Drills Done Right: How to Train for the Digital Blackout

Every healthcare organization has a downtime plan—but not every organization is ready for downtime.

In theory, most hospitals can point to a binder, PDF, or checklist that outlines what to do when the electronic health record (EHR), communication systems, or clinical platforms go offline. But when the real-world stress of an IT failure hits, plans alone aren't enough. The difference between disruption and disaster often comes down to one thing: training.

Just like trauma response or emergency codes, downtime must be practiced—not just discussed. That means moving beyond policy and into action through structured, realistic downtime drills that test systems, staff, and readiness.

Here’s how hospitals can build effective downtime training programs that prepare teams for the inevitable digital blackout.

Why Training Matters More Than Planning

A well-written plan is useless if staff don’t know how to execute it.

Too often, downtime protocols are reviewed annually or only discussed during audits. Staff may not know where the paper forms are stored, how to complete a manual MAR, or what to do when secure messaging fails. In a high-stakes clinical environment, guessing is not an option.

Downtime Drills Close the Gap Between Theory and Practice:

• Reveal real-world obstacles like missing supplies, unclear roles, or workflow bottlenecks

• Build muscle memory for manual workflows and alternate communication methods

• Boost confidence among frontline staff and clinical leadership

• Strengthen cross-team coordination when normal systems are unavailable

A drill may last 90 minutes—but its impact on patient safety and operational resilience is long-lasting.

Key Elements of an Effective Downtime Drill Program

1. Scenario-Based Planning: Simulate What Could Really Happen

Choose scenarios based on your most likely and highest-risk events:

• EHR outage during a trauma activation

• VoIP communication failure in the ICU

• Network disruption impacting pharmacy order entry

• Power outage affecting lab and imaging systems

Make the scenario as realistic as possible. Tailor it to the department’s environment and workflows.

2. Interdisciplinary Participation: Involve Every Level of the Organization

Downtime isn’t just a clinical or IT event—it affects everyone. Include:

• Physicians, nurses, and ancillary staff

• IT and informatics

• Pharmacy, lab, radiology

• Administrative and unit coordinators

• Executive sponsors and safety officers

Cross-functional participation ensures the whole system is stress-tested—not just individual departments.

3. Role-Specific Training Objectives

Each role should have a defined set of actions to test during the drill. Examples:

• Can a nurse access the downtime MAR and administer medications correctly?

• Can a physician place lab and imaging orders using paper forms?

• Can the unit coordinator document a transfer without electronic systems?

• Can pharmacy receive, verify, and fulfill a manual order?

Success means staff don’t just understand what to do—they can actually do it.

4. Drill Tools: Use the Real Downtime Kits and Workflows

Don’t simulate using placeholders. Use actual downtime tools:

• Paper documentation forms

• Communication backups (e.g., two-way radios, overhead paging)

• Manual tracking logs for procedures, medications, and orders

• Printed patient summaries and ID verification tools

The goal is to build fluency with the same materials they’ll use during a real event.

5. Live Observation and Documentation

Assign observers with checklists to monitor how staff perform:

• Was the correct form used?

• Were verbal read-backs completed?

• Did staff escalate concerns or delays appropriately?

• Was communication between departments effective?

Observers can be from quality, safety, or risk teams—providing unbiased assessment and feedback.

6. Structured Debrief and Feedback Loop

After the drill, gather all participants for a formal debrief:

• What worked well?

• What barriers or confusion emerged?

• Were supplies and tools easily accessible?

• Did documentation meet safety and compliance standards?

Capture these insights in a post-drill report, assign follow-up actions, and incorporate improvements into future drills and planning.

Making Downtime Drills Part of Culture

Drills shouldn’t be one-time events. They should be embedded into the organizational culture just like fire drills, rapid response training, or sepsis huddles.

Best Practices:

• Conduct at least two major drills annually

• Rotate departments and systems being tested

• Coordinate with emergency management and IT

• Incorporate downtime into new hire onboarding and clinical education

Training ensures that when systems fail, staff don’t. They respond calmly, competently, and with patient safety top of mind.

Final Thoughts: Drills Build Confidence Before Crisis

You don’t rise to the level of your downtime plan. You fall to the level of your training.

Hospitals that run regular, well-designed downtime drills are better equipped to maintain safe, efficient operations when systems go dark. They don’t panic. They pivot. And they recover faster—with fewer safety events, less operational confusion, and more resilient teams.

Ready to Put Your Downtime Plan to the Test?

At Stone Risk Consulting, we help healthcare organizations design and facilitate live downtime drills that align with clinical workflows, IT recovery, and safety protocols. From scenario development to post-drill analysis, we ensure your team is prepared when it matters most. Contact us to schedule your next drill.