Skip to main content

key takeaways

  • Mock Code Blue simulations should be tailored to the group participating and the purpose of the training.
  • In-situ, low-fidelity mock codes can be run often and are easy to attend — ideal for frequent team trainings.
  • New staff can benefit from the more realistic, immersive setup available at an off-unit simulation location.

By now, the benefits of mock Code Blues are well-established: improved response time, staff competence and confidence, and better outcomes, to name a few.1-3 And particularly for hospitals that are accredited by The Joint Commission (TJC), mock codes are a smart strategy from a regulatory approach as well: They can help fulfill TJC’s requirements for providing resuscitation education and training.

But it’s not as simple as implementing a mock Code Blue program, running it on autopilot, and hoping to reap the rewards. Hospitals have to determine which simulation best meets their needs. There are several types of mock Code Blue simulations to choose from, with pros and cons to each.

What are the options available, and which type is best for your hospital? Keep reading as we help your hospital answer these questions with a 3-step process.

Step 1: Identify the target training group

Mock codes aren’t one-size-fits-all: Training should be tailored to the group you are trying to target. In particular, consider what mock code training should look like for both these groups:

New staff

Emergency events can happen at any time, so it’s important that new staff members are quickly trained and brought up to speed.

Do new staff members know their role, the team composition, hospital protocols and practices, and location of emergency equipment? These factors can vary across hospitals and departments, so training is essential.

Team training

Code Blues require high levels of coordination between interdisciplinary staff members (physicians, nurses, respiratory therapists, pharmacists, etc.)

Frequent mock code trainings allow team members to marry the practical aspects of the code — hands-on experience with defibrillators, mechanical cardiopulmonary resuscitation (CPR) devices, crash cart equipment, etc. — with equally important components like teamwork and communication. These trainings can also expose any weaknesses (e.g., role overlap or confusion) before they become an issue during an actual event. The more practice the team has working together on a Code Blue response, the better.

Step 2: Know your options

Hospitals have some flexibility when choosing which types of mock codes to run. Depending on the resources available and the specific goals of the training, you can tweak different aspects of the event — like where it is held and how closely it mimics an actual code. Let’s take a look at the options available:

 Realism: low fidelity vs high fidelity


Low-fidelity mock codes use a basic setup that is easily transportable, often using a partial manikin, rhythm generator, and defibrillator.

  • Main advantage: Since these trainings are easy to set up, they can be done more frequently and from nearly anywhere.
  • Main drawback: Scenarios are less realistic and require a little imagination from staff to execute.

By contrast, high-fidelity mock codes use more advanced equipment to better mimic an actual event.

  • Main advantage: High-fidelity mock codes are more realistic. The manikins can be placed in many different patient rhythms and can respond to treatments given by staff, giving the team hands-on practice with scenarios they might actually encounter during a real event.
  • Main drawback: Manikins can be heavy and difficult to move, so it’s not as easy to transport this setup or to use it in a patient area.

For a more in-depth look at the pros and cons of high- and low-fidelity mock codes, check out our blog post on this topic.

 Location: In-situ vs. simulation location


In-situ mock codes are held on a unit where the staff members work. They usually pair well with low-fidelity codes.

  • Main advantages: In-situ codes are easy for staff to attend and less disruptive to their schedules and other clinical responsibilities. Plus, you can run these codes unannounced, which is ideal because it gives hospitals a better sense of team members’ true readiness and response — and any barriers to care.
  • Main drawback: Sessions must be kept short to limit time away from clinical work and patient care.

Another option is to run mock codes at an off-unit location that is set up like a clinical area.

  • Main advantages: A simulation location can usually support a more realistic, high-fidelity setup. Plus, team members may find it easier to focus in a distraction-free environment, away from patient care and clinical responsibilities.
  • Main drawback: Because staff need to leave the unit for these trainings, scheduling is often more difficult.

Step 3: Put it all together

The final step is to match up the target training group with the type of mock Code Blue simulation.

Focusing on team training?

Consider an in-situ, low-fidelity mock code. They’re easier for staff members to attend, which is crucial for ensuring full participation and improving teamwork/communication skills as a group.

New staff at your hospital?

Try a high-fidelity mock code at a simulation location. It’s an opportunity to work on skills in a protected place, where everything that happens during the training stays in that dedicated space. This supports psychological safety, which is ideal for new hires. And since these codes are often less rushed, scenarios can be repeated until skills are perfected and new staff members gain the comfort level they need.

Consider a combination approach

That said, these are just some factors to consider. Your hospital may come to a different conclusion based on resources, needs, and staff availability. Alternatively, you may also find that a combination of training types works best.

For example, while low-fidelity mock codes are great for frequent team trainings and skills reinforcement, the team may also benefit from a more immersive, realistic setup every so often — especially to focus on a specific scenario. Similarly, new staff may also find it helpful to train in a location where actual codes will take place.

The bottom line

There are several types of mock code simulations to choose from, so it’s important to tailor these trainings to your hospital’s needs. Whatever solution your hospital lands on, the goal is to be thoughtful about the target training group, the purpose of the training, and the different options available. By doing this, you are most likely to maximize the benefit that your staff derives from the training.

And for all types of mock Code Blue simulations, remember to be consistent, offer feedback, capture data and track improvement over time, and be open to changing your approach as needed. With these strategies, you’ll be well on your way to better preparing your team to respond confidently and effectively in emergency situations.


Practice makes perfect

Looking for more ways to maximize your hospital’s Code Blue training? Read our article on how to optimize mock codes 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. 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.
  3. 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.
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.