How One Hospital Fends Off 'Code Blues'

A fast heartbeat, or a nurse's concern, can quickly bring a team to check on an ill patient.

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A commentary in the just-out issue of the Journal of the American Medical Association caught my eye today. I'll come back to the subject—the logic of withholding Medicare payments for treating certain preventable hospital-acquired complications—in a future post. I'm mentioning it now because of an observation by the authors about what happens in healthcare when well-meaning people make changes: "Unintended consequences are the norm rather than the exception."

Earlier in the day I'd run into an interesting example in long post in Paul Levy's "Running a Hospital" blog. Last spring, Beth Israel Deaconess Medical Center, where Levy is president and CEO, introduced a new approach to rescuing patients who might be on the verge of a sudden decline. Signs that all is not well aren't obvious. It's more like hints—they may be breathing faster, or their blood oxygen or urine production may have dropped. The hospital's "Triggers" program authorized a nurse to bring in help if any of a set of clinical triggers (such as a heart rate higher than 130 beats per minute) goes awry, or even if the nurse simply has an uneasy feeling about a patient—"marked nursing concern" is what the program calls it.

In its first year, the Triggers program has had remarkable success. "The number of 'codes' on our floors," writes Levy, "has gone down so dramatically that residents now need to practice emergency resuscitation mainly in the simulation center because so few actual patients need it." Hmm. There's an unintended consequence. But, as he says, what a lovely problem to have....