A Study on the Success and Other Correlates of Code Blue Cases in a Multi-specialty Teaching Hospital in Bihar

Introduction: “Code blue” (CB) is common emergency code,used by hospitals to alert trained emergency response teamof any cardiac arrest. The factors affecting the outcome ofresuscitative services are inherent to the patient and also tothe functioning of the Code Blue System (CBS). The primaryobjective was to assess the success of ‘Code Blue’ in terms ofsurvival. The other objective was to identify the patient andsystem variables associated with a favorable outcome.Material and methods: This was a cross sectionalretrospective study done in a multispecialty teaching hospitalin Bihar during the period from April 2018 to March 2019.The study was conducted after approval from the InstitutionalEthics Committee. Data was gathered from the Code BlueReport Form and further details of individual patients weretracked from their medical records. Data was entered in anExcel Spreadsheet and analyzed using descriptive statistics,Chi-square test and logistic regression analysis using SPSSVersion 21 software.Results: A total of 111 CB calls were initiated during theperiod. Code Blue activated for cardiac arrest situations onlywere considered in the study. Emergency response calls forphysiologically acute changes in the patients were excluded.Immediate success of resuscitation services for Code Bluecalls was 63.06%, beyond 24 hours this was 27.03% and atdischarge this was just 9.01%. Factors such as age, time ofCode Blue during or outside routine hospital working hours,associated comorbidities, procedures like dialysis, operationor chemotherapy done in the last 24 hours preceding the CodeBlue and duration of CPR were found to have a significanteffect on the success rate.Conclusion: We conclude, that formal training of all thehealthcare providers on BLS is of paramount importance.Further in depth analysis is required to find out the root causeof the problems that are associated with the ‘Code Blue’process which is affecting the success rates beyond routinehospital working hours.

Review of code blue system and audit

Background: Code Blue systems are communication systems that ensure the most rapid and effective resuscitation of a patient in respiratory or cardiac arrest. Code blue was established in Bharati Hospital and Research Centre in Sept 2011 in order to reduce morbidity and mortality in wards. The aim of the study was to evaluate the current code blue system and suggest possible interventions to strengthen the system.Methods: It was retrospective observational descriptive study. The study population included all consecutive patients above the age of 18 years for whom code blue had been activated. Data was collected using code blue audit forms. The data was analysed using SPSS (Statistical Package for social sciences) software.Results: A total of 260 calls were made using the blue code system between September 2011 to December 2012. The most common place for blue code activation was casualty. The wards were next, followed by dialysis unit and OPD. The indications for code blue team activation were cardio-respiratory arrest (CRA) (88 patients, 33.84%), change in mental status (52 patients, 20%), road traffic accidents RTA (21, 8.07%), convulsions (29 patients 11.15%), chest pain (19 patients, 8.46%), breathlessness (18 patients,6.92%) and worry of staff about the patient (17 patients, 6.53%), presyncope (10 patients, 3.84%), and others (6 patients, 2.30%). The average response time was 1.58±0.96 minutes in our study. Survival rate was more in medical emergency group 46.15% than in CRA group 31.61%. Initial success rate was 35.2% and a final success rate was 34.6%.Conclusions: Establishment of code blue team in the hospital enabled us to provide timely resuscitation for patients who had “out of ICU” CRA. Further study is needed to establish the overall effectiveness and the optimal implementation of code blue teams. The increasing use of an existing service to review patients meeting blue code criteria requires repeated education and a periodic assessment of site-specific obstacles to utilization.

Efficacy and Safety of Cloud based Continuous Monitoring Systems in Management of Patients in Non-ICU Settings in a Tertiary Care Hospital

Introduction: Continuous monitoring is the most vital aspect in the management of patients in non-ICU settings. Continuous monitoring systems have revolutionized the management of vulnerable patients which alerts the doctors to identify the critical events and intervene timely. In this study, we present our experience of using cloud connected continuous monitoring systems at our hospital. Objectives: To study the efficacy and safety of continuous monitoring systems in the management of patients in a non-ICU setting. Material and methods: A retrospective hospital-based study was conducted in the Acute Medicine ward (AMW) of Ramaiah teaching Hospital, Bangalore. Patients were connected to a cloud based continuous monitoring system for automatic collection and documentation of vital signs. All patients admitted in AMW between September 2017 and January 2018 was included in the study. For comparison, data were collected from September 2016 to January 2017 when the continuous monitoring systems were not implemented. We compared the number of admissions, code blue events. Results: Total of 470 patients in the pre- ICU settings were connected to a continuous monitoring system. There was 88% reduction in the ICU admissions as compared to the previous year. About 11.2% of patients were transferred to ICU and in these patients, continuous monitoring helped the doctors to identify the critical event. There was a significant reduction in code blue events using a continuous monitoring system. There was a significant reduction in medical expenses also. Conclusion: Continuous monitoring reduced the clinical burden on ICU due to the availability of remote monitoring capabilities, and continuous monitoring of reduced medical expenses for patients with improved clinical outcomes.

Code Blue evaluation in children's hospital / 世界急诊医学杂志（英文）

@#BACKGROUND: True alarm rate of the Code Blue cases is at a low level in the Dr. Beh?et Uz Children''s Hospital in ?zmir. This study aims to analyse the use of the Code Blue alarm cases in the children''s hospital.METHODS: This retrospective clinical study evaluated the age and the gender of the cases, the arriving time of the Code Blue team, the date and time of the Code Blue Call, the reasons of the Code Blue Call, and the verifi cation which were all obtained from the Code Blue forms of the hospital dated between January 2014 and January 2015. The data of 139 Code Blue cases'' forms were investigated and was divided into two groups: before and after the education containing 88 and 51 cases, respectively.RESULTS: Conversive disorder (26％ to 13％,P<0.01), syncope (21.5％ to 19.6％,P<0.01), convulsion (17％ to 13.7％,P<0.01), hypoglycemia (4.5％ to 3.9％,P<0.01), anxiety (4.5％ to 1.9％, P<0.01), head trauma due to syncope (4.5％ to 0％), cardiac arrest (1.1％ to 0％), respiratory difficulties (2.2％ to 1.9％,P<0.01), suspicion of myocardial infarction (2.2％ to 1.9％,P<0.01), fall from stairs (2.2％ to 0％) and agitation cases (1.1％ to 0％) were reduced, however, the hypertension cases were dramatically increased (3.4％ to 29.4％,P<0.01) owing to the hospital staff''s education. The Pearson''s correlation coeffi cient before and after education was 0.837. About 97.8％ of the Code Blue cases were false calls with female greater than male (P<0.01).CONCLUSION: The results of this study show that more education is required for the hospital''s staff and a new color code that is to say pre-diagnosis team should be formed.