Variations in Code Team Composition During Different Times of Day and Week and by Level of Hospital Complexity

Area of Science:

• Healthcare Management
• Emergency Medicine
• Clinical Operations

Background:

• Previous studies indicate lower survival rates for in-hospital cardiac arrests during off-hours (nights and weekends).
• Variations in healthcare personnel availability and experience during different times of day and week are suspected contributors.

Purpose of the Study:

• To evaluate variations in code team personnel and intubation responsibilities during different times (day/night, weekday/weekend) within the US Veterans Affairs (VA) system.
• To compare these variations across different hospital complexities.

Main Methods:

• A survey was distributed to hospital leaders across 123 eligible VA hospitals.
• Survey data focused on code team membership, leadership, and intubation performance during four distinct time periods.
• A response rate of 75.6% (93 hospitals) was achieved.

Main Results:

• Code teams were significantly smaller during off-hours compared to regular hours.
• Intensivist physicians, anesthesiologists, and pharmacists were significantly more involved in code teams during regular hours.
• Intensivist physicians led codes and performed intubations more frequently during regular hours and in high-complexity hospitals. Respiratory therapists were more involved in intubations in low-complexity hospitals, especially at night.

Conclusions:

• Significant disparities exist in code team composition, leadership, and intubation responsibilities between regular and off-hours.
• Low-complexity (often rural) hospitals exhibit distinct team compositions and role distributions compared to high-complexity hospitals, particularly concerning off-hour critical care delivery.