Evaluation of the Effect of Mock Code Simulations on Code Blue Outcomes in a Saudi Tertiary Care Hospital

Background and aim: Mock code simulations have been employed to enhance resuscitation preparedness. However, support evidence from adult Saudi tertiary care hospitals remains scarce, particularly concerning their correlation with actual Code Blue outcomes rather than solely simulated performance. This study assesses whether implementing an in-situ mock code simulation program is associated with improvements in Code Blue outcomes and resuscitation performance metrics. This study aimed to provide context-specific evidence on changes in resuscitation process indicators and clinical outcomes, thereby supporting institutional efforts to strengthen emergency preparedness and patient safety in Saudi tertiary care practice. Methods: A quantitative retrospective pre/post-intervention study was conducted utilizing Code Blue records from January to December 2025, including all adult patients with documented Code Blue incidents within the hospital, and analyzed 37 adult Code Blue records. The variables that were analyzed in this study included demographic characteristics, process indicators, advanced cardiovascular life support (ACLS) adherence metrics, and clinical outcomes. Results: Primary clinical outcomes, return of spontaneous circulation (ROSC) (pre: 13/20, 65.0%; post: 13/17, 76.5%) and 28-day mortality, showed no statistically significant differences. Significant improvements were observed in ACLS adherence as follows: 2-min pulse time documentation increased from five (31.3%) to 16 (94.1%), rhythm identification increased from nine (56.3%) to 15 (88.2%), and epinephrine for non-shockable rhythms increased to 100.0% (17/17). Conclusions: No statistically significant differences were observed in primary clinical outcomes, including return of spontaneous circulation and 28-day mortality. The most notable findings were ACLS adherence, particularly during each 2-min pulse check and 2-min rhythm check, and epinephrine administration in non-shockable rhythms. Mock code significantly enhanced ACLS adherence and quality process, although no immediate improvements were noted in survival outcomes. These results suggest that simulation-based training should be maintained and expanded as a strategy to strengthen resuscitation processes and team performance.