Use of a Clinical Nurse Specialist to Decrease Code Calls: Evaluation and Outcomes

Purpose:
To evaluate the use and effectiveness of an existing rapid response team before and after involvement of a dedicated Clinical Nurse Specialist (CNS).

Background/Significance:
A CNS reviewing monthly code and rapid response calls, identifying missed opportunities, and giving feedback to clinical staff, would lead to a reduction in total codes and an increase in rapid response calls.A rapid response team was established in 2006 at our 460 bed tertiary care hospital. Starting January 2010 a CNS was tasked with reviewing all records of rapid response calls and code calls.

Methods:
Retrospective review of 336 rapid response calls and 250 code calls in the adult inpatient setting from July 2009 to June 2012 was conducted. Review included patient's clinical condition, vital signs, and treatments prior to the calls and subsequent outcomes. In February 2010 results of that review revealed missed opportunities. Possible earlier interventions were presented and feedback given to clinical staff, nursing and medical leadership. We continuously reviewed 278 code calls and 770 rapid response calls from July 2010 to March 2012. Calculations of both total codes and rapid response calls per 1000 inpatient discharges were examinied.

Results:
In the retrospective analysis, rates of code calls and rapid response calls were measured. Comparing the 5 year period from July 2006 to June 2010 to the period from July 2010 to March 2012 after the introduction of a CNS, code blue calls decreased from 8.54 to 6.68 per 1000 discharges, and rapid response calls increased from 10.93 to 18.49 per 1000 patient discharges.

Conclusions and Implications for Practice:
The introduction of a CNS was associated with a progressive decline in code calls, with a steady increase in rapid response calls which are following the Institute for Healthcare Improvement recommendations.