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Updated: Nov 11, 2025
Setup and Execution Of the Blindfolded Code Training Exercise
Published on: March 29, 2019
Evaluation of Communication and Safety Behaviors During Hospital-Wide Code Response Simulation
Dennis M Ren1, Anna Abrams, Maureen Banigan
1From the Division of Emergency Medicine (D.M.R., R.B., J.M.C, P.Z.), Children's National Hospital, Washington, DC; Division of Emergency Medicine (A.A.), Children's Hospital Colorado, Aurora, CO; Department of Anesthesiology and Critical Care Medicine (M.B.), Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics (R.B., J.M.C., A.G., R.I., P.Z.), George Washington University School of Medicine and Health Sciences; Simulation Program (L.N., H.A.W.), Children's National Hospital; School of Nursing & Allied Health (A.G.), Liverpool John Moores University in Liverpool, England; Division of Biostatistics and Study Methodology (R.I.), Children's Research Institute, Children's National Hospital, Washington, DC; Department of Pediatrics (M.O.), Maine Medical Center, Portland, ME; Department of Emergency Medicine (M.P.), University of Florida College of Medicine; University of Florida Center for Experiential Learning and Simulation (M.P.), University of Florida College of Medicine, Gainesville, FL; and Global Health Initiative Children's National Hospital (R.S.), Washington, DC.
Introduction:
To understand the baseline quality of team communication behaviors at our organization, we implemented institution-wide simulation training and measured the performance of safety behaviors of ad hoc teams in emergent situations.
Methods:
Clinicians participated in 2 interprofessional video-recorded simulation scenarios, each followed by debriefing. Using a standardized evaluation instrument, 2 reviewers independently evaluated the presence or absence of desired team safety behaviors, including escalating care, sharing a mental model, establishing leadership, thinking out loud, and identifying roles and responsibilities. We also scored the quality of sharing the mental model, closed-loop communication, and overall team performance on a 7-point scale. Discordant reviews were resolved with scoring by an additional reviewer.
Results:
A total of 1404 clinicians participated in 398 simulation scenarios, resulting in 257 usable videos. Overall, teams exhibited desired behaviors at the following frequencies: escalating care, 85%; sharing mental models, 66%; verbally establishing leadership, 6%; thinking out loud, 87%; and identifying roles and responsibilities, 27%. Across all reviews, the quality of the graded behaviors (of 7 points) was 2.8 for shared mental models, 3.3 for closed-loop communication, and 3.2 for overall team performance.
Conclusions:
In a simulation setting with ad hoc teams, there was variable performance on completing safety behaviors and only a fair quality of graded communication behaviors. These results establish a baseline assessment of communication and teamwork behaviors and will guide future quality improvement interventions.
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