War-game an ESI triage rewrite by proving each acuity lane has a named owner, a measured age-out, and a reverse path before draft labels start governing every ED claim.
ESI triage rewrites fail when "rewritten" means a status without a decision artifact, when teams dual-count a draft acuity as both approved and live, and when high-volume pods still pin to one thin triage desk because the lane inventory is incomplete. The review needs one written inventory of acuity lanes, one owner who can deny a risky shortcut, and a documented consequence when a failed rewrite ages past the deadline.
Pin the rewrite scope
State which pods the rewrite covers, the effective date, which acuity lanes change, how versions are stored, and what happens to patients already in flight. Name the ESI bands that feel it first and the throughput promises that depend on coherent acuity handling. If the memo mixes an ESI triage rewrite with a left-without-being-seen ladder and a boarding crisis path, 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 an ESI rollback within a stated window.
Break points to force early
- A high-acuity band stays soft while the aggregate ESI 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 pod without a trusted ESI state.
- The primary ESI export lags beyond the planned observation window.
- An operator skips an ESI gate because a shift cutoff is near.
For each break point, require detection time, pod impact, containment, and the authority to force an ESI rollback. Commands and export links belong in the runbook.
Opposing passes on the rewrite
Feed Pingpong the rewrite memo, the lane exhibits, and seating briefs for ED ops, triage nursing, registration, and quality. First pass steelmans the rewrite. 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 ED ops lead seat, a left-without-being-seen ladder, a boarding crisis stress test, and a bed flow huddle rule. More operating decisions live in the war-game decisions hub.
Ship the rewrite only when approved and blocked ESI labels can be reproduced from stored ESI exports without a verbal override.