War-game a ventilator wean protocol by proving each grade lane has a named owner, a measured age-out, and a reverse path before draft clocks start governing every wean trial.
Ventilator wean protocols fail when "ready to wean" means a status without a decision artifact, when teams dual-count a draft grade as both aspirational and live, and when high-risk wean families still pin to one thin respiratory desk because the lane inventory is incomplete. The review needs one written inventory of wean lanes, one owner who can deny a risky shortcut, and a documented consequence when a failed grade ages past the deadline.
Freeze one wean family first
State which wean classes the protocol covers, the effective date, which grade lanes change, how versions are stored, and what happens to patients already in flight. Name the units that feel it first and the safety promises that depend on coherent wean handling. If the memo mixes a ventilator wean protocol with an ICU stepdown hand-off and a staffing ratio cut, 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 ventilator wean protocol rollback within a stated window.
| Lane | Owner | Age-out | Reverse path |
|---|---|---|---|
| Spontaneous trial | Named respiratory lead | Measured hours | Documented abort |
| Extubation ready | ICU charge | Measured hours | Documented restore |
| High-risk dual path | LTACH ops | Measured hours | Documented re-route |
Fill the table from stored exports, not from memory. Empty cells are blockers, not notes for later.
Break points to rehearse
- A high-risk wean class stays soft while the aggregate ventilator 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 grade state.
- The primary wean export lags beyond the planned observation window.
- An operator skips a grade gate because a bed cutoff is near.
For each break point, require detection time, unit impact, containment, and the authority to force a ventilator wean protocol rollback. Commands and export links belong in the runbook.
Run the grades through hostile seats
Feed Pingpong the protocol memo, the lane exhibits, and seating briefs for ICU ops, LTACH ops, respiratory therapy, and nursing. First pass steelmans the protocol. 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 LTACH ops lead seat, an ICU stepdown hand-off, a staffing ratio cut stress test, and a ventilator capacity cut stress test. More operating decisions live in the war-game decisions hub.
Ship the protocol only when approved and blocked grade labels can be reproduced from stored wean exports without a verbal override.