War-game an OR case cart delay by proving each cart lane has a named owner, a measured age-out, and a reverse path before draft holds start governing every cart lane.
OR case cart delays fail when "ready for wheels-in" means a status without a decision artifact, when teams dual-count a draft hold as both aspirational and live, and when specialty tray families still pin to one thin sterile desk because the lane inventory is incomplete. The review needs one written inventory of cart lanes, one owner who can deny a risky shortcut, and a documented consequence when a failed hold ages past the deadline.
Case-cart break points
- A specialty tray class stays soft while the aggregate OR 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 cart without a trusted hold state.
- The primary case-cart export lags beyond the planned observation window.
- An operator skips a hold gate because a wheels-in cutoff is near.
For each break point, require detection time, unit impact, containment, and the authority to force an OR case-cart delay rollback. Commands and export links belong in the runbook.
| Cart lane | Owner | Age-out | Reverse path |
|---|---|---|---|
| Standard case cart | Named sterile charge | Measured minutes | Documented hold |
| Implant dual path | Materials ops | Measured minutes | Documented restore |
| Add-on bridge cart | OR charge nurse | Measured minutes | Documented re-route |
Fill every cell from stored exports. Empty cells block approval.
Lock one cart family before scale
State which case classes the delay covers, the effective date, which hold lanes change, how versions are stored, and what happens to carts already in flight. Name the services that feel it first and the safety promises that depend on coherent case-cart handling. If the memo mixes an OR case cart delay with a tray turnaround SLA and a par level cut, split them.
Write the decision you will make if the war game finds nothing new. Also write the reverse criteria: the missed lane, sterile gap, or wheels-in deadline that would force an OR case-cart delay rollback within a stated window.
Seat the case-cart package
Feed Pingpong the delay memo, the lane exhibits, and seating briefs for sterile processing, materials, perioperative, and anesthesia. First pass steelmans the delay. 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 materials ops lead seat, the central sterile ops lead seat, a tray turnaround SLA, and a par level cut. More operating decisions live in the war-game decisions hub.
Ship the delay only when approved and blocked hold labels can be reproduced from stored case-cart exports without a verbal override.