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The Impact on Patient Prognosis of Changes to the Method of Notifying Staff About Accepting Patients With
Youichi Inoue1,2, Keisuke Okamura3,4,2, Hideaki Shimada5
1Emergency Room, Imamura Hospital, Tosu, Saga, Japan.
Insights
Implementing a Code Blue system improved outcomes for out-of-hospital cardiac arrest (OHCA) patients by increasing the number of staff present and enhancing survival rates. This system facilitates better emergency room preparedness and patient care.
Area of Science:
- Emergency Medicine
- Cardiology
- Healthcare Systems Improvement
Background:
- Hospitals designated for emergency care frequently treat out-of-hospital cardiac arrest (OHCA) patients.
- Traditional notification methods for OHCA patient arrivals caused delays in emergency room (ER) preparation.
- A Code Blue system (CB) was implemented to broadcast impending OHCA patient arrivals hospital-wide, aiming to expedite ER readiness.
Purpose of the Study:
- To retrospectively analyze the clinical impact of introducing a Code Blue system (CB) on OHCA patient prognosis.
- To evaluate if the CB system is a clinically meaningful advancement in managing OHCA patients.
Main Methods:
- Retrospective analysis comparing OHCA patient cases before and after CB implementation.
- Data collected from March 3, 2022, to March 22, 2023 (pre-CB) and March 23, 2023, to July 23, 2024 (post-CB).
- Comparison of key outcome metrics including return of spontaneous circulation (ROSC) and survival to discharge.
Main Results:
- The mean number of medical staff at admission significantly increased from 5.4 to 15.0 post-CB implementation (P < 0.001).
- While not statistically significant, the ROSC rate increased from 20% to 30%, and survival to discharge rose from 3% to 10%.
- In specific subgroups, such as OHCA patients with cardiac disease, ROSC rates showed marked improvement, particularly those with initial ventricular fibrillation or pulseless electrical activity (0% to 100%).
Conclusions:
- Code Blue system implementation may enhance ROSC rates and survival to discharge for OHCA patients.
- The CB system appears to improve the quality of medical care by enabling rapid assembly of necessary medical staff.
- Efficiently gathering medical teams allows for predefined roles to be executed promptly, optimizing patient management.
Background:
Our hospital is a designated emergency hospital and accepts many patients with out-of-hospital cardiac arrest (OHCA). Previously, after receiving a direct call from emergency services to request acceptance of an OHCA patient, the emergency room (ER) chief nurse notified medical staff. However, this method delayed ER preparations, so a Code Blue system (CB) was introduced in which the pending arrival of an OHCA patient was broadcast throughout the hospital.
Methods:
In this study, we retrospectively analyzed the impact of introducing CB at our hospital on OHCA patient prognosis to examine whether the introduction of CB is clinically meaningful. We compared consecutive cases treated before introduction of the CB (March 3, 2022, to March 22, 2023) with those treated afterwards (March 23, 2023, to July 23, 2024).
Results:
A total of 30 cases per group were included. The mean number of medical staff present at admissions increased significantly from 5.4 ± 0.6 to 15.0 ± 3.0 (P < 0.001). Although not statistically significant, the introduction of the CB increased the return of spontaneous circulation (ROSC) rate from 20% to 30%, survival to discharge rate from 3% to 10%, and social reintegration rate from 0% to 3%. ROSC occurred in 15 patients. Among OHCA patients with cardiac disease, the ROSC rate tended to increase from 0% to 43% (P = 0.055). In addition, in OHCA patients with cardiac disease whose electrocardiogram initially showed ventricular fibrillation or pulseless electrical activity, the ROSC rate increased from 0% to 100%. ROSC tended to be influenced by the total number of staff and physicians present and the number of staff such as medical clerks, clinical engineers, and radiology technicians (P = 0.095, 0.076, 0.088, respectively).
Conclusions:
Introduction of a CB may increase the ROSC rate and the number of patients surviving to discharge. It also appears to improve the quality of medical care by quickly gathering all necessary medical staff so that they can perform their predefined roles.
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