Skip to main content

key takeaways

  • Studies show that mock Code Blues can improve performance, staff confidence, and patient outcomes.
  • Hospitals looking to optimize their mock Code Blue program should focus on the following areas: goal setting, training scenarios, data collection, logistics, and debriefing.

The research is clear: Mock Code Blues work. Studies have shown that a robust mock code program can help improve response time, staff competency and confidence during events, and patient outcomes.1-4 But while the benefits of mock codes are well-established, hospitals are often looking for a little more guidance when it comes to the logistics of implementation — and we’re here to help.

If your hospital is just starting to roll out a mock Code Blue program, check out our blog for everything you need to know to get started. Already have an established program and looking to optimize? This article is for you. Keep reading to learn our top tips to take your hospital’s mock codes to the next level.

1. Revisit your goals regularly

The ultimate goal of any mock Code Blue program is to improve patient outcomes, but it helps to get more specific than that. Your hospital likely set a number of goals at the inception of the program, but the work doesn’t end there. It’s important to revisit those goals regularly. Doing so helps gauge the program’s effectiveness and determine any areas of weakness that could be improved going forward. For example:

  • Team training: Is the code team comfortable working together, do they work in sync, and how well do they communicate in a high-stakes scenario?
  • Role expectations: Does every team member know their role during the code (e.g., documenter, compressor, medication nurse) and have a clear understanding of its requirements and how to meet them?
  • New staff orientation: How prepared are new staff members for emergency response? Do they understand their role, the hospital protocols, and how to respond effectively? Are mock codes occurring frequently enough to prepare them for real-life events?
  • High-quality cardiopulmonary resuscitation (CPR): Is the code team regularly meeting the metrics for high-quality CPR in mock codes and in actual events? What are common areas of weakness, and how could those areas be better targeted in mock scenarios?

2. Provide the right training scenarios

The clinical scenario you put staff members in during training is an important piece of any successful mock Code Blue program.

One key factor to consider is timing. It’s no secret that clinicians are pressed for time, so scenarios should be targeted and relatively quick to complete. For example, you might place a patient in pulseless ventricular tachycardia or ventricular fibrillation to see how quickly staff can respond to an emergency alarm, start CPR, defibrillate, and find epinephrine in the crash cart.

The more established your program — and the more data you have — the easier it will be to determine which specific mock code scenarios will be most beneficial to staff. That brings us to our next point: data collection.

3. Upgrade your data collection system

Hopefully you already gave some thought to the specific data points you want to capture at the start of your hospital’s mock Code Blue program. Make sure you also consider an equally important question: How is the data being collected?

Data is only useful if you can learn from it and make those learnings actionable. That’s why keeping data collection simple and easy to correlate is essential. Hospitals have a couple collection methods to consider, ranked from least to most effective:

Average: Data collection form on paper

This is the method most hospital staff are familiar with, and it requires little to no training. But keep in mind that the same downsides of paper documentation that can hinder performance during an actual code apply in practice as well. Errors are more likely, paper forms can get lost, and it wastes time to transfer data to an electronic format later on.

Better: Electronic survey or spreadsheet

Using existing tools — like an Excel spreadsheet or a survey via Microsoft Forms — is a step in the right direction. These strategies move the documentation format from paper to electronic. But these tools weren’t designed specifically for codes and will require time, effort, and manipulation to produce the data you want.

Best: Electronic Code Blue documentation tool

If your hospital has already invested in a dedicated Code Blue documentation tool (or is planning to), this is the optimal method. Not only will this give staff ample opportunity to practice and become comfortable with the technology, but these tools are designed to easily and efficiently collect code data.

For example, CoDirector® Resuscitation Software from Nuvara® makes it easy to run mock codes with its Training Mode feature. Training Mode preserves data integrity and simplifies analysis by storing mock code data separately from actual event/patient data. It also mimics the functionality clinicians would use during an actual event: timers to track recurring interventions during the code, guardrails to stay aligned with Advanced Cardiac Life Support/Pediatric Advanced Life Support algorithms, debriefing reports, and more. This helps make training as realistic and effective as possible.

Mock Code Blue Data: It Matters!

If you need more reasons to prioritize accurate, efficient data collection for mock codes, consider all the ways that data can be analyzed and used:

  • To help highlight strengths and weaknesses at your hospital and guide the direction of the mock code program going forward (for example, to identify which specific training scenarios staff may need more of)
  • To show improvement/gains from the program to staff and the resuscitation committee
  • To demonstrate the impact of your time and effort and obtain continued support from administration

4. Fine-tune the logistics

If your mock Code Blue program has been running for any length of time, you’ve likely settled on the basics: location, frequency, low-fidelity or high-fidelity mock codes, etc.

Now is the time to fine-tune those logistics, change anything that’s not working, and evaluate a few additional considerations:


Skip the calendar invite: Surprise (rather than pre-scheduled) simulations are considered the gold standard for mock codes. Since the team won’t have a scheduled event to prepare for, hospitals will get a more accurate picture of the team’s readiness and response.


If the simulation is done in a public space, plan on having the debrief in a private staff room or break room. It’s important that the team can speak openly and honestly without concern that patients or families may overhear the discussions.


Per The Joint Commission, any items used for training need to be labeled as such. This helps prevent errors and confusion — for example, so that training medications and real medications do not get mixed up.

5. Recommit to regular debriefing

Did your hospital set out with the best intentions to hot debrief after every mock code but fell off the bandwagon at some point? It’s not uncommon: Studies show that hospitals struggle to implement regular hot debriefs after actual codes,5 let alone practice ones.

That said, debriefing is an important part of the event, so it’s crucial to make it a priority. Debriefs reinforce the great work staff has done and help build muscle memory for the parts that need improvement. To improve consistency, designate a leader who is responsible for facilitating a quick discussion immediately after the event ends. Then follow these tips to make the most of your hot debrief:

  • Keep morale high. Start with the positive, discuss opportunities for improvement, and end on a high note.
  • Share information. Use the debrief as an opportunity to review any upcoming changes in emergency response policies or discuss trends noticed by the resuscitation committee.
  • Take action afterward. Listen to staff about any barriers they bring up. Document these and bring them back to the resuscitation committee or department affected. For example, if crash carts were stocked incorrectly, work with materials management to resolve the issue.


Keep improving

Looking for more ways to improve code performance and patient outcomes? Read our top 5 tips for improving Code Blue response next.


  1. Herbers MD, Heaser JA. (2016). Implementing an in situ mock code quality improvement program. American Journal of Critical Care, 25(5), 393–399.
  2. Ngo DQ, Vu C, Nguyen T, et al (2020). The effect of mock code blue simulations and dedicated advanced cardiac life support didactics on resident perceived competency. Cureus. Retrieved July 29, 2021, from
  3. Josey K, Smith ML, Kayani AS, et al (2018). Hospitals with more-active participation in conducting standardized in-situ mock codes have improved survival after in-hospital cardiopulmonary arrest. Resuscitation, 133, 47–52.
  4. Tofil NM, Lee White M, Manzella B, et al (2009). Initiation of a pediatric mock code program at a children’s hospital. Medical Teacher, 31(6), e241–e247.
  5. Malik AO, Nallamothu BK, Trumpower B, et al. (2020). Association between hospital debriefing practices with adherence to resuscitation process measures and outcomes for in-hospital cardiac arrest. Circ Cardiovasc Qual Outcomes. 13(11).
The information provided in this article is strictly for the convenience of our customers and is for general informational purposes only. Publication by Nuvara does not constitute an endorsement. Nuvara does not warrant the accuracy or completeness of any information, text, graphics, links, or other items contained within this document. Nuvara does not guarantee you will achieve any specific results if you follow any advice in the document. It may be advisable for you to consult with a professional such as a lawyer, doctor, nurse, business advisor, or professional engineer to get specific advice that applies to your specific situation.