Maintaining Optimal Trauma Outcomes: Resilience in the Midst of a Ransomware Attack

Study Overview
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Brief Summary
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Retrospective review of de-identified hospital emergency room and trauma registry data and operating room case logs from April 9th through June 9th, 2016, 2017 examining outcomes as affected by a ransomware attack in a level I trauma center

Detailed Description
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On April 9, 2017, Erie County Medical Center, Western New York's sole level I trauma center was under cyberattack. The perpetrators utilized ransomware that gained access to the hospital's web server and encrypted hospital data, forcing a system-wide downtime for nearly 2 months. Electronic medical records, imaging, and interdepartmental communication were severely affected, forcing the hospital to temporarily return to pre-EMR era operations. We examined the impact of this cyber disaster on the outcomes of trauma care. Retrospective review of de-identified hospital emergency room and trauma registry data and operating room case logs from April 9th through June 9th, 2016, 2017, and 2018. Baseline characteristics of study cohort for each period will be examined using the chi-square test for categorical variables and the Student's t-test for continuous variables that are normally distributed. This was an exempt study in our institution.

Official Title
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Maintaining Optimal Trauma Outcomes: Resilience in the Midst of a Ransomware Attack

Conditions
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Trauma, Electronic Health Record

Intervention / Treatment
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* Other: Event


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All trauma patient admissions that were seen through the ECMC Trauma Center from April to June 2016 and April to June 2017 Adult patients >13 years old Exclusion Criteria: -Patients who came through the emergency department that were not categorized as trauma patients
Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Control<br>Trauma admissions in April-June 2016. | |
| Ransomware Group<br>Trauma admissions in April-June 2017. | Other: Event<br>* Ransomware attack<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital and ICU length of stay (LOS), and in-hospital mortality | Hospital and ICU length of stay (LOS) in days And in-hospital mortality between cohorts expressed as percentage of cohort | April to June 2016 and 2017 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Disposition at discharge and AHRQ patient safety indicators: DVT/PE, CLABSI, CAUTI, and organ/space surgical infection. | Disposition at discharge defined as either discharged home, died, or sent to a rehabilitation facility, all expressed as the proportion of the cohort group with the above-mentioned findings reported in percentages All AHRQ patient safety indicators: DVT/PE, CLABSI, CAUTI, and organ/space surgical infection are indicated as the proportion of the cohort group with the above-mentioned findings reported in percentages | April to June 2016 and 2017 |