War-game a crisis bed rule by proving each hold lane has a named owner, a measured age-out, and a reverse path before draft clocks start governing every crisis bed assignment.
Crisis bed rules fail when "held" means a status without a decision artifact, when teams dual-count a draft clock as both aspirational and live, and when high-acuity ED and inpatient lanes still pin to one thin intake desk because the lane inventory is incomplete. The review needs one written inventory of crisis hold lanes, one owner who can deny a risky shortcut, and a documented consequence when a failed hold ages past the deadline.
Write the rule as a decision artifact
State which crisis classes the rule covers, the effective date, which hold lanes change, how versions are stored, and what happens to patients already in flight. Name the units that feel it first and the access promises that depend on coherent crisis bed handling. If the memo mixes a crisis bed rule with a boarding crisis and a bed flow huddle rule, split them.
Write the decision you will make if the war game finds nothing new. Also write the reverse criteria: the missed lane, capacity gap, or hold deadline that would force a crisis bed rule rollback within a stated window.
Failures to surface before go-live
- A high-acuity ED lane stays soft while the aggregate crisis-bed dashboard stays green.
- Two teams claim the same lane ownership and neither can force a freeze at week end.
- A restore has already left a desk without a trusted hold state.
- The primary crisis-bed export lags beyond the planned observation window.
- An operator skips a hold gate because a transfer cutoff is near.
For each failure, require detection time, unit impact, containment, and the authority to force a crisis bed rule rollback. Commands and export links belong in the runbook.
Hostile chairs on the holds
Feed Pingpong the rule memo, the lane exhibits, and seating briefs for behavioral health ops, ED ops, bed management, and psychiatry leadership. First pass steelmans the rule. Later passes attack from those seats. Final pass turns surviving objections into phased lane rules, mitigations, or a changed recommendation. Agreement across passes is not proof. Keep the objections that still have evidence gaps.
Pair with the behavioral health ops lead seat, a boarding crisis stress test, a bed flow huddle rule, and the ED ops lead seat. More operating decisions live in the war-game decisions hub.
Ship the rule only when approved and blocked hold labels can be reproduced from stored crisis-bed exports without a verbal override.