The combination of surge capacity operations and EHR downtime is one of the most demanding scenarios a healthcare facility can face, and it is one that occurs more often than most organizations anticipate. Surge events, whether driven by a mass casualty incident, a disease outbreak, a regional disaster, or seasonal volume spikes, create the exact conditions that make EHR downtime most likely: elevated network load, IT teams diverted to operational support, and systems pushed beyond their normal operating parameters. When those conditions produce an EHR outage, the facility is managing two simultaneous crises with a workforce that is already stretched.
How Surge Capacity Changes the Downtime Environment
Understanding what surge capacity operations change about the downtime environment helps clarify why the standard downtime response plan needs surge-specific modifications.
Patient volume is significantly higher than normal, which means the number of patients needing registration, identification, and documentation support through the downtime workstations is larger than the system was sized for in the original deployment. A Tier 1 deployment covering five workstations that is adequate for normal patient volumes may be insufficient during a surge event where the ED alone is managing three times its normal census.
The staff-to-patient ratio is lower than normal, which means each nurse, registration clerk, and clinical support staff member is managing more patients simultaneously. The cognitive load that staff are managing during a surge event is already at or near capacity, which means the additional demand of managing downtime procedures is hitting a workforce with less reserve capacity than it has during normal operations.
The patient population during a surge event is often less well-known to the clinical team than the normal inpatient population. Mass casualty patients may arrive unidentified. Patients transferred from other facilities may have limited records available. Patients presenting from an affected community may have conditions or medication histories that are not in the local EHR. The downtime workstation’s value as a source of patient history is lower in a surge event because the patient population is more likely to have no existing record in the local system.
New patients are being registered at a much higher rate than normal, which means the pre-loaded bank of downtime encounter numbers needs to be large enough to accommodate surge-level registration volume rather than just normal-operations downtime volume.
How dbtech Supports Surge Capacity Downtime Operations
dbtech’s Downtime Solution supports surge capacity downtime operations through several capabilities that are relevant to the specific challenges of this scenario:
The patient registration workflow in dbtech, including the ability to assign downtime encounter numbers and print barcoded wristbands, scales to support higher registration volumes without requiring changes to the software configuration. The practical limit is the number of workstations available for registration use and the size of the pre-loaded encounter number bank, both of which should be evaluated against surge-level volume requirements during the initial deployment rather than after a surge event reveals the gap.
dbtech’s eForms can be configured with a surge-specific triage documentation form that captures the minimum required information for initial patient identification and triage disposition during a mass casualty event. This form is distinct from the standard clinical documentation forms and is optimized for speed rather than completeness, reflecting the different documentation priorities of surge triage compared to routine clinical care. Organizations with mass casualty or disaster response responsibilities should include this surge-specific form in their eForms library as part of their disaster preparedness planning.
The locally stored patient data on the downtime workstations provides the clinical team with reference information for any patients who are already in the system, even when the EHR is unavailable. In a regional disaster scenario where the EHR is unavailable because of infrastructure damage rather than a software failure, the locally cached patient data may be the only source of prior medical history for patients who are known to the facility.
Pre-Planning for Surge and Downtime Simultaneously
The most important preparation for managing surge capacity downtime is incorporating the combined scenario explicitly into the facility’s downtime preparedness planning and the mass casualty or disaster preparedness planning. These two planning efforts are almost always developed independently, and the specific intersection of the two scenarios is rarely addressed in either plan.
Specific pre-planning steps that reduce the burden of managing the combined scenario include:
- Calculating the surge-level registration volume the facility might need to process during a mass casualty event and confirming that the downtime encounter number bank is large enough to accommodate that volume for an outage lasting 24 hours or more
- Developing and validating a surge-specific triage eForm that registration and nursing staff have practiced using, so that the form is familiar when it is needed under the combined pressure of a mass casualty response and a system outage
- Identifying which clinical areas would need additional downtime workstations during a surge event and where those workstations would be sourced, whether through temporary redeployment from lower-priority areas or through a pre-arranged equipment reserve
- Including a combined surge-and-downtime scenario in the facility’s annual tabletop exercise program, since this is the scenario most likely to expose coordination gaps between the disaster response plan and the downtime preparedness plan
To discuss how dbtech’s deployment and configuration can be optimized for surge capacity scenarios, contact our team or request a demo.