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key takeaways

  • Resuscitation report cards are a useful feedback strategy for Code Blue events. They offer a brief synopsis of the event, areas for improvement, and any changes implemented in an easy-to-digest written/visual format.
  • Report cards allow staff members to review data in their own time, when they are best able to absorb the information.

All clinicians need feedback to improve, but it’s especially essential for Code Blue events. When the odds are against the patient and the margin for error is so small, it’s critical that clinicians continue to refine and improve their response for next time.

Well-known strategies like cardiopulmonary resuscitation (CPR) feedback and hot debriefing are valuable feedback tools that every hospital can benefit from using. But like anything else, they each have their individual strengths and weaknesses — and they may leave some gaps when it comes to optimal Code Blue feedback.

In this article we’ll talk about another feedback strategy that can help fill those gaps: the resuscitation report card.

What is the resuscitation report card, how is it different from other feedback strategies, and how can your hospital use it to its advantage? Keep reading to find out.

Go-to strategies: Real-time feedback & hot debriefing

The good news is that hospitals have several options to choose from when it comes to delivering useful, actionable feedback to staff. Let’s take a look at some of the most common strategies hospitals turn to: real-time CPR feedback and hot debriefing.

Real-time CPR quality feedback


What it is:

In the literature, real-time feedback typically refers to CPR. There are several options for CPR feedback available to hospitals: defibrillators that provide real-time audiovisual feedback, portable devices placed on the patient’s chest, end-tidal carbon dioxide readings, and more.


  • Allows responders make in-the-moment adjustments to improve CPR quality.1
  • Helps responders meet the requirements for high-quality CPR, which has been consistently shown to improve outcomes.


  • Doesn’t pull the whole picture together: An effective Code Blue response is more than just CPR alone — it also involves adherence to clinical protocols.
  • Responders are limited in how much feedback they can absorb and act on in the moment.

Hot debriefing


What it is:

Another well-studied feedback tool, hot debriefing occurs when the resuscitation team convenes immediately after the event to review quality data and discuss the strengths and weaknesses of the response.


  • Entire team is typically available immediately after the event.
  • Aids in knowledge retention since events are still fresh.
  • Reduces stress and burnout.
  • Can improve outcomes.


  • Debrief may be cut short due to other clinical demands.
  • Responders may not have enough mental capacity to fully absorb data immediately after a stressful event.

The bottom line


Real-time feedback and hot debriefs are both proven and effective strategies for delivering feedback to staff during and after the event, but they each have drawbacks as well.

This is where the resuscitation report card comes in. Keep reading to learn how it can help round out a hospital’s Code Blue feedback strategy.

What is the resuscitation report card?

Resuscitation committees regularly review quality data for Code Blue events to discuss any instances of nonadherence to expected events or interventions, possible barriers to care, logistical changes to support quality improvement, and more.

Some of this information can be put in an easy-to-digest, written/visual report card format to be shared with staff for a particular event.

The format can be flexible to meet the hospital’s needs, but it typically provides the highlights of the event, areas for improvement, and any changes implemented.

How is the report card shared with staff?


Report cards can be shared with staff multiple ways: via email, discussed in depth at a staff meeting or cold debrief, placed in a staff room for review, etc.

Importantly, report cards can also be used to open the line of communication in the other direction as well. Encourage staff to review the report card and send feedback to a resuscitation committee email address. The feedback can then be discussed and addressed at upcoming staff meetings.

 What are the benefits?


  • Timing: Staff members can review data in their own time — when they have the mental capacity and are best able to absorb the material. This is typically after they have had some time to step back from the adrenaline of the event itself and reflect.
  • Retention: The written/visual format can be a useful addition to verbal discussions and may help data and takeaways stick.
  • Open communication: Report cards can open the lines of communication and help staff feel heard about potential barriers. For instance, if any issues were discussed at the hot debrief, these can be summarized on the report card (along with the actions being taken to address them). It’s a strategy that not only helps share information across staff, but also shows clinicians that their concerns are heard and taken seriously. This creates a culture of psychological safety at the hospital, which is crucial for clinician engagement and buy-in to achieve meaningful change over time.7

Using the report card at your hospital

Hospitals that are utilizing real-time CPR feedback and debriefing might wonder where the resuscitation report card fits in — or whether it’s necessary if other measures are being used.

The point isn’t to advocate for one feedback approach over another: each strategy has its place and its individual strengths and weaknesses. Instead, think of the resuscitation report card as another tool at your hospital’s disposal, one that is ideally used alongside strategies like real-time feedback and hot debriefing.

When it comes to feedback, the more reinforcement the better. Providing feedback at different times (during, immediately after the event, or in the weeks that follow) and in different formats (verbal vs. written/visual) will help to balance out the weaknesses of each approach, reach as many staff as possible, and provide responders with the full clinical picture.


Read on

Looking to incorporate more feedback strategies at your hospital? Read our article on hot debriefing next.


  1. Nassar BS, & Kerber R. (2017). Improving cpr performance. Chest, 152(5), 1061–
  2. Mullangi S, Bhandari R, Thanaporn P, et al. (2020). Perceptions of resuscitation care among in-hospital cardiac arrest responders: a qualitative analysis. BMC Health Services Research, 20(145).
  3. Institute of Medicine. (2015). Strategies to improve cardiac arrest survival: a time to act. Washington, DC: The National Academies Press.
  4. Kessler DO, Cheng A, & Mullan PC. (2015). Debriefing in the emergency department after clinical events: a practical guide. Annals of Emergency Medicine, 65(6): 690-698.
  5. Edelson DP. (2008). Improving in-hospital cardiac arrest process and outcomes with performance debriefing. Archives of Internal Medicine, 168(10), 1063.
  6. Lee J, Lee H, Kim S, et al (2020). Debriefing methods and learning outcomes in simulation nursing education: A systematic review and meta-analysis. Nurse Education Today, 87, 104345.
  7. French-Bravo M, & Crow G. (2015). Shared governance: The role of buy-in in bringing about change. OJIN: The Online Journal of Issues in Nursing, 20(2).
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