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From an adult survival rate of only 25.8 percent to high incidence of post-cardiac arrest complications, Code Blue outcomes simply aren’t what they should be.1,2

Response teams are doing the best they can with the tools and systems they have at their disposal. But, despite documented best practices that could prevent tens of thousands of deaths, clinicians are often constrained by outdated, disparate, manual emergency care processes.

One solution? Empower Code Blue responders with the same advancements now standard in many other areas of the hospital:

  • Technology design & functionality updates
  • Process digitalization, automation, & integration
  • Data-driven improvements that impact quality of care

Keep reading to learn about the latest innovations designed to improve clinical performance across four key aspects of hospital emergency care.

1. Resource Management

Why it matters

Proper management of crash cart medication, supplies, and equipment is a vital — and often overlooked — aspect of hospital emergency care.

When every second counts, clinicians can’t afford to waste time searching for missing or difficult-to-access items. Plus, expired or improperly stored resources can expose hospitals to compliance and liability issues. That’s why every resuscitation cart should be code-ready and fully compliant at all times.

Yet the design of the crash cart hasn’t really changed in decades, and cart checks and inventory are still typically performed via pen and paper. These manual, error-prone processes:

  • Often miss hidden issues that contribute to patient safety events3
  • Eat up a significant amount of clinicians’ time
  • Are sometimes not standardized across hospitals
  • Often don’t connect to pharmacy/central supply systems
  • Don’t provide centralized awareness or accountability for cart status

Code Blue Innovation 1:

Electronic Inventory Monitoring

 

What is it? 

Software that integrates with pharmacy, central supply, barcode or RFID scanners, smart sensors, and other systems to manage crash cart resources.

How does it help?

Enables faster, easier, more accurate crash cart resupply and reporting, plus greater assurance of cart readiness:

  • Provides real-time digital visibility of all resources on the cart
  • Allows clinicians to easily maintain an accurate count of medications, supplies, and equipment
  • Monitors medication status including administration, expiration, and restocking, all while alerting pharmacy and central supply of needed actions along the way

What to look for:

  • Automatic notifications about upcoming expiring medications, specific crash carts that need restocking after a code,  and cart tampering alerts
  • Ability to integrate with advanced hardware systems, such as crash cart drawer sensors that monitor access to storage areas in real time

Code Blue Innovation 2:

Digital Cart Check System

 

What is it? 

Software that integrates with smart sensors, inventory, and central administration systems to track cart readiness.

How does it help?

Enables efficient, standardized cart checks and centralized visibility to cart status hospital-wide:

  • Allows hospitals to easily standardize cart check data fields
  • Promotes accountability by giving administrators a system-wide view of cart check status — including which carts are non-compliant
  • Documents and saves cart check forms electronically for easy reference and reporting

What to look for:

Integration with smart sensors on crash carts, such as: 

  • Storage area sensors that track access to drawers and other side compartments
  • Equipment sensors that detect the presence of key items, such as the cardiac board
  • Climate sensors that monitor ambient temperature and humidity for compliance with medication storage regulations

Code Blue Innovation 3:

Advanced User-centric Crash Cart

 

What is it? 

A modern, purpose-built resuscitation cart that integrates with advanced software.

How does it help?

Improves access, organization, and efficiency, so clinicians are empowered to deliver the care patients need the moment they need it:

  • Consolidates all medications, supplies, and equipment on the cart so team members don’t have to run to multiple locations
  • Eliminates clutter, provides easy access to all supplies, and improves restocking efficiency with software-driven inventory intelligence
  • Allows clinicians to begin treatment faster with quick-start features

What to look for:

  • Smart sensors that integrate with inventory management and cart check software
  • Readiness indicator lights that alert passersby of real-time cart status
  • Two-way drawer that allows clinicians to access medications and supplies at the same time without impeding one another
  • Secure compartment for rapid sequence intubation drugs
  • Safety power system that allows the defibrillator and suction pump to plug directly into the cart, which detaches harmlessly from the wall via a breakaway plug

2. Quality & Consistency of Care

Why it matters

Studies have shown that time to care, CPR quality, and time between interventions directly impact in-hospital cardiac arrest (IHCA) outcomes.4–6 So closely monitoring and optimizing these factors is an essential part of Code Blue treatment.

But it’s difficult for teams to consistently align interventions and practices to their hospital’s clinical protocols during an emergency response. With traditional systems and processes, so much depends on the clinician’s memory, training, and confidence level — not to mention team dynamics and cooperation between responders — that standardizing care is virtually impossible.

Code Blue Innovation:

Real-time Performance Monitoring & Assistance

 

What is it? 

Hardware and software systems that allow clinicians to digitally monitor and optimize CPR, epinephrine administration, and other interventions as the code unfolds.

How does it help?

  • Provides feedback on CPR performance, including compression depth and rate, pauses, and more
  • Monitors other key parameters as well as time between interventions
  • Enables clinicians to adjust care accordingly both in the moment and over time via reporting and review of documented data

What to look for:

  • Pre-configured treatment algorithms based on patient rhythms that provide specific guidance on next steps in real time
  • Systems that also determine appropriate medication dosing based on patient weight and hospital protocols
  • An automated dashboard of patient rhythm and intervention timers that provides real-time feedback based on documented actions

3. Event Documentation

Why it matters

Accurate and thorough event documentation is necessary to achieve several critical tasks in the Code Blue care process: 

  • Collect the data needed to evaluate performance and optimize practices, both in real time and retrospectively.
  • Record and reconcile medications, supplies, and equipment used.
  • Maintain complete, compliant patient records.

But, once again, documentation is typically performed manually. Processes vary widely from one scribe to another, and recorders face a number of challenges:

  • Given the urgency and fast-paced nature of Code Blue treatment, scribes/recorders may have trouble keeping up and accurately capturing the timing of rhythms and interventions as they occur. In fact, partial documentation often takes place after the code is over — far too late to guide interventions or even guarantee accuracy for debriefing.
  • Combined with the manual nature of resource management, manual event documentation also makes it harder to record information about medications administered during the code, harder to tie that information back to the hospital’s formulary National Drug Code (NDC), lot number, expiration, and serial number, and harder as a result to mitigate resulting risk and liability for patients and hospitals.

Code Blue Innovation:

Purpose-built Digital Documentation System

 

What is it? 

Software that enables scribes/recorders to document all Code Blue parameters, interventions, and medications in real time.

How does it help?

  • Allows scribe to document as quickly as events occur throughout the code
  • Supports analysis and review via searchable reporting formats
  • Automatically and securely integrates with the patient’s EHR

What to look for:

  • Software installed on a mobile touchscreen device designed for emergency response documentation
  • Software that dynamically guides documentation based on pre-configured algorithms and current patient rhythms and interventions
  • Medication documentation based on the current hospital formulary to ensure accuracy and compliance

4. Data-driven Optimization

Why it matters

In order to improve IHCA performance and outcomes over time, clinicians and hospitals should perform “hot” and “cold” debriefs.7,8

  • “Hot” debriefs: The response team reviews event data immediately following a code to evaluate their performance, comparing against hospital goals and industry benchmarks.
  • “Cold” debriefs: Larger groups review cases monthly or quarterly to spot trends, vet best practices, and implement evidence-based improvements.
  • In both cases, reviewers need comprehensive, high-quality data on every Code Blue event. 

But, as noted previously, event data is usually collected manually, resulting in inaccuracies or missing information. It’s then typically filed as a flat, unsearchable PDF that has simply been scanned in. This format is not amenable to data export, analysis, or reporting without first being transcribed by dedicated data entry resources — an expensive process that can introduce even more errors. 

As a result, it’s challenging to derive reliable insights during “cold” debriefing sessions. And because “hot” debriefs are not data-driven, clinicians often see little value in sticking around for them once a code is completed.

Code Blue Innovation:

Automated Electronic Reporting

 

What is it? 

Software that integrates with EHR, hospital reporting, and event documentation systems to create insight-rich, analysis-friendly Code Blue debriefs and reports.

How does it help?

  • Immediately provides a precise, quantified, instructive snapshot of the response team’s performance for “hot” debriefing
  • Creates detailed “cold” debriefs that hospitals can use to improve outcomes system-wide over time
  • Delivers a single, shared, comprehensive view of Code Blue operations, including how to improve them

What to look for:

  • Software that interfaces with the hospital’s Electronic Health Record to automatically deliver code event documentation to the patient profile
  • Solutions that document quality indicators and facilitate benchmarking clinical performance against others
  • Systems that make reports easily accessible from dedicated devices and web-based or central management applications
  • Software that allows data to be easily exported for deeper analysis

Innovation, delivered

In-hospital cardiac arrest is a serious problem that continues to result in unacceptably poor outcomes.1,2 But following established best practices and implementing advanced technologies can help save more lives. See how Nuvara combines the latest innovations in a single system to improve clinical performance before, during, and after Code Blue events.

References

    1. Holmberg MJ, Ross CE, Fitzmaurice GM, et al. Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes. 2019 July;12:1-8.
    2. Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020 Mar;141:e139-e596.
    3. The Joint Commission. Crash-cart preparedness. Quick Safety. 2017 Apr; 32:1-3. 
    4. Meaney PA, Bobrow BJ, Mancini ME, et al. Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. 2013;128:417-435.
    5. Abella BS, Sandbo N, Vassilatos P, et al. Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation. 2005;111:428-434.
    6. Bircher NG, Chan PS, Xu Y. Delays in cardiopulmonary resuscitation, defibrillation, and epinephrine administration all decrease survival in in-hospital cardiac arrest. Anesthesiology. 2019;130:414-422.
    7. IOM (Institute of Medicine). 2015. Strategies to improve cardiac arrest survival: a time to act. Washington, DC: The National Academies Press.
    8. Kronick SL, Kurz MC, Lin S, et al. Part 4: systems of care and continuous quality improvement. 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(suppl 2): S397-S413.