No abstract

Introduction: In-hospital cardiac arrest mortality has improved only modestly in the past decade. Prior studies support the role of earlier defibrillation and epinephrine administration to improve outcomes. Timely code team activation facilitates expedient interventions and may provide an opportunity for quality improvement. We sought to accelerate the time to code team activation and increase the early distribution of patient-specific data to improve targeted treatments. Methods: We mapped code blue buttons present behind each patient bed to patient data through the Electronic Health Record. Use of the code blue button sent patient-specific data including admitting diagnosis, recent procedural history, presence of difficult airway, and most recent potassium, bicarbonate, troponin, and hemoglobin levels through a secure text messaging system to the code blue teams’ smartphones. Simultaneously, the code blue button contacted the hospital operator who activated the code blue team through traditional methods including overhead page and pager alerts. We piloted the system on four medicine inpatient units from November 2019 through May 2022. In our analysis, we evaluated the time from code blue button press to smartphone message receipt vs overhead page, time to epinephrine administration, and survival to hospital discharge. Results: There were 35 cardiac arrest events on the participating hospital units. The code blue button was the primary mode of code team activation for 12/35 (34.3%) of the events. The code team received smartphone notifications a median of 78 seconds (IQR = 47-127 seconds) before traditional notifications. The initial rhythm was non-shockable for 34/35 (97.1%) of the patients. The median time to documented epinephrine administration for codes activated with or without the code button was 2:57 and 4:00 (IQR = 0:34-6:07 vs. 2:07-4:30; p = 0.89). Survival to hospital discharge was 3/12 (25.0%) for codes activated with the code button and 4/23 (17.4%) when activated by other methods (p = 0.61). Conclusion: Implementation of a smartphone-based code button activated notification system reduced the time to code team activation by over one minute. Further evaluation in larger cohorts is necessary to assess the effect on patient outcomes.