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When it comes to emergency cardiac resuscitation, every hospital is different. From systems and processes to data collection and review, many variables shape each institution’s response procedures.

That variability is one reason some hospitals continue to fall behind the American Heart Association’s goals for in-hospital cardiac arrest (IHCA) survival while others exceed expectations. Yet in some areas, flexibility is necessary to ensure each hospital’s resources are used as efficiently as possible.

One such variable is the structure of Code Blue response teams. Some hospitals create centralized resuscitation teams — dedicated groups that focus on resuscitation events and medical emergencies. Others prefer to deploy non-centralized resuscitation teams that consist of clinical staff trained in resuscitation response, but who have other responsibilities they break away from when activated for an emergency. But what are the pros and cons of each — and how do you know which might be best for your hospital? Keep reading to find out.

Centralized Resuscitation Teams

Centralized resuscitation teams are smaller, well-organized, highly specialized groups whose sole responsibility is to respond to in-hospital emergencies. Team makeup generally stays consistent, so the same groups are all scheduled for the same shifts at the same time.

Pros: Cohesive, proficient, and easier to manage

Centralized resuscitation teams typically train together as a “pit crew” unit.1 That means each responder is trained in depth for a specific, specialized role, leaders are trained in leadership and communication, and all team members learn how to work together seamlessly as a team.2 With this style of training, fewer responders are needed, and responses are more likely to be executed efficiently and proficiently.

Cons: Expensive and inflexible

Centralized code teams can be extremely resource-intensive in terms of staff time and training budget. For example, it’s somewhat unlikely that any given hospital would have need for the resuscitation team 100 percent of the time, so there might be long stretches where the team is underutilized. On the flip side of that, having only one small emergency response team to deploy could put patients at risk if multiple codes happen at once.

Additionally, when team members are highly specialized and play such a critical role on a dedicated team, any availability issues are greatly magnified. If someone on the team leaves, goes on vacation, experiences an illness, or requires time off for any other reason, the ability of these teams to remain fully staffed and run properly is severely impacted.

Best for: Larger hospitals with more funding and resources

Considering how challenging and expensive the balancing act of resource management can be, it makes most sense for larger hospitals and/or those who deal with a lot of emergency care scenarios to use centralized resuscitation teams. In these institutions, it’s also more likely that more than one team could be needed at any given time, so there would be more flexibility in scheduling and backfilling.

Non-centralized Resuscitation Teams

Non-centralized resuscitation teams consist of staff who are trained extensively in resuscitation but who have other clinical care responsibilities across various areas of the hospital. They are pulled away from these duties to respond to Code Blue events as needed throughout their shifts.

Pros: Higher availability and efficient resource utilization

With non-centralized resuscitation teams, there’s a larger pool of responders to pull from. This makes it easier to handle multiple resuscitation events at one time as well as to support changes in staffing or availability. 

Plus, if there are very few or no emergency events in a given shift, those team members are still being utilized elsewhere as part of their core job functions.

Cons: Challenging training and team dynamics

The membership of any non-centralized resuscitation team can change from day to day — or even minute to minute — depending on staffing and clinical responsibilities. Additionally, the pool of team members can be much larger, so it’s more difficult to coordinate schedules and train everyone together. 

This may result in a lack of cohesion and clarity in team roles, which can negatively impact communication and the care delivered during code responses.

Best for: Hospitals with less funding and fewer resources

Many hospitals simply can’t afford to hire dedicated resuscitation teams. But employing Code Blue training best practices can help non-centralized teams avoid potential pitfalls by:

  • Clearly defining the role of each responder
  • Reiterating training requirements and reinforcing skills via mock codes3
  • Ensuring team leaders are trained in leadership skills and communication
  • Reviewing performance through standardized QI processes
  • Identifying any deviations from expectations and reinforcing best practices to continually enhance resuscitation responses4,5

What’s Right for Your Hospital?

Ultimately, the type of resuscitation team that works best for any specific hospital setting will depend on staffing models, acuity needs, training capabilities, and other factors. While there’s no one-size-fits-all solution, a team that can communicate concisely and work together as a cohesive unit will ultimately have a positive impact on patient outcomes during cardiac resuscitation events.

Ready to Learn More?

Check out this quick article to learn how you can build the best Code Blue response team, from identifying key roles and responsibilities to empowering team members to optimize their performance.

References

  1. Hunziker, S., O’Connell, K. J., Ranniger, C., Su, L., Hochstrasser, S., Becker, C., Naef, D., Carter, E., Stockwell, D., Burd, R. S., & Marsch, S. (2018). Effects of designated leadership and team-size on cardiopulmonary resuscitation: The basel-washington simulation (bawasim) trial. Journal of Critical Care, 48, 72–77. https://doi.org/10.1016/j.jcrc.2018.08.001
  2. Spitzer, C. R., Evans, K., Buehler, J., Ali, N. A., & Besecker, B. Y. (2019). Code blue pit crew model: A novel approach to in-hospital cardiac arrest resuscitation. Resuscitation, 143, 158–164. https://doi.org/10.1016/j.resuscitation.2019.06.290
  3. Saunders, R., Wood, E., Coleman, A., Gullick, K., Graham, R., & Seaman, K. (2021). Emergencies within hospital wards: An observational study of the non-technical skills of medical emergency teams. Australasian Emergency Care, 24(2), 89–95. https://doi.org/10.1016/j.auec.2020.07.003
  4. Cooper, S. J., & Cant, R. P. (2014). Measuring non-technical skills of medical emergency teams: An update on the validity and reliability of the team emergency assessment measure. Resuscitation, 85(1), 31–33. https://doi.org/10.1016/j.resuscitation.2013.08.276
  5. Davis, D. P., Aguilar, S. A., Graham, P. G., Lawrence, B., Sell, R. E., Minokadeh, A., & Husa, R. D. (2015). A novel configuration of a traditional rapid response team decreases non-intensive care unit arrests and overall hospital mortality. Journal of Hospital Medicine, 10(6), 352–357. https://doi.org/10.1002/jhm.2338
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