Impact of Pre-EMR Staff During the Crowdstrike Outage

Summary: Electronic Medical Records (EMRs) have become ubiquitous in Emergency Departments (EDs), particularly after the passing of the Meaningful Use Act in 2009. While they offer numerous advantages, they are susceptible to downtime, necessitating a return to paper-based systems. These downtime periods will likely disrupt workflow and patient care, highlighting the importance of effective training and preparation for downtime proceedings. Preparation for these procedures can be particularly challenging, especially for those with limited experience in paper-based systems. Experienced clinicians, particularly those who practiced medicine before the widespread adoption of EMRs, can play a crucial role in training their colleagues and starting downtime procedures during unexpected interruptions in electronic systems. During the 2024 CrowdStrike outage, the emergency department experienced an EMR outage spanning two clinical shifts, beginning at approximately 3:09 AM. Faculty interviews were performed as part of the after-action report for this prolonged outage. Post-outage debriefings revealed that overnight staff, many of whom (five out of six attendings) had limited to no clinical experience prior to 2009, struggled with downtime workflows. In contrast, the 7 AM shift, staffed by four attendings with pre-2009 clinical experience, navigated the outage more effectively and with less stress. It was also reported that the experienced overnight Charge-Nurse (with more than 20 years of experience) had critical knowledge of implementing paper downtime procedures and helped guide the overnight staff through the CrowdStrike outage. This highlights the importance of having experienced clinicians across all shifts to significantly improve downtime operations and facilitate just-in-time training for less experienced staff. As operations rely more heavily on EMRs, maintaining a robust approach to downtime preparedness is essential. By leveraging the expertise of experienced clinicians, healthcare organizations can effectively train their staff, optimize workflow, and ensure patient safety during system outages, which are both scheduled and unplanned.