Ongoing serious impact of cyberattack on HSE on Ireland’s Emergency Departments

While Ireland’s 28 Emergency Departments (EDs) and 11 Injury Units remain open, and its vitally important that this is understood, all have been very seriously impacted by the Ransomware Cyberattack on the HSE and the consequent need to shut down the multitude of ICT systems used in the public hospital system. The public needs to understand how this complete absence of the ICT backbone of the service will impact on them and the role they can play in lessening the patient safety risk of not having access to key data. While some hospitals are harder hit than others, many of the difficulties are common.

Key issues are as follows:

• Only those with a need for emergency treatment should attend an ED. Serious consideration should be given to attending other services not impacted by the absence of ICT (Primary Care, Private hospital services), where these services exist and/or are appropriate to the clinical issue. While ED medical & nursing staff will do their best to attend to those presenting, care will be provided first to those with the greatest need for care and there will inevitably be delays in patient throughput;
• As patient administration systems are not accessible, please bring with you any information of use to us in delivering care. Documentation which includes a Medical Record Number (MRN) / Patient Chart Number (PCN) is particularly helpful. This information is typically on addressograph stickers used on hospital documentation. Current medication lists, prescriptions and discharge summaries from previous episodes of care (where patients /carers have access to these) are also very useful;
• Electronic ordering of blood tests, x-rays and scans is not available; these have to be requested manually. Many of the automatic processes used in laboratories are unavailable, requiring tests to be done manually with long delays in normal turn-around times;
• We do not have access to previous x-ray or scan images or results. If an x-ray has to be requested it has to reviewed in real time on the machine used by the radiographer to take the image. This is a painfully slow, time-consuming process which interferes with the Radiographer’s workflow, further adding to delays;
• The telephone systems in many hospitals are carried on computer networks and have been affected. Even where these are still functioning, clinical staff are fully engaged in providing patient care. Please do not telephone the ED except in an emergency situation;
• If scheduled (elective) services have been cancelled as a result of the cyberattack, please do not present to the ED seeking the care/test/intervention that has been deferred. The ED will not be in a position to assist and you will be unnecessarily adding to our significant workload but doing so in vain;
• COVID-19 is still a real threat to patients and staff alike; the precautions taken by EDs to reduce the risk of COVID transmission have to remain in force.

It is important that members of the public understand how difficult the provision of care is in the current unprecedented situation and that this situation is likely to continue for some considerable time. We ask for your forbearance as we try to help you as best we can. Please help us to help you by following the above advice.

We are also acutely aware that HSE ICT personnel and many others are working day and night to restore these vital services as soon as possible and although we are currently struggling to provide our normal level of care, all of us at the frontline greatly appreciate their efforts at this difficult time.