War-game a post-acute hand-off by proving each hand-off lane has a named owner, a measured age-out, and a reverse path before draft lanes start governing every post-acute transfer.
Post-acute hand-offs fail when "handed off" means a status without a decision artifact, when teams dual-count a draft lane as both approved and live, and when high-risk transfer families still pin to one thin coordinator because the lane inventory is incomplete. The review needs one written inventory of hand-off lanes, one owner who can deny a risky shortcut, and a documented consequence when a failed lane ages past the deadline.
State the hand-off in writing
State which transfer families the hand-off covers, the effective date, which lanes change, how versions are stored, and what happens to transfers already in flight. Name the units that feel it first and the care promises that depend on coherent post-acute handling. If the memo mixes a post-acute hand-off with a readmission review ladder and a discharge planning backlog, split them.
Write the decision you will make if the war game finds nothing new. Also write the reverse criteria: the missed lane, placement gap, or patient deadline that would force a hand-off rollback within a stated window.
Break points to rehearse
- A high-dollar transfer class stays soft while the aggregate hand-off 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 post-acute state.
- The primary hand-off export lags beyond the planned observation window.
- An operator skips a hand-off gate because a discharge cutoff is near.
For each break point, require detection time, placement impact, containment, and the authority to force a hand-off rollback. Commands and export links belong in the runbook.
Adversarial passes on the lanes
Feed Pingpong the hand-off memo, the lane exhibits, and seating briefs for care management, utilization review, clinic, and quality. First pass steelmans the hand-off. 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 care management lead seat, a readmission review ladder, a discharge planning backlog stress test, and a length of stay target. More operating decisions live in the war-game decisions hub.
Ship the hand-off only when approved and blocked lane labels can be reproduced from stored post-acute exports without a verbal override.