Codes Outside the ICU

Codes outside of the Intensive Care Unit (ICU) setting are quality data that are monitored because patients outside the ICU are typically more stable and less likely to experience a code than patients inside the ICU. A code is when a patient experiences cardiac (heart) or respiratory (breathing) arrest and requires medical intervention such as chest compressions or tube insertion to help breathing.
 
Packard Children’s goal is zero codes outside the ICU setting. The hospital has implemented several measures (see below) to help prevent codes and to bring critical care expertise to all patients regardless if they are in the ICU or other areas of the hospital. 
 
A low score is better than a high score.
 

Codes Outside the ICU per 1000 Patient Days January-December 2010

Last Updated: March 2011

Benchmark data: Benchmark data are from the Pediatric Health Information System database collected by the Child Health Corporation of America.

What This Graph Says
Packard Children’s Hospital’s codes outside the ICU rate compares favorably to other children’s hospitals in the United States. 
 
Our codes outside the ICU rate is shown in red in the figure above. Packard Children’s Hospital’s rate of 0.095 per 1000 patient days is in the top 25th percentile compared to 39 other children's hospitals in the United States.
 

Codes Outside of the ICU Setting (Absolute Number)

Last Updated: March 2011
 
What This Graph Says
The above graph shows the number of codes outside of the ICU setting between December 2007 - November 2010. Lucile Packard Children's Hospital has consistently performed below our historical mean since the implementation of our Rapid Response Teams in September 2005.

What We Are Doing to Improve the Codes Outside the ICU

Packard Children’s Hospital's goal is zero codes outside the ICU. If a code does occur outside the ICU, Packard Children’s reviews the incident to look for trends and how to prevent a similar code in the future. Efforts to decrease the incidents of codes outside of the ICU setting include:

• Implemented Rapid Response Teams in 2005. Rapid Response Teams are highly specialized critical care teams consisting of physicians, nurses and respiratory therapists. They work 24x7 to proactively evaluate patients whose symptoms suggest the possibility of a code that might happen shortly. The teams determine if immediate medical intervention is needed to prevent a code from occurring. Packard Children’s Hospital has been recognized for its Rapid Response Teams nationally and internationally by:
  • Being awarded the Child Health Corporation of America's (CHCA) 2007 RACE for Results award for its success in implementing Rapid Response Teams
  • Publishing a paper in the Journal of the American Medical Association (JAMA) in November 2007
    
    
• Implemented the “Family Activated Rapid Response Team” in January 2009. Families are encouraged to contact the bedside nurse and/or the Rapid Response Team if they have any medical concerns about their child.
  
  
• Created a hospitalist service, a group of senior physicians (attendings) that specialize in taking care of patients in the hospital. The hospitalists ensure oversight by senior level physicians of every patient in Packard Children’s Hospital, 24 hours per day, 7 day per week.
  
  
• Ensuring the safe and efficient movement of patients between the ICU and the medical-surgical units.