Abstract
Purpose: The comprehensive code blue clinical education program aimed to improve Return of Spontaneous Circulation (ROSC) rates from cardiopulmonary arrest (CPA) through interprofessional collaboration and shared decision-making.
Methods: In a single-population time-series study, we examined data from Q1 of 2021 to Q2 of 2022. During Q3 of 2021, a novel comprehensive code blue clinical education program was implemented. The comprehensive code blue program included bi-monthly meetings with managers, directors, physicians, pharmacists, and nurses to analyze and review CPA data; the formation of a debrief tool based on evidence-based resuscitation science; a bi-monthly flyer disseminating a summary of CPA data; the creation of a code narrator class; and required Advance Cardiac Life Support (ACLS) for medical/surgical charge nurses. Outcomes and analyses were measured through the American Heart Association (AHA) Get with the Guidelines Resuscitation® (GWTG®) Tool that monitors all CPAs and rapid responses (RR) in the state of Washington. Comparative analyses were completed each quarter and CPAs/RR were reviewed by the Code Blue Committee at each meeting.
Results: Overall, after implementing the comprehensive code blue program, our 123-bed Level III Trauma Hospital increased the rate at which RRs were called, decreased the number of CPA events, and increased the survivability of a CPA. Q2 2021 ROSC was 14.3% (n=7) with one hospital RR called (n=91 statewide). Comparatively, Washington state hospitals achieved ROSC 56.5% (n=113) of the time in Q2 2021. By the fourth quarter of 2021, hospital-wide ROSC had increased to 72% (n=8). One year since implementation, the hospital has called 15 RRs (compared to 24 statewide) with an overall decrease in the number of CPA events (n=4). Of those CPAs, three out of four achieved ROSC (75%).
Conclusion: ROSC was associated with significantly higher values after initiating an interprofessional and comprehensive code blue program. In one metanalysis that examined 658 European-American patients, ROSC is achieved on average, 34.7% of the time. Washington state rates have ranged between 56.5% and 66.9% over the last two years. In three months, through interprofessional collaboration in creating code blue debrief forms, analyzing CPA events, increasing evidenced-based resuscitation education with staff, and disseminating CPA and RR communication, hospital-wide ROSC achievement increased from 14.3% to 75%. Most importantly, triggers to CPAs were more widely recognized, increasing the number of RRs and decreasing the overall CPA events. For hospital-wide acceptance and adoption of the novel code blue program, a code narrator class was developed to educate recorders on documentation for the AHA GWTG® data abstractors. Further, all recorders were certified in ACLS to improve their understanding of CPA events. Finally, a mock drill system was established to run through various CPA scenarios. An organization that focuses on a comprehensive code blue program based on evidence-based resuscitation science has the potential to save lives, increase the level of competency and confidence in live CPA events, enhance staff rapport and shared decision-making, improve externally benchmarked outcomes, and promote the concept and application of evidence-based practice.
Notes
References
Borkowska, M. J., Jaguszewski, M. J., Koda, M., Gasecka, A., Szarpak, A., Gilis-Malinowska, N., ... & Smereka, J. (2021). Impact of coronavirus disease 2019 on out-of-hospital cardiac arrest survival rate: A systematic review with meta-analysis. Journal of Clinical Medicine, 10(6), 1209.
Gilmartin S., Martin L., Kenny S., Callanan I., Salter N. (2020). Promoting hot debriefing in an emergency department. British Medical Journal.10.1136/bmjoq-2020-000913.
Grossestreuer A., Moskowitz A., Edelson D., Ornato J., Berg K., ... & Goldberger Z. (2022) American Heart Association. Get With the Guidelines Resuscitation. https://www.heart.org/en/professional/quality-improvement/get-with-the-guidelines/get-with-the-guidelinesresuscitation
Pepe, P. E., Aufderheide, T. P., Lamhaut, L., Davis, D. P., Lick, C. J., Polderman, K. H., ... & Yannopoulos, D. (2020). Rationale and strategies for development of an optimal bundle of management for cardiac arrest. Critical Care Explorations, 2(10).
Ribeiro, I. (2021). Cardiopulmonary resuscitation in patients diagnosed with or suspected of COVID-19: A narrative review of the literature. International Journal of Advanced Engineering Research and Science.
Sanfilippo F, Murabito P, Messina A, Dezio V, Busalacchi D, Ristagno G, Cecconi M, Astuto M (2020). Cerebral regional oxygen saturation during cardiopulmonary resuscitation and return of spontaneous circulation: A systematic review and meta-analysis. Resuscitation. 10.1016/j.resuscitation.2020.12.002.
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document, Video Recording
Study Design/Type
Other
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Interprofessional, Interdisciplinary, Code Blue Clinical Education Program, Return of Spontaneous Circulation
Recommended Citation
Zimmerman, Brittany; Calabro, Emily E.; and Montgomery, Stephany, "A Novel Interprofessional Approach to Saving Lives Through Evidence-Based Resuscitation Science and Education" (2025). Creating Healthy Work Environments (CHWE). 4.
https://www.sigmarepository.org/chwe/2023/presentations_2023/4
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Austin, Texas, USA and Virtual
Conference Year
2023
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Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-10-14
A Novel Interprofessional Approach to Saving Lives Through Evidence-Based Resuscitation Science and Education
Austin, Texas, USA and Virtual
Purpose: The comprehensive code blue clinical education program aimed to improve Return of Spontaneous Circulation (ROSC) rates from cardiopulmonary arrest (CPA) through interprofessional collaboration and shared decision-making.
Methods: In a single-population time-series study, we examined data from Q1 of 2021 to Q2 of 2022. During Q3 of 2021, a novel comprehensive code blue clinical education program was implemented. The comprehensive code blue program included bi-monthly meetings with managers, directors, physicians, pharmacists, and nurses to analyze and review CPA data; the formation of a debrief tool based on evidence-based resuscitation science; a bi-monthly flyer disseminating a summary of CPA data; the creation of a code narrator class; and required Advance Cardiac Life Support (ACLS) for medical/surgical charge nurses. Outcomes and analyses were measured through the American Heart Association (AHA) Get with the Guidelines Resuscitation® (GWTG®) Tool that monitors all CPAs and rapid responses (RR) in the state of Washington. Comparative analyses were completed each quarter and CPAs/RR were reviewed by the Code Blue Committee at each meeting.
Results: Overall, after implementing the comprehensive code blue program, our 123-bed Level III Trauma Hospital increased the rate at which RRs were called, decreased the number of CPA events, and increased the survivability of a CPA. Q2 2021 ROSC was 14.3% (n=7) with one hospital RR called (n=91 statewide). Comparatively, Washington state hospitals achieved ROSC 56.5% (n=113) of the time in Q2 2021. By the fourth quarter of 2021, hospital-wide ROSC had increased to 72% (n=8). One year since implementation, the hospital has called 15 RRs (compared to 24 statewide) with an overall decrease in the number of CPA events (n=4). Of those CPAs, three out of four achieved ROSC (75%).
Conclusion: ROSC was associated with significantly higher values after initiating an interprofessional and comprehensive code blue program. In one metanalysis that examined 658 European-American patients, ROSC is achieved on average, 34.7% of the time. Washington state rates have ranged between 56.5% and 66.9% over the last two years. In three months, through interprofessional collaboration in creating code blue debrief forms, analyzing CPA events, increasing evidenced-based resuscitation education with staff, and disseminating CPA and RR communication, hospital-wide ROSC achievement increased from 14.3% to 75%. Most importantly, triggers to CPAs were more widely recognized, increasing the number of RRs and decreasing the overall CPA events. For hospital-wide acceptance and adoption of the novel code blue program, a code narrator class was developed to educate recorders on documentation for the AHA GWTG® data abstractors. Further, all recorders were certified in ACLS to improve their understanding of CPA events. Finally, a mock drill system was established to run through various CPA scenarios. An organization that focuses on a comprehensive code blue program based on evidence-based resuscitation science has the potential to save lives, increase the level of competency and confidence in live CPA events, enhance staff rapport and shared decision-making, improve externally benchmarked outcomes, and promote the concept and application of evidence-based practice.
Description
Summary: Beginning 2021, 14% of patients would survive a cardiopulmonary arrest at our Level III Trauma Hospital in Washington state, where statewide averages were 62%. Through interprofessional collaboration, we implemented a comprehensive code blue clinical education program. By Q2 of 2022, 75% of patients were surviving arrest.
Target Audience: Clinical
Themes: Interprofessional/Interdisciplinary
Subject Group: Adults
Demographic Group: Healthcare Workers