Stress-test an involuntary hold review by proving that each hold window and restore rule can place unanswered review requests inside the planned lane, survive override pressure, and avoid trapping units inside a green compliance slide that hides long-lived soft holds.
Involuntary hold reviews often list a legal checklist while leaving restore behavior, override authority, and abort ownership implicit. Those edges decide whether a late hold stays inside the review packet or leaves a broken patient path live under peak volume. The exercise should follow actual clock inventories, unit maps, and escalation paths rather than a clean compliance deck.
Map every hold clock
List every involuntary 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 involuntary hold review incidents with raw timelines and any waivers. Include the source of truth for open clock 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 hold classes are excluded from the review path and why.
Include the calendar of known events for the next two quarters: court blackout dates, coverage leaves, and census spikes that shrink the usable response window. A review budget that ignores those dates will look calm until the week they land.
Drills that expose soft clocks
- A minority high-acuity unit keeps a side-channel while the aggregate hold dashboard stays green.
- A restore has already left a desk without a trusted clock state.
- The primary hold dashboard lags beyond the planned observation window.
- An operator skips a hold gate because a hearing cutoff is near.
- Automated and human divert messages collide under the new review 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 an involuntary hold review rollback. Require commands and dashboard links in the runbook.
Who owns the review after the window
Run the package in Pingpong with behavioral health ops, psychiatry leadership, risk, and legal ops seats. Ask behavioral health ops which unit decision becomes unsafe first if holds still stick after the claimed window. Ask legal ops whether petition macros can absorb a forced override. Ask owners to show the exact review version or export used as the exit condition.
Related reviews include the behavioral health ops lead seat, a crisis bed rule, a boarding crisis stress test, and a bed flow huddle rule. Browse the war-game decisions hub for adjacent controls.
Authorize the published review path only after a timed drill restores usable hold hygiene inside the documented budget without an undocumented manual step.