War-game a transfer center SLA by proving each accept lane has a named owner, a measured age-out, and a reverse path before draft clocks start governing every transfer claim.
Transfer center SLAs fail when "accepted" means a status without a decision artifact, when teams dual-count a draft clock as both aspirational and live, and when high-volume referring sites still pin to one thin intake desk because the lane inventory is incomplete. The review needs one written inventory of accept lanes, one owner who can deny a risky shortcut, and a documented consequence when a failed accept ages past the deadline.
Write the SLA as a decision, not a slide
State which transfer classes the SLA covers, the effective date, which accept lanes change, how versions are stored, and what happens to requests already in flight. Name the referring sites that feel it first and the capacity promises that depend on coherent transfer handling. If the memo mixes a transfer center SLA with a ventilator capacity cut 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 accept deadline that would force a transfer SLA rollback within a stated window.
Break points to force early
- A high-volume referring site stays soft while the aggregate accept 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 accept state.
- The primary transfer export lags beyond the planned observation window.
- An operator skips an accept gate because a bed cutoff is near.
For each break point, require detection time, site impact, containment, and the authority to force a transfer SLA rollback. Commands and export links belong in the runbook.
Seat the hostile chairs
Feed Pingpong the SLA memo, the lane exhibits, and seating briefs for transfer center, ICU ops, ED ops, and bed management. First pass steelmans the SLA. 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 a ventilator capacity cut stress test, the ICU ops lead seat, a bed flow huddle rule, and the ED ops lead seat. More operating decisions live in the war-game decisions hub.
Ship the SLA only when approved and blocked accept labels can be reproduced from stored transfer exports without a verbal override.