War-game an urgent read SLA by proving each read lane has a named owner, a measured age-out, and a reverse path before draft clocks start governing every urgent imaging claim.
Urgent read SLAs fail when "read" means a status without a decision artifact, when teams dual-count a draft clock as both aspirational and live, and when high-volume ED and ICU lanes still pin to one thin reader desk because the lane inventory is incomplete. The review needs one written inventory of urgent read lanes, one owner who can deny a risky shortcut, and a documented consequence when a failed read ages past the deadline.
Write the SLA as a decision, not a slide
State which urgency classes the SLA covers, the effective date, which read lanes change, how versions are stored, and what happens to studies already in flight. Name the referring units that feel it first and the access promises that depend on coherent urgent reads. If the memo mixes an urgent read SLA with a modality schedule freeze and a contrast shortage, 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 read deadline that would force an urgent read SLA rollback within a stated window.
Break points to force early
- A high-volume ED lane stays soft while the aggregate urgent-read 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 read state.
- The primary urgent-read export lags beyond the planned observation window.
- An operator skips a read gate because a transfer cutoff is near.
For each break point, require detection time, unit impact, containment, and the authority to force an urgent read 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 imaging ops, ED ops, ICU ops, and radiology leadership. 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 the imaging ops lead seat, a contrast shortage stress test, a modality schedule freeze, and the ED ops lead seat. More operating decisions live in the war-game decisions hub.
Ship the SLA only when approved and blocked read labels can be reproduced from stored urgent-read exports without a verbal override.