Abstract 17076: Empowering Telemetry Technicians to Call Code Blue

Abstract

Background: Delays in treatment of in-hospital cardiac arrest (IHCA) events are associated with lower survival and poor neurologic outcomes. With centralized telemetry, telemetry technicians need to notify nursing staff of life-threatening arrhythmias immediately for nursing to verify a patient's clinical status and determine whether code blue activation is necessary. Delays in this verification lead to delays in code activation, which can in turn lead to increased morbidity and mortality. Objective: We sought to assess the impact of empowering telemetry technicians to activate code blues on IHCA code survival, survival to discharge, time to cardiopulmonary resuscitation (CPR), and inappropriate code activation. Methods: We implemented a quality improvement protocol September 1, 2016 at Parkland Memorial Hospital, a 900-bed, urban, safety-net hospital, in Dallas, Texas to empower telemetry technicians to call code blue directly for the following life-threatening arrhythmias: ventricular fibrillation, sustained ventricular tachycardia of greater than 30 seconds, asystole, or bradycardia less than 30 beats/minute. We performed a retrospective chart review of all IHCA in patients on centralized telemetry at Parkland for one year prior to the intervention and three years post intervention to look at code survival and survival to discharge. Secondary outcomes were time to CPR and inappropriate code activation. Results: The pre intervention code survival was 12/20 (60.0%) and the post intervention code survival was 46/55 (83.6%) (p=0.03). The pre intervention survival to discharge was 3/20 (15.0%) and the post intervention survival to discharge was 21/55 (38.2%), (p=0.0585). The time to CPR, in seconds, was 180 versus 120 (p=0.58) for pre and post intervention non-PEA codes. There were 0 inappropriate code activations post intervention. Conclusions: Empowering telemetry technicians to activate code blue for general ward patients on centralized telemetry showed a significant improvement in code survival and a trend in survival to discharge. Importantly, there were no inappropriate code activations by telemetry technicians, highlighting the safety of this intervention.