Abstract 106: Emergency Medical Response for Non-Hospitalized Patient Events in a Children’s Hospital

Abstract

Introduction: Hospital-based Code Blue (CB) teams are designed for hospitalized patients (HP) with unanticipated medical emergencies outside of an intensive care unit (ICU). At our pediatric institution, the same team responds to CB calls involving non-hospitalized patients (NHP) such as outpatients, visitors, and staff. The appropriate team composition for responses to NHP emergencies in a children’s hospital has not yet been studied. Hypothesis: There are significant differences between the characteristics of NHP and HP who require emergency medical response, and the majority of responses for NHP do not require advanced emergency or critical care. Methods: We analyzed a retrospective cohort of CB responses at a large, urban, academic children’s medical center over a one-year period (January 1 - December 31, 2017). Rapid response team (different from CB team) activations were excluded. We evaluated the demographic and clinical characteristics of NHP-related CB responses and compared them to HP-related CB responses. Results: The Code Blue team was activated 168 times, of which 135 (80.4%) were NHP-related and 33 (19.6%) were HP-related. Ninety-one (67.4%) of the NHP responses involved adults (age >18 years) compared to 6 (18.2%) of the HP. The CB team transferred 107 (79.3%) of the NHP to an emergency department, and 19 (75.6%) of the HP to an ICU for further care. The primary type of condition and most common critical interventions performed by the CB team are listed in the table below. Conclusions: Code blue activations in our children’s hospital more often involve NHP than HP. NHP responses are more likely to involve adults and infrequently require critical interventions. Use of a pediatric CB team for initial response to NHP events may be an unnecessary use of pediatric critical care resources. Future studies are warranted to evaluate the most effective CB team structure, training, and certification for NHP emergency responses.