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Center for Professional Practice of Nursing

Center for Professional Practice of Nursing

NEWS | June 3, 2013

Code Blue training initiative pulsates with innovation and success


Working to improve cardiac arrest training — training for what are called “Code Blue” events — a multidisciplinary UC Davis Health System team has created a novel initiative that takes advantage of the university’s high-tech simulation facilities and equipment and its highly regarded emergency and trauma-care expertise.

“Few formalized training programs exist in the country for interprofessional, multidisciplinary Code Blue teams,” said Aaron Bair, associate professor of emergency medicine and medical director for the UC Davis Center for Health and Technology, where much of the simulation training and expertise are based. “The lack of team training can result in confused or poor communication during a code event. We’ve designed a program that identifies specific processes and measures for improvement and is able to provide educational opportunities throughout the health system to address deficiencies.”

Known as the Code Blue Team Training Initiative, Bair and his colleagues are working their way through various units at UC Davis Medical Center, where they have been scheduling short but intense cardiopulmonary arrest scenarios using high-fidelity human patient simulators. The exercises involve the full range of clinical care personnel, including residents, pharmacists, respiratory therapists, nurses, physicians and others.

“What’s unique about this initiative is that not only do we use portable simulation mannequins to create a very realistic Code Blue scenario,” said Bair, “but we have a team of observers taking detailed notes. The exercises are also videotaped, and we provide immediate feedback as well as a follow-up debriefing so that every participant learns about their strengths and knows the areas where there is room for improvement.”

Data gathered during the exercises assess both technical and non-technical skills, such as measuring the compression fraction during CPR (the fraction of time during a pulseless arrest when chest compressions are actually being performed, which can correspond to survival outcomes), CPR interruptions, the timing of medications, leadership and communication. Video from the training exercise is available to participants so they can better understand the key training principles. In addition, the Code Blue Team is producing new online educational modules at the Center for Health and Technology to help enhance code response skills and performance. A number of these modules are already available through iTunes U.

Code Blue Team
Code Blue team training leaders. Picture (left to right) Karrin Dunbar, Francisco Ramirez, Aaron Bair, Bill Hammontree, Matthew Carlisle, Sam Clark, Vivienne Ng and Joe Barton

“One of the areas we’re also focused on in this initiative is to providing better, more meaningful baseline metrics,” added Bair. “Just as athletes need baseline numbers to set goals and measure their sport’s improvement, clinical care providers also need to have meaningful performance targets. An important part of our initiative involves measuring performance and optimal CPR times. And much like many athletes, so much depends on good teamwork – the kind of effort that simply takes lots of practice.”

The Code Blue team’s work – which earlier this year won first place for its research poster at the health system’s Integrating Quality Symposium – aligns well with the University of California’s focus on continuous quality improvement (CQI). Last week, UC’s Office of Risk Services announced a grant of more than $1 million to fund a new collaborative resuscitation training program at UC Davis and the other medical center campuses over the next few years. Similar to the UC Davis Code Team initiative but on a larger scale, the new systemwide program will integrate hospital resuscitation training with CQI data and a modular educational curriculum. It also includes the development of resuscitation leadership teams at each campus, creation of a resuscitation database to document outcomes, and establishment of a resource center for training materials and best practices.

“UC’s advanced resuscitation training program dovetails nicely with the work we’ve been doing here at UC Davis to significantly improve cardiac-arrest outcomes,” noted Bair. “Continuous quality improvement in clinical care only happens if we ceaselessly strive for excellence in the work we do and the care we provide.”

UC Davis Health System is improving lives and transforming health care by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education, and creating dynamic, productive partnerships with the community. The academic health system includes one of the country's best medical schools, a 619-bed acute-care teaching hospital, a 1000-member physician's practice group and the new Betty Irene Moore School of Nursing. It is home to a National Cancer Institute-designated comprehensive cancer center, an international neurodevelopmental institute, a stem cell institute and a comprehensive children's hospital. Other nationally prominent centers focus on advancing telemedicine, improving vascular care, eliminating health disparities and translating research findings into new treatments for patients. Together, they make UC Davis a hub of innovation that is transforming health for all. For more information, visit