Stress-test an after-hours call spike by proving that each hold window and restore rule can place unanswered night calls inside the planned lane, survive override pressure, and avoid trapping on-call teams inside a green volume slide that hides long-lived soft holds.
After-hours call spikes often list a phone tree while leaving restore behavior, override authority, and abort ownership implicit. Those edges decide whether a late clinical question stays inside the night packet or leaves a broken coverage path live under peak volume. The exercise should follow actual call inventories, on-call maps, and escalation paths rather than a clean facilities deck.
Inventory before the drill
List every after-hours call 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 after-hours call spike incidents with raw timelines and any waivers. Include the source of truth for open call 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 night call would require a different procedure, then review whether that action is still permitted. Capture maximum acceptable dwell in measurable units, including which visit modalities are excluded from the after-hours path and why.
Include the calendar of known events for the next two quarters: holiday coverage blackouts, agency delays, and census spikes that shrink the usable response window. An after-hours budget that ignores those dates will look calm until the week they land.
Spike scenarios worth timing
- A minority visit bay keeps a side-channel while the aggregate night dashboard stays green.
- A restore has already left a shift without a trusted call state.
- The primary after-hours dashboard lags beyond the planned observation window.
- An operator skips a call gate because a shift cutoff is near.
- Automated and human divert messages collide under the new spike rule.
- Abort authority is unclear at week end and the update lands on the wrong amendment.
For each scenario, identify detection time, plant impact, containment, and the authority to force an after-hours call spike rollback. Require commands and dashboard links in the runbook.
Ownership once the spike window closes
Run the package in Pingpong with hospice ops, home care ops, nursing, and on-call medical seats. Ask hospice ops which visit decision becomes unsafe first if calls still stick after the claimed window. Ask home care whether night macros can absorb a forced override. Ask owners to show the exact call version or export used as the exit condition.
Related reviews include the hospice ops lead seat, a caregiver backup rule, the home care ops lead seat, and a bereavement caseload spike stress test. Browse the war-game decisions hub for adjacent controls.
Authorize the published spike path only after a timed drill restores usable hold hygiene inside the documented budget without an undocumented manual step.