Background and objectives: Cyberattacks against healthcare institutions are an increasing threat and have the potential to impair health outcomes. Current research is limited and focuses mainly on the technical consequences, whereas little is known about the healthcare staff experiences and the impact on emergency care, both during the incident and in the recovery phase. This study aims to explore the impact of a sample of large ransomware attacks against hospitals between 2017 and 2022 on acute care delivery and patient care during the recovery phase. Methods: This interview-based qualitative study assessed the experiences of emergency healthcare professionals and Information and Communication Technology (ICT) staff and investigated the challenges faced when struck by a major hospital ransomware attack. The semi-structured interview guideline was based on current literature and cybersecurity expert consultation. Transcripts were anonymized and information tracing back to participants and/or their organizations was removed for privacy purposes. Results: Nine participants were interviewed, including emergency healthcare providers and ICT-focused staff. Five themes were constructed from the data: impact and challenges regarding patient care continuity, challenges during the recovery process, personal impact on healthcare staff, preparedness, and lessons identified and future recommendations. Conclusions: According to the participants of this qualitative study, ransomware attacks have a significant impact on emergency department (ED) workflow, acute patient care and the personal wellbeing of healthcare providers. Preparedness for such incidents is often limited and many challenges are encountered during the acute and recovery phase of the attack. Proactive preparedness efforts are essential to improve contingency planning and to develop response strategies for hospital ransomware attacks.

Background: Healthcare organizations are becoming increasingly dependent on Information technology (IT) for the provision of routine services. IT failures within hospital systems can impact acute patient care, including emergency department (ED) closure and the cancellation of operations. This study aims to gain insight into the impact of hospital IT failures in the Netherlands on acute care delivery and to provide recommendations for future preparedness. Methods: This is a systematic scoping review of major acute care disruptions in Dutch hospitals between 2000 and 2020. Incidence of etiology, duration, ED diversion, and closure of multiple locations was evaluated. IT failures were included when associated with the closure of hospital departments and/or evacuations. Results: Thirty-nine IT failures resulting in acute care disruption were identified. The majority occurred between 2010 and 2020 (n=37, 95%). Of the 39 events, 33 (85%) were primary IT failures and were mainly caused by computer network and/or hospital software failure. Secondary events predominantly resulted from power failure. Most events (n= 36, 92%) were resolved within minutes to hours. All events were associated with an ED closure, 27 (69%) with an operating room (OR) stop and two (5%) with external hospital evacuation of one or more patients. Furthermore, 17 incidents (44%) involved multiple hospital locations, and seven (41%) of these involved closure of multiple locations with an ED. Conclusion: The impact of IT failures on acute care disruptions in the Netherlands has considerably increased since 2010. This stresses the urge to improve IT security and business continuity in todays hospitals.