Code Blue Awareness: System Changes to Improve Code Blue Chain of Survival in a Hospital

BACKGROUND AND OBJECTIVES: Speed of code blue response is vital in intrahospital cardiac arrests. Correct activation of the dedicated team is the first step of the chain of survival. We describe an improvement implementation strategy to improve knowledge of code blue activation in a newly opened community hospital. METHODS: Staff from various domains were randomly invited to participate in a baseline anonymous survey on knowledge and awareness of how to activate code blue. A comprehensive root cause analysis using the Ishikawa Diagram and Human Factors Analysis and Classification System was performed by the Code Blue Committee members. Four interventions targeting the root causes were instituted. Following the interventions, another anonymous survey was performed a few months later to measure the proportion of staff who correctly activated code blue. The respondents were also asked which intervention aided them the most. RESULTS: The proportion of staff with correct code blue activation in Outram Community Hospital increased more than 4-fold from 19.3% to 88.4%. The intervention in which staff cards were affixed with the code blue telephone number may have the greatest likelihood for successful recall. CONCLUSION: We successfully improved code blue activation awareness in a new hospital through our improvement initiatives. Further work is ongoing with looking at improving the end-to-end process of the code blue response.