Nursing & Patient Care
New emergency response system launched
Members of the Cardiopulmonary Resuscitation Committee examine a piece of emergency equipment
Sweeping changes have greatly improved how care is now provided when emergencies occur at DFCI. In the past, when a patient or visitor experienced an unexpected event such as chest pain or a fall, a "code blue" would bring large numbers of staff to the scene. Often, reports Glen Kimball, RRT, manager for respiratory care, too many people would respond, raising a potential for confusion. And because there is no emergency room at the Institute, the city of Boston's 911 system would be called as well. This response, says Kimball, was often overwhelming for the patient. "It increased the patient's fears of what was happening," he explains.
As a first step toward streamlining the response to emergencies, Kimball and his colleagues on the Dana-Farber Cardiopulmonary Resuscitation (CPR) Committee determined who should respond, what each person's role should be, how the responders should be trained, and how the right group would be called. A subcommittee analyzed problems that occurred during actual events and devised solutions.
This past year, the group looked at additional opportunities for improvement. For example, they realized that when emergencies occurred in clinical areas, staff clinicians could often provide much of the needed care. They asked — why not give clinicians the option of initiating a limited "code blue" response in certain situations? Kimball reports that putting this option in place has resulted in a "huge improvement" in the way emergencies are handled in clinical areas.
The group has also examined the use of the 911 system. Kimball notes, "Once we were functioning well, we realized we were inappropriately using the 911 resource and underutilizing the expertise of the clinicians we now had on the code teams." In October, a new system that has reduced reliance on 911 was implemented during regular business hours for all adult emergencies. The call to 911 is now deferred unless specifically requested by the code team.
Matt Kulke, MD, who co-chairs the CPR committee with Kimball, agrees that the new systems have been a success. He notes, "The new code response team utilizes many of the talented staff that already work at Dana-Farber. By including pharmacists, nurses, respiratory therapists, and physicians on the team, we provide top-level emergency care and create a safer and less stressful atmosphere for our patients."
