond the planned observation window.
- An operator skips a vent gate because a transfer cutoff is near.
- Automated and human divert messages collide under the new capacity rule.
- Abort authority is unclear at week end and the update lands on the wrong amendment.
For each drill, identify detection time, unit impact, containment, and the authority to force a ventilator capacity rollback. Require commands and dashboard links in the runbook.
Who owns the cut after the window
Run the package in Pingpong with ICU ops, respiratory therapy, transfer center, and nursing seats. Ask ICU ops which unit decision becomes unsafe first if holds still stick after the claimed window. Ask respiratory therapy whether device macros can absorb a forced override. Ask owners to show the exact vent version or export used as the exit condition.
Related reviews include the ICU ops lead seat, a transfer center SLA, a bed flow huddle rule, and a boarding crisis stress test. Browse the war-game decisions hub for adjacent controls.
Authorize the published vent path only after a timed drill restores usable hold hygiene inside the documented budget without an undocumented manual step.