135 - Preparing Perioperative Teams for Downtime in a Digital Healthcare Era

Description: Description of Team
To strengthen preparedness during electronic medical record (EMR) outages, Penn Presbyterian Medical Center launched a nursing-led initiative to improve documentation workflows in the perianesthesia setting. Clinical Nurse Educators led the project in collaboration with the Director of Nursing Clinical Systems and a Clinical Implementation Specialist. Together, the team brought expertise in perioperative care, electronic systems, and staff education to support safe and efficient practice during system disruptions.

Preparation and Planning
Following the July 2024 CrowdStrike outage, which disrupted EMR access nationwide, the perianesthesia team conducted a structured debrief to assess challenges. Staff were interviewed, and the completed downtime documentation was reviewed. These findings were brought forward by the team as part of a system-wide workgroup focused on improving response procedures and materials.

As part of this work, standardized forms were redesigned to better mirror EMR workflows. At the entity level, Penn Presbyterian implemented additional improvements, including reorganizing downtime boxes to separate provider and nursing content, creating premade folders for surgical cases, and updating clinical resources on designated computers to support perioperative workflows during outages.

Assessment
Perioperative operations were halted during the outage, causing significant disruption to patient care. The event exposed a widespread lack of familiarity with paper documentation, particularly among early-career nurses. Interviews and chart reviews revealed confusion about which forms to use, how to complete them, and where to find them. Existing materials did not reflect the natural flow of care, making it difficult for staff to respond effectively. These findings underscored the need for clearer tools, better organization, and targeted training.

Implementation
In June 2025, a drill was conducted to test the revised workflow using a real surgical patient. The patient moved through preoperative, intraoperative, and postoperative phases. Two nurses were assigned to each phase, one documenting in the EMR, and the other using paper forms under simulated outage conditions. Staff retrieved patient information using only the Business Continuity Access (BCA) computer. The drill evaluated usability, workflow alignment, and documentation accuracy.

Outcomes
Post-drill interviews and reviews showed that the revised forms were clear, easy to follow, and aligned with clinical steps. Nurses completed documentation without delays or omissions. Premade folders supported the process, and staff reported increased confidence with manual workflows. Opportunities for further education were also identified.

Implications for Perioperative Nursing
As electronic dependency grows, perioperative teams must remain ready for unexpected outages. This initiative demonstrated that thoughtful design, team engagement, and drill-based training can improve preparedness and safeguard patient care.