Calling Code Blue in ED

Christy1019, ASN, RN · May 11, 2012

I'm with you... just because the ED isn't a trauma center, doesn't mean they aren't capable of responding to a medical resusciation, hence they work in the EMERGENCY department lol. I don't know why it seems to bug me so much when I hear of all these "response teams" that are not ER staff, responding to situations in the ER and then generally take over. Why do I have to bother being ACLS/BLS, TNCC, ENPC, and CCRN certified if i am to be deemed incapable of handling a trauma or medical resus patient? You don't usually hear of groups of ER staff going to med-surg floors and taking over giving meds, or to the ICU and messing w/ventric's and balloon pumps just because I am qualified to do so...

the little things that annoy me.. lol:twocents:

Anna Flaxis, BSN, RN · May 11, 2012

At my facility, the ED staff handles all prehospital arrests. Inpatient codes are handled by the Code Team, which consists of an RT, a pharmacist, an ED doc, an ED nurse, and an ED tech.

becca001 · May 11, 2012

Thanks for the answers. Right now, the Code Blue team consist of an ICU nurse, step down nurse, an ED nurse, the hospitalist/intern, RT and primary nurse plus whatever nurse can be spared from the floor that inititated the Code. We are not large enough or have enough staff to be able to run a full time code team.

Medic2RN, BSN, RN, EMT-P · May 11, 2012

Our Code Blue team is an ER nurse, ER doc and RT. If it's in hospital, obviously, the primary nurse is involved. We respond to ICU codes, but the norm is that we are released upon arrival.

The Rapid Response Team (road runner) is an ICU nurse, RT and the primary nurse. We call Code Blues in the ED and for prehospital codes in order for RT and radiology to know what's happening and to arrive ASAP.

VICEDRN, BSN, RN · May 11, 2012

I think the logic is fuzzy...

Rapid response team...standardized response to in-patient codes.

ED team...standardized response to outpatient codes.

sounds standardized...to the situation.

sauconyrunner · May 11, 2012

THere is no point in calling a Code Blue for an ED patient or a Pre-hospital arrest.

In the ED there is staff that are all trained and competent to handle the arrest. Thus there is no need for a Code team to respond.

I have been part of the code team (from the ED) and I have to say that if you all arrived down in the ED to "run a code" I think most of the staff would kind of giggle. We are usually frustrated and amused at the things that some of the staff do during codes on the floors. We see a lot of pre-hospital codes, and it can happen 5-6 times a day...whereas on the floor it is an unusual situation. ED staff are fully capable and are extremely efficient at running codes. They work in that environment, and know where everything is. Why bring someone in who will be looking for stuff and not sure where everything is and does not participate in codes on a very regular basis, when you have a team that is actually better prepared than your code team.

On the floors, there are nurses that are not trained to handle an arrest (No ACLS, etc) and there may or may not be an MD to respond. So a Code Blue is called so that the trained people can come.

Our ICU actually does not call codes overhead either anymore, because again, there is an intensivist 24/7 in the ICU and all the nurses there are fully trained in code procedures.

I kind of sound like a big bag of wind, but I think it's kind of an odd idea. the Emergency Dept is for Emergencies.

srobb11 · May 12, 2012

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.

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.

NurseLatteDNP, MSN, DNP, RN · May 12, 2012

We are a trauma 2 hospital and we call ALL codes in the hospital. Our code blue team is the ED. But the reason we call the code, because this will alert CT to empty their suites and lab techs to head to the code. In some cases Pharmacy responds as well. These are our codes:

Code Blue anywhere in the hospital for patients or visitors: ER doc, ER code blue team, lab, radiology, respiratory, house supervisor, primary nurse (if applicable).

Code Rapid anywhere in the hospital for patients or visitors: ICU nurse, respiratory, lab, house supervisor, primary nurse.

Code Stroke: Neuro nurse, house supervisor, primary nurse.

Code Trauma: ER Trauma team, ER doc, lab, radiology, house supervisor.

Altra, BSN, RN · May 12, 2012

Agree with previous posters ... a code really isn't out of the ordinary in the ER. It's just part of what we do, often several times a day. For the in-house code team to respond in the manner in which they respond to other inpatient units ... it's just not necessary.

P.S. ... OP, is someone in anesthesia bored, that they brought up this idea?

becca001 · May 12, 2012

P.S. ... OP, is someone in anesthesia bored, that they brought up this idea?

No. The two biggest proponents of this idea are managerial and educators. I'm not certain what their agenda is but it's become a fairly fierce debate. Currently, Director of the ED is saying no way. I just needed some input from others in the ED. Thanks everyone

sauconyrunner · May 12, 2012

P.S. ... OP, is someone in anesthesia bored, that they brought up this idea?

No. The two biggest proponents of this idea are managerial and educators. I'm not certain what their agenda is but it's become a fairly fierce debate. Currently, Director of the ED is saying no way. I just needed some input from others in the ED. Thanks everyone

Becca, I think the thing is to remind your Managers and Educators that the purpose of a Code team is to respond to go to places where people do not have the skills to run a code. Not to interject into an area that is already capable of running a code. Do they have any idea how many codes or near codes occur daily in your ED?

I can promise the ED staff will die laughing when a Code Team arrives to "rescue them"...

I think you will also see poorer outcomes, frankly speaking. I have not seen a code team respond with the cohesiveness of an ED team that works together day in and day out...