Learnings From a National Cyberattack Digital Disaster During the SARS-CoV-2 Pandemic in a Pediatric Emergency Medicine Department.

OBJECTIVE: The primary objective was to analyze the impact of the national cyberattack in May 2021 on patient flow and data quality in the Paediatric Emergency Department (ED), amid the SARS-CoV-2 (COVID-19) pandemic. METHODS: A single site retrospective time series analysis was conducted of three 6-week periods: before, during, and after the cyberattack outage. Initial emergent workflows are described. Analysis includes diagnoses, demographic context, key performance indicators, and the gradual return of information technology capability on ED performance. Data quality was compared using 10 data quality dimensions. RESULTS: Patient visits totaled 13 390. During the system outage, patient experience times decreased significantly, from a median of 188 minutes (pre-cyberattack) down to 166 minutes, most notable for the period from registration to triage, and from clinician review to discharge (excluding admitted patients). Following system restoration, most timings increased. Data quality was significantly impacted, with data imperfections noted in 19.7% of data recorded during the system outage compared to 4.7% before and 5.1% after. CONCLUSIONS: There was a reduction in patient experience time, but data quality suffered greatly. A hospital's major emergency plan should include provisions for digital disasters that address essential data requirements and quality as well as maintaining patient flow.

This infant is having a stroke: an illustrative case report.

BACKGROUND: Paediatric stroke is a rare event, and timely intervention is required to minimise long-term disability, reduced quality of life and financial implications. Although reperfusion strategies such as thrombolysis and thrombectomy are now well established in the adult population, and paediatric consensus guidelines allow for reperfusion therapies in children, access is currently limited due to diagnostic delays. This challenge is partly due to the rarity of presentation, infrastructure and public awareness to support early diagnosis as exists in the adult setting. We use an illustrative case and literature to describe an achieved case of paediatric stroke within an Irish setting. METHODS: We use the case of an 8-month-old male infant presenting with acute-onset left-sided hemiplegia to illustrate what can be achieved in an Irish setting. RESULTS: Stroke was identified quickly following presentation, timely neuroimaging and multidisciplinary involvement with disposition to paediatric intensive care unit where thrombolysis was administered. Although the patient has some speech delay, he is recovering well with normal gross motor function. CONCLUSIONS: Paediatric stroke care should be available to all children presenting with acute stroke symptoms; however, the rarity of the diagnosis would suggest a national strategy will be required to provide equitable care at a national level.