Calling Code Blue in ED

[becca001]

As part of the Code Blue Team, I am participating in a committee to revamp our Code Blue policies. We are a 100 bed hospital with no tramua level designation. ED is 25 bed unit and sees between 100-190 pts in a 24 hour time frame. The Code Blue team is different members throughout the hospital, all ACLS nurses and hospitalist/interns. Some on the committee are arguing that Code Blue should be called within the ED for all codes, including pre-hospital arrests, citing EBP's that standardized response increases outcome. Some(myself included) argue that responding to an arrest that began pre-hospital creates chaos to a team that is already established. My other part to the arguement is that I am leaving 4 critical care patients (I work weekend nights) to respond. What is the procedure at your hospital? What would you change if you could? Thanks in advance to all who read and answer.

[Dixielee, BSN, RN]

I think it's a great idea for someone else to respond to emergencies in the ED. Then maybe as an ED nurse, I can go to lunch!:icon_roll

Seriously though, I agree with what others have said. Why should someone come into "my house" to run the show when I am fully educated and capable and know where supplies are because I put them there? It seems like a recipe for conflict and poor outcomes to me.

I would never want to respond to an emergency in the operating room, the delivery room or NICU, so why would they respond to an emergency in the EMERGENCY DEPARTMENT????

[VICEDRN, BSN, RN]

I know its such a naughty thought but all I can think is...you guys gonna take this patient right to an ICU bed the minute the code team intubates them right? You're not gonna need any ER resources right and you sure as heck wouldn't dream of leaving them occupying our bed and time now would you? ;-)

its too much...really. lmao!

[NO50FRANNY]

I know this might not be relevant given the difference in size of the facilities but I will tell you how our CODE BLUE response works anyway. If there is a cardiac arrest in the hospital (700 bed facility) as in, anywhere BUT in the emergency department or ICU/NICU, emergency department nurse x 1 who must have ALS (two if we can spare the staff) and 1 senior ICU doctor respond. The phone call comes through to ED only (ICU doc gets paged). The nurse who answers the phone takes the details, it's categorised as either a medical emergency, or a cardiac arrest, I know it sounds silly but if no pulse it is us, otherwise it's not. In an arrest, nurse from ED runs with trolley to the respective ward, ICU doc meets them there. The idea of the ICU doc + ED nurse is that obviously, after an arrest ICU is next stop (or heaven) so it is ultimately going to be their patient, they can also decide to withdraw treatment. ED nurse is to run the code and assist with intubation, the idea of this is that we are the most experienced nurses aside from ICU to do it, ward nurses are always awesome and assist. ICU and ED deal with their own arrests, no team. If the call is a medical emergency, ICU nurse responds only. All the wards have what we call MERT (medical emergency response team) call criteria on all the patients observation charts, any vital sign that falls outside certain criteria is deemed a medical emergency and a senior medical registrar and ICU nurse will attend. Institution of this criteria has dramatically reduced the number of cardiac arrests that we attend. Our emergency doctors do not attend either unless there are exceptional circumstances (only once that I can recall, the ICU reg couldn't get the tube down and asked for help). This system seems to work well for us. If a code team (from elsewhere in the hospital) rocked into our ED for a cardiac arrest I would probably die laughing (so would ICU) but politics and non-clinicians tend to run these kind of shows unfortunately.

[becca001]

Thanks again for all the responses. I greatly appreciate any and all responses. You guys are the greatest.:yelclap:

[MikeRNWI]

Our code teams work similarly to the post above. Granted, we are a Level 1 Trauma center, and a academic medical center, but our ED fully handles all pre-hospital arrests themselves. Our ICU's handle their own codes (with the occassional exception of the Neuro ICU).

If a Code Blue is called overhead, our ICU's rotate being code responders, and the Charge Nurses respond, along with the ICU and ED docs/pharmacists. Our hospital also has Critical Care Floats, who respond to codes(they do respond to the ED codes, but can be told to leave if adequate staff is available), help with ICU transports for scans, etc.

[wildlaurel]

In my ED we don't call Code Blues when we have a pt arrest or a CPR in progress come in. ED staff handles all codes in our department. If there is a Code Blue called anywhere else in the hospital, one of our docs responds with one of our EMT's and the rapid response team also responds - but none of those are ED nurses. The ED charge nurse does respond with the EDP if a code blue is called in a off-unit area (e.g., lobby or CT scan). The RRT also responds in that situation as well.

[Medic2RN, BSN, RN, EMT-P]

I thought of this thread the a few days ago. I'm glad that my hospital calls all Codes regardless of where they occur. I was at the other end of our ED when a Code Blue was called in the ER. A patient suddenly coded in a room on the far end of where I was. I and other nurses would not have known this was going on. I was able to respond quickly to help out.

Just another situational possibility in this scenerio.

[NO50FRANNY]

I thought of this thread the a few days ago. I'm glad that my hospital calls all Codes regardless of where they occur. I was at the other end of our ED when a Code Blue was called in the ER. A patient suddenly coded in a room on the far end of where I was. I and other nurses would not have known this was going on. I was able to respond quickly to help out.

Just another situational possibility in this scenerio.

I'm not sure if this would help your department but if there is an emergency in any bay, or room, anywhere in our department, including imaging/ultrasound/short stay/CT, we have a big red button with emergency written on it that is wired into a (very) loud bell system. If that red button is pushed, the location will show on strategically placed signs around the department so everyone can see. This way, even if you have a pt. at the far end of short stay, if you press this button you will have a million helpers with a trolley in less than 30 seconds. Not sure of the expense but when woman gives birth in the waiting room toilets, I am glad that button is there!

[CrashED]

I don't know about any of you, but at my hospital if a code blue is called, so many people arrive that it can spin someones head. We run our own codes in emerg, and it runs smoother then any floor code! The last floor code I went to, as the ER RN I have to manage lines, and do meds....well, I had to plow through 20 people just to get through the door to the patient! For that reason, we do not call ED Code Blues, unless its a mass casuality or something that our doc needs back up..if its just a run of the mill resussitation or trauma, we are quite capable of doing it without the audience of every med resident on site!

[canoehead, BSN, RN]

I work in a 20 bed ER, and we had a debate about calling codes. On one hand ICU, lab, RT, Xray and the inpatient doc want to know they have priority work coming their way, but on the other hand we get scads of people that don't have a lot of code experience getting in the way, or trying to help with only a vague idea of what they are doing.

After a series of just gross pediatric codes I spoke with my supervisor. We can page ancillary services and docs, but once people come to watch they get very snotty about being asked to leave. They feel insulted, and that we don't value their skills. Codes are just not a common occurance on the floors, and they have no idea where our equipment is, so no, I don't want them in the way while we try to save a life. I personally don't want any students or people just watching when a parent is losing their child...

So I asked if we could call extra staff only as we needed them, particularly nursing staff. There was no official written policy made about calling codes in the ER, perhaps because once they thought about the issues it was hard to make hard and fast rules. I have CPEN, and don't need a pediatric nurse to help, but someone with different strengths might let the peds nurse run the show. If someone with burns comes in the ICU nurse will need to come down and help me with drips/meds/lines though.

I think that no one can be an expert in everything, but in the ER you can expect your staff to be professional enough to know their own strengths and weaknesses. It would also depend on how many of your own staff were available to help out.

[ZippyGBR, BSN, RN]

Since there is already a team in place in the ER fully capable of handling a code 24/7, it seems extremely counterproductive to have a Code Blue Team respond to the ER. Also, it takes away care from other areas that these members are having to vacate to respond to the code. We do not call code blues in the ER at my facility, unless the nurse/tech/whomever is alone in the room and pushes the button, in which case it will be called overhead, but only ER personnel respond.

other than a few busy and poorly staffed nights where we were struggling anyway , it's been very very rare in my ED experience to put a crash call out, yes we've fast bleeped the senior ED if they were off the department and fast bleeped an anaesthetist if relevant but not put the crash call out - as it does especially in hours is bring more and more bodies into the resus room , which is pointless if you've already got a an ED doc or 2 and a couple of ED nurses ...

[HyperSaurus, RN, BSN]

I work at a 300 bed hospital, level 2 trauma center. The only place that codes aren't called overhead/hospital wide is in the NICU and Cath lab. Otherwise, they are announced, even in the ED. Our code team is 1 ICU nurse (first nurse), 1 cardiac nurse (IV nurse), 1 medical nurse (recorder), whoever the primary nurse is, hospitalist, sometimes resident, sometimes ED doc (if hospitalist is unavailable), and RT.