Blankenship Angela C, Fernandez Richard P, Joy Brian F, Miller Julie C, Naguib Aymen, Cassidy Steven C, Simsic Janet, Phelps Christina, Harrison Sheilah, Galantowicz Mark, Yates Andrew R
Angela C. Blankenship is an advanced practice nurse, Nationwide Children's Hospital, Columbus, Ohio. Richard P. Fernandez, Brian F. Joy, Steven C. Cassidy, Janet Simsic, and Christina Phelps are pediatric cardiologists, Nationwide Children's Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio. Julie C. Miller is a pharmacist and Aymen Naguib is a pediatric cardiac anesthesiologist, Nationwide Children's Hospital. Sheilah Harrison is a quality improvement specialist, Nationwide Children's Hospital. Mark Galantowicz is a cardiothoracic surgeon, Department of Surgery, The Ohio State University. Andrew R. Yates is a pediatric cardiologist and intensivist, Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital.
Am J Crit Care. 2016 Jul;25(4):e90-7. doi: 10.4037/ajcc2016302.
To identify a cause for clinical deterioration, examine resuscitation efforts, and identify and correct system issues (thus improving outcomes) via a multidisciplinary code-review process soon after cardiopulmonary arrest.
Retrospective analysis of code events in a tertiary pediatric heart center from September 2010 to December 2013 and review of surgical-cardiac data from January 2010 to December 2013.
A multidisciplinary team reviewed 47 code events, 16 of which (34%) were deemed potentially preventable. At least 2 issues were identified during 66% (31/47) of cardiopulmonary arrests reviewed. Key issues identified were related to communication (62%), environment/culture/policy (47%), patient care (including resuscitation, 41%), and equipment (38%). About 60% of reviewed arrests resulted in educational initiatives (eg, mock code, in-service education) and 47% resulted in a new policy or modification of existing policy. Less common were changes in equipment (32%) or modification of staffing needs (11%). Changes most frequently occurred in the unit specific to the event (68%) but some changes occurred throughout the Heart Center (32%) or across the hospital system (13%). Survival to discharge after cardiopulmonary arrest has improved over time (P = .03) to 81% for cardiac surgical patients in our center.
A multidisciplinary code-review committee can identify deficiencies and lead to educational initiatives and improvements in care. When coupled with a hospital-wide "code blue" review process, these changes may benefit the institution as a whole.
