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With the rise of electronic health systems, paper-based medical records are quickly becoming a thing of the past. Both clinicians and patients are more likely than ever to use electronic means to share, access, store, and communicate key medical information. And organizations like the Centers for Medicare & Medicaid are doing their part to accelerate the transition, underscoring the importance of — and their own commitment to — using digital data for quality measures.

But there’s at least one clinical area where electronic records haven’t caught on: Code Blues. During a high-stakes, life-or-death emergency, most hospitals are still using paper-based methods to document key events, timing, and interventions. This affects everything from the accuracy of the data collected to the stress scribes experience during the code.

Keep reading to learn the main drawbacks of paper-based methods, and how electronic Code Blue documentation can help.

1. Accurate timekeeping

Drawback of paper documentation

Code Blue teams that use paper documentation rely on timepieces to track events and interventions. But the type of timepiece used — wall clock, personal device, bedside monitor, etc. — can vary depending on any number of factors: scribe preference, location of the code, or simply whatever resource happens to be most accessible in the moment. As a result, event timing is one of the least standardized aspects of Code Blues.1

why it matters

If choice in timepiece seems like a trivial detail, think again. The inconsistencies add up: differences between timepieces can range from seconds to minutes.2 And since Code Blue execution is extremely time-sensitive, these seemingly minor discrepancies can mean the difference between a well-timed intervention or a delay in care.

In short: Precision matters. Hospitals need to know exactly when events and interventions occurred during the code to gauge performance and flag areas for improvement. Inaccurate timing during individual codes can mean missed opportunities for improvement and risk mitigation across the hospital.

electronic advantage

The good news? Electronic Code Blue documentation lessens or eliminates many of these concerns.

  • Electronic timestamps offer timekeeping simplicity, accuracy, and consistency.
  • Rather than trying to enforce consistent use of an external timepiece, accurate event timing is built into the tool itself.
  • Electronic timing is less error-prone than manual methods, which require scribes to continually check a timepiece and record the findings on paper.

How NUVARA® Can help

Nuvara’s CoDirector® resuscitation software takes it a step further by offering timers to pace recurring actions during the code: cardiopulmonary resuscitation intervals and pauses, pulse and rhythm checks, medication administration, and more. Since these dynamic timers are based on the patient’s rhythm and Advanced Cardiac Life Support (ACLS) protocols, they have the added advantage of helping responders adhere to established guidelines throughout the code.

2. Comprehensive data capture

Drawbacks of paper documentation

Paper-based documentation methods are riddled with problems that affect the quality and completeness of the data collected. Codes move quickly, so illegible handwriting, accidental omissions, and incorrect information are common. And it’s not for lack of effort or efficiency on the scribes’ part. Scribes are doing everything in their power to avoid these kinds of issues, but they’re limited by the tools available to them.

Plus, hospitals are often looking to compile and use that data in aggregate to inform continuous quality improvement initiatives. But anyone who has tried to manually extract information from paper records knows that it’s a cumbersome, error-prone, and inefficient endeavor.

why it matters

Accurate, comprehensive code data is crucial for everyone involved:

  • For the patient, the information in their medical record affects subsequent medical decisions, interventions, and care.
  • For staff, “if it isn’t documented, it didn’t happen.” Accurate, real-time documentation reduces liability risk and can help protect clinicians in the event of a malpractice claim.3
  • For the hospital, accurate performance and outcome data drives feedback, training, and continuous quality improvement initiatives. It’s also essential to ensure compliance with The Joint Commission.
  • Nationally, some hospitals send their data to voluntary registries, like the American Heart Association’s Get With The Guidelines®-Resuscitation, often used for benchmarking purposes. It’s only logical that the usefulness of those benchmarks depends on the accuracy of the data submitted.

electronic advantage

It’s faster and easier to document information electronically than by hand, so scribes are far less likely to miss important information.

Research backs this up. In studies of simulated cardiac arrest events, electronic documentation clearly outperforms paper:

  • One study found that electronic documentation had 28% fewer omissions, 36% less “noise” (such as cross outs and partial documentation), and overall caught 24% more critical information than paper.4
  • In another study, electronic documentation had 88% sensitivity for capturing all events, compared to 67.9% on paper.5

And although more research is needed on live cardiac arrests instead of simulations, one such study recently demonstrated similar findings: both legibility and data accuracy improved with electronic documentation.6

How NUVARA Can help

  • Nuvara’s CoDirector resuscitation software proactively prompts users to record meaningful information during the code, ensuring more accurate and comprehensive data collection.
  • The clean, intuitive documentation screen helps scribes avoid common documentation pitfalls, such as unclear, illegible information or accidental omissions.
Paper Code Blue documentation sheet on a clipboard
Electronic Code Blue documentation on a tablet

3. Improved clinician satisfaction

Drawbacks of paper documentation

Cumbersome and outdated paper documentation methods add unnecessary stress for the team during an already high-pressure emergency event. And if discrepancies are discovered after the code ends (different timings noted by the scribe and on the defibrillator, for example), it requires staff time and effort to reconcile these issues afterward.

There are implications for staff engagement and burnout as well. Since data from paper records is difficult to extract and analyze, clinicians typically receive little or no feedback on their performance once the code ends. In cases where the patient doesn’t survive, clinicians often walk away feeling demoralized — wondering if they could have done something differently, and never really knowing the answer.

why it matters

Clinician satisfaction and burnout are top concerns nationally, so hospitals always need to be on the lookout for opportunities to better support their staff. And removing sources of preventable stress and frustration is an important piece of that.

electronic advantage

  • Supports clinicians during the code: Equipped with the right tools, scribes can accurately document the details with greater ease and less stress.
  • Increases satisfaction: Not surprisingly, studies have shown that scribes strongly prefer electronic Code Blue documentation over paper.5-6
  • Saves clinician time after the code: Electronic Code Blue documentation helps responders capture data accurately the first time — greatly reducing (or better yet, eliminating) time spent on data reconciliation and double documenting after the code ends. This time and energy can instead be channeled into tasks that clinicians naturally gravitate toward and find fulfilling — like delivering high-quality, individualized care to their patients.
  • Enables data-driven feedback: Since electronic tools capture and analyze data in real time, clinicians can receive objective feedback immediately afterward during a hot debrief. This allows them to move forward from the event with actionable items for improvement — or with the peace of mind that they did everything possible for the patient.

How NUVARA Can help

  • CoDirector’s simple, user-friendly interface supports scribes during a high-stakes, fast-paced emergency event.
  • Auto-generated hot debrief reports offer the code team immediate feedback after the event.


Ready to try electronic Code Blue documentation?

With a user-friendly design, ACLS-based software prompts, and auto-generated feedback for the code team, Nuvara’s CoDirector resuscitation software can transform Code Blue documentation at your hospital.


  1. Allan, N., Bell, D., & Pittard, A. (2011). Resuscitation of the written word: Meeting the standard for cardiac arrest documentation. Clinical Medicine, 11(4), 348–52.
  2. Ferguson, E. A., Bayer, C. R., Fronzeo, S., Tuckerman, C., Hutchins, L., Roberts, K., Verger, J., Nadkarni, V., & Lin, R. (2005, March 1). Time out! Is timepiece variability a factor in critical care? American Journal of Critical Care, 14(2), 113–120.
  3. Paterick Z.R., Patel, N.J., Ngo, E., et. al. (2018, Oct.) Medical liability in the electronic medical records era. Proc (Bayl Univ Med Cent), 31(4).
  4. Grigg, E., Palmer, A., Grigg, J., Oppenheimer, P., Wu, T., Roesler, A., Nair, B., & Ross, B. (2013, July 29). Randomised trial comparing the recording ability of a novel, electronic documentation system with the AHA paper cardiac arrest record. Emergency Medicine Journal, 1–7.
  5. Peace, J.M., Yuen, T.C., Borak, M.H., Edelson, D.P. (2014, Feb.) Tablet-based cardiac arrest documentation: a pilot study. Resuscitation, 85(2): 266-269.
  6. Joseph, B., Sulmonte, K., DeSanto-Madeya, S., Koeniger-Donohue, R., & Cocchi, M. (2022). Improving accuracy in documenting cardiopulmonary arrest events. AJN, American Journal of Nursing, 122(4), 40–45.
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