108 Emergency Department Crowding Resulting from a Local Health System Cyberattack

Abstract

Emergency department crowding continues to be a concern in many major urban emergency departments. The causes of ED crowding are complex and multi-factorial, and now cyber attach threats are contributing to this ongoing issue. We analyze the impact of a cyberattack on a large, multi-hospital health system on the already burdensome crowding in our emergency department. This is a retrospective study evaluating the boarding of admitting patients on two EDs from a single healthcare system during an ongoing ransomware cyberattack on a neighboring health system in San Diego. San Diego regional hospitals serve an estimated population of roughly 3.3 million residents across a 4,206-square-mile land mass; approximately 1.4 million reside within the City of San Diego. One ED is in an urban level one trauma center and the other is a suburban academic hospital. They have a combined annual census of ∼80, 000). Census and admitted patients from the two-week period before (April 17 through April 30, 2021) and two weeks after (May 2 through May 15, 2021) the incident started (May 1, 2021). In the study period, the number of admissions, discharges and LWBS statuses increased therefore increasing daily ED census. Between the pre- and post-cyberattack periods, the average number of admissions, discharges, LWBS and overall census increased by 46 (95% CI = 24.32, 67.68), 7 (95% CI = -1.93, 17.93), 25 (95% CI = 13.55, 36.45) and 8 (95% CI = 3.02, 12.98), respectively. The number of EDIPs increased in the post-period. The percent of admissions being held in the ED to ED census were roughly 13% in the pre-period and 14% in the post-period, demonstrating an increased in the percent % of EDIPs within daily ED volume. These results reveal the significant rise in ED visits and boarding as a result of the ransomware cyberattack on a neighboring health system. As these attacks likely become more common in the future, local and regional response strategies to consider the safe management of patients by other unaffected health systems may help reduce the impact on ED crowding and maintain flow in the department so a sustained surge doesn’t impact patient safety.