Introduction: Code team activations for adults at our children’s hospital continue to rise. In 2024, the code team responded to 287 activations. Of those, 115 (45%) involved adult non-patients. Additionally, 21% of those events involved code activations at entrances and outside areas of our campus, and some involved victims of intentional violence (VoIV). In 2023, video reviews of these code activations identified opportunities to streamline code response, prioritize a basic life support (BLS) focus, and minimize pulling critical care resources out of the ICUs for a BLS response. Methods: Key stakeholders undertook a comprehensive risk assessment, evaluating code response at entrances and outside areas. As a result, a new code response model was developed, the Focused Assessment and Swift Transport Response (FASTR). FASTR is a nurse-led code team, comprised of a subset of the full code team. The smaller size of the FASTR team allowed for enhanced training with all FASTR responders prior to go-live. More than 160 code responders participated in a two-hour didactic and simulation-based training, which covered key concepts including scene safety, car extractions, CPR in transit, and other critical content. The FASTR program was implemented in February 2025. Results: The FASTR team has responded to 18 activations since go-live. Baseline data from 2024 on the overall quality of code response at entrances or outside areas had 57% positive responses (excellent or good on Likert-type scale). Perception of safety during code response was only 51.2% positive response. When re-surveyed in July 2025, 100% of FASTR responders had positive responses on overall quality of code response. Additionally, 100% of responders indicated a positive perception of safety. Almost all (98%) indicated they feel the quality of the FASTR response in these scenarios is superior to full code team response, and that FASTR represents a more efficient response (90%), with more rapid disposition to the ED and enhanced role clarity. Conclusions: FASTR represents a high quality, more efficient code team response, while allowing critical care expertise (intensivists, pharmacists, and anesthesiology providers) to remain in their respective departments. Focused training has also improved overall perceptions of safety during FASTR activations.
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