Code Triage Implementation Impact on Code Blue Team Respiratory Therapists

Background: An established code blue (CB) response team is essential for cardiopulmonary arrests within hospitals. Within U.S. hospitals, over 15,000 children receive CPR during their hospitalization. However, with employees, family members, and outpatient visitors, incidents that do not require the same medical attention a CB team would provide can occur. On June 27, 2022, our pediatric hospital (260-bed, Level 1 Trauma, Level IV NICU) created a tiered emergency response system to support lesser acuity emergencies, allowing clinical staff to remain at the bedside for qualifying emergency response events (Figure 1). The Code Triage Team (CTT) intended to care for non-admitted patients who needed medical attention but were breathing and awake/oriented. The CTT members include 2 EMTs, while the CB Team (CBT) consists of an RN, RT, and a PICU Fellow. We aim to assess the impact of Code Triage (CT) and Code Response Teams (CRT) on RT time off the unit. Methods: In an IRB-exempt retrospective study, we evaluated the number of CB events a year before (6/27/2021–6/26/2022), the go-live of CTT, and then the number of CB and CT the year following (6/27/2022–6/26/2023). Electronic medical record documentation for CB was reviewed during the study period to determine an average time standard for RTs to respond to code blues. CTT and CBT events were reviewed in the post-go-live period to determine how many CTT events escalated to a CBT response. Data were analyzed using a paired t-test to determine statistical significance. Results: The average time for an RT to respond to a CB in our facility was 45 min. In the year before CTT, there were 177 CBs, resulting in 132.75 h of CB RT time (equivalent to 0.26 FTE). Post initiation of CTT, there were 74 CB and 148 CTT, leading to a decrease of 77.25 h (82.07% decrease) for CB RT response (equivalent to 0.11 FTE). There was a 41.8% decrease in CB after initiation of CTT (Figure 2). Of the CTT events, 1% were escalated to a CBT during the post-go-live period (n = 2). Conclusions: With the creation of the CTT, there was a statistically significant decrease (P < .05) in the number of CBs called and the time the RT spent out of critical care units (P< .05). A tiered emergency response system can support RT value efficiency and reduce the risk for errors by limiting care interruptions for CBT members. Further studies must be done to evaluate the effectiveness of a CTT in other environments and assess the impact on staff and patient satisfaction.Figure 1 details how to determine if a patient needs a code triage or code blue response.Figure 2 details the frequency of code blue and code triage events in the study period and the impact on RT time off the unit to respond.