War-game a PACU boarding cut by proving each boarding lane has a named owner, a measured age-out, and a reverse path before draft clocks start governing every recovery bay.
PACU boarding cuts fail when "ready for floor" means a status without a decision artifact, when teams dual-count a draft clock as both aspirational and live, and when high-acuity boarding families still pin to one thin charge desk because the lane inventory is incomplete. The review needs one written inventory of boarding lanes, one owner who can deny a risky shortcut, and a documented consequence when a failed clock ages past the deadline.
Lock one boarding family before scale
State which boarding classes the cut covers, the effective date, which clock lanes change, how versions are stored, and what happens to patients already in flight. Name the bays that feel it first and the safety promises that depend on coherent boarding handling. If the memo mixes a PACU boarding cut with an anesthesia delay spike and a same-day discharge rule, split them.
Write the decision you will make if the war game finds nothing new. Also write the reverse criteria: the missed lane, acuity gap, or patient deadline that would force a PACU boarding cut rollback within a stated window.
| Lane | Owner | Age-out | Reverse path |
|---|---|---|---|
| Uncomplicated floor | Named PACU charge | Measured hours | Documented hold |
| Stepdown bridge | PACU ops | Measured hours | Documented restore |
| High-acuity dual path | Anesthesia lead | Measured hours | Documented re-route |
Fill the table from stored exports, not from memory. Empty cells are blockers, not notes for later.
Boarding break points
- A high-acuity boarding class stays soft while the aggregate PACU 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 case without a trusted clock state.
- The primary boarding export lags beyond the planned observation window.
- An operator skips a clock gate because a bay turnover cutoff is near.
For each break point, require detection time, bay impact, containment, and the authority to force a PACU boarding cut rollback. Commands and export links belong in the runbook.
Hostile seats on the boarding clocks
Feed Pingpong the cut memo, the lane exhibits, and seating briefs for PACU, anesthesia, bed management, and quality. First pass steelmans the cut. 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 an anesthesia delay spike stress test, the perioperative lead seat, a same-day discharge rule, and a boarding crisis stress test. More operating decisions live in the war-game decisions hub.
Ship the cut only when approved and blocked clock labels can be reproduced from stored boarding exports without a verbal override.