Code Green: An Effective Approach to Respond to Obstetric Emergencies Outside of the Labor and Delivery Unit

Abstract

Poster Presentation Purpose for the Program During an emergency, a swift response by the health care team improves patient outcomes. This has been noted in most types of medical emergencies. Medical rapid response teams have existed in tertiary care centers for more than 30 years and have been used more in the past 10 to 15 years. Many hospitals began seeing improved patient outcomes after forming rapid response teams. Proposed Change University Hospitals Case Medical Center (UHCMC) MacDonald Women's Hospital (MWH) has applied this process to obstetric emergencies in the obstetric units and is also creating a plan to implement this throughout all of UHCMC on every type of inpatient unit. The Code Green procedure was developed to alert specified team members of obstetric emergencies. The plan was to empower nurses to call a Code Green at the start of an obstetric patient's decline to access the correct medical team. Also, the goal was to decrease challenges of communication between different units and improve patient outcomes. Implementation, Outcomes, and Evaluation Several quality cases within the MWH with delays in patient care were analyzed. It was noted that many of them involved challenges in communication between the different obstetric units. An interdisciplinary team was developed, including obstetricians, anesthesiologists, and nursing staff from all three obstetric units. The outcome was the initial Code Green response intended to be a systematic rapid response to patients who experience an obstetric emergency within the hospital. A plan was created for a team that consisted of the obstetric chief resident and a prespecified nurse who would respond directly to the patient's location no matter where in the hospital that might be. Additional staff, including anesthesia, would be on standby. All hospital staff within MWH and the emergency department were educated using various methods before initiation. Within the Women's Hospital, communication and timeliness of response to emergencies has improved. However, the education has been found to be limited in the emergency department, and the Code Green is not always used appropriately in this area. Reeducation is being planned. Later, the Code Green will be opened to the entire inpatient setting to include any obstetric patient admitted to UHCMC. Implications for Nursing Practice The new Code Green promotes empowerment of nurses to initiate rapid responses for obstetric patients off of the labor and delivery unit and access the correct medical team. It improves interdisciplinary communication, which leads to improved patient outcomes.