War-game an access infection ladder by proving each grade lane has a named owner, a measured age-out, and a reverse path before draft clocks start governing every vascular access case.
Access infection ladders fail when "escalated" means a status without a decision artifact, when teams dual-count a draft grade as both aspirational and live, and when high-risk access families still pin to one thin infection desk because the lane inventory is incomplete. The review needs one written inventory of infection lanes, one owner who can deny a risky shortcut, and a documented consequence when a failed grade ages past the deadline.
State the ladder in writing
State which access classes the ladder 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 infection handling. If the memo mixes an access infection ladder with a chair utilization freeze and an isolation protocol cut, split them.
Write the decision you will make if the war game finds nothing new. Also write the reverse criteria: the missed lane, culture gap, or patient deadline that would force an access infection ladder rollback within a stated window.
Break points to rehearse
- A high-risk access class stays soft while the aggregate infection 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 infection export lags beyond the planned observation window.
- An operator skips a grade gate because a treatment cutoff is near.
For each break point, require detection time, unit impact, containment, and the authority to force an access infection ladder rollback. Commands and export links belong in the runbook.
Adversarial passes on the grades
Feed Pingpong the ladder memo, the lane exhibits, and seating briefs for dialysis ops, infection control, nephrology, and quality. First pass steelmans the ladder. 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 dialysis ops lead seat, the infection control lead seat, an isolation protocol cut, and an outbreak response ladder. More operating decisions live in the war-game decisions hub.
Ship the ladder only when approved and blocked grade labels can be reproduced from stored infection exports without a verbal override.