Nurse prevented resident from calling code

[Spodermin]

---

Members don't see this ad.

Yes you read that correctly.

I was in an M&M where we were reviewing a near miss where a child with a retropharyngeal abscess was admitted to the ward instead of going directly to the OT because the radiologist didn't mention anything about it in his report and no one bothered to have a look at the damn thing.
Long story short, the senior resident is called to check on the patient in the ward. She has a look at the kid, checks the xray, obviously freaks out and decides to call a code.
The senior nurse prevented her from doing so because she "doesn't think it's an emergency"

I'm listening to this and all I can think of is WHAT THE F*CK!

 

[itisallrelative]

Wow. Did the ENT attending have an aneurysm after hearing that? Also wonder what the ID'll have to say... Was the radiologist in attendance? Depending on what all else was involved, something like that could carry severe consequences for the rads. Nurse would be fired, immediately.

 

[frenchyn]

Yes you read that correctly.

I was in an M&M where we were reviewing a near miss where a child with a retropharyngeal abscess was admitted to the ward instead of going directly to the OT because the radiologist didn't mention anything about it in his report and no one bothered to have a look at the damn thing.
Long story short, the senior resident is called to check on the patient in the ward. She has a look at the kid, checks the xray, obviously freaks out and decides to call a code.
The senior nurse prevented her from doing so because she "doesn't think it's an emergency"

I'm listening to this and all I can think of is WHAT THE F*CK!

Was the patient in severe respiratory distress or cardiac arrest? As far as I know, the people who respond to code are intensivist, sometimes anesthesia, and ICU nurses. This child's condition may require immediate intervention, but these are not the one should be seeing the patient. He/she need a specialist. If the child is not in severe respiratory distress or cardiac arrest, then the senior resident just need a STAT specialist consult.

 

[Osteoth]

I didn't even know nurses could do that...

 

[deleted480308]

define "prevented". Said they disagreed? Tried to apply some verbal pressure? Literally physically wouldn't let them call? Used some official administrative override?

where I'm from, literally anyone call a rapid which would have increased the number of people looking at the asphyxiating patient

 

[Spodermin]

Was the patient in severe respiratory distress or cardiac arrest? As far as I know, the people who respond to code are intensivist, sometimes anesthesia, and ICU nurses. This child's condition may require immediate intervention, but these are not the one should be seeing the patient. He/she need a specialist. If the child is not in severe respiratory distress or cardiac arrest, then the senior resident just need a STAT specialist consult.

Apparently the child was in respiratory distress and she wanted an intensivist to be there in case they needed to intubate.

define "prevented". Said they disagreed? Tried to apply some verbal pressure? Literally physically wouldn't let them call? Used some official administrative override?

where I'm from, literally anyone call a rapid which would have increased the number of people looking at the asphyxiating patient

Yeah physically wouldn't let her get on the PA system to call a code...

Wow. Did the ENT attending have an aneurysm after hearing that? Also wonder what the ID'll have to say... Was the radiologist in attendance? Depending on what all else was involved, something like that could carry severe consequences for the rads. Nurse would be fired, immediately.

Rads wasn't there, I can only imagine what would have happened if they were present. ENT literally had tears rolling down her face after the incident.

 

[WingedOx]

define "prevented". Said they disagreed? Tried to apply some verbal pressure? Literally physically wouldn't let them call? Used some official administrative override?

where I'm from, literally anyone call a rapid which would have increased the number of people looking at the asphyxiating patient

Yeah, my spidey sense is that your interpretation isn't exactly correct here.

...and by "you" I mean the OP.

 

[Spodermin]

Yeah, my spidey sense is that your interpretation isn't exactly correct here.

...and by "you" I mean the OP.

Maybe you're right, I wasn't there when it happened. Just got to hear something I'm pretty sure I'll never hear of again.

 

[libertyyne]

This makes no sense. Did the nurse lock the resident in the bathroom without access to a zone phone, cell phone, room phone, code button? The nurse can express disagreement, and the resident can calmly walk away to a different phone and call the code. But what is even weirder is there is no incentive for the nurse to not have more people look at the child. If anything nurses tend to be a little trigger happy with the rapid response /code buttons , but I would rather have a false positive in those cases vs delay in care.

 

[CherryRedDracul]

This makes no sense. Did the nurse lock the resident in the bathroom without access to a zone phone, cell phone, room phone, code button? The nurse can express disagreement, and the resident can calmly walk away to a different phone and call the code. But what is even weirder is there is no incentive for the nurse to not have more people look at the child. If anything nurses tend to be a little trigger happy with the rapid response /code buttons , but I would rather have a false positive in those cases vs delay in care.

Same. This is the first time I'm hearing of a nurse NOT wanting to call a rapid response/code.

 

[evilbooyaa]

Maybe the nurse felt a rapid response would be more reasonable, as code generally means about to arrest. However, if the resident though intubating was a serious risk, then code is a reasonable call. Wonder if the nurse was there to give her side of the story.

 

[sliceofbread136]

Was the patient in severe respiratory distress or cardiac arrest? As far as I know, the people who respond to code are intensivist, sometimes anesthesia, and ICU nurses. This child's condition may require immediate intervention, but these are not the one should be seeing the patient. He/she need a specialist. If the child is not in severe respiratory distress or cardiac arrest, then the senior resident just need a STAT specialist consult.

Wrong. A code or rapid response or what ever the hospital in question calls it is simply an ICU consult. At worst they give their input and the patient stays on the floor. If anyone at all is concerned and want to call extra help then no one should be able to stop that whether it’s the senior nurse or the hospital ceo. If you think about it like any other diagnostic test, this would be one that needs a high sensitivity and specificity is something that can be sacrificed. Otherwise these things end up in your m+m

 

[libertyyne]

Wrong. A code or rapid response or what ever the hospital in question calls it is simply an ICU consult. At worst they give their input and the patient stays on the floor. If anyone at all is concerned and want to call extra help then no one should be able to stop that whether it’s the senior nurse or the hospital ceo. If you think about it like any other diagnostic test, this would be one that needs a high sensitivity and specificity is something that can be sacrificed. Otherwise these things end up in your m+m

Bolded is incorrect. This varies according to hospital. Rapid response may be a page to the rapid response team which includes RR nurses, maybe a midlevel/resident. A code usually gets more resources - ICU team, respiratory therapy, rapid response nurses, rapid response midlevels, anasthesia. The only logical explaination if a nurse did ask a resident not to call a code is that the nurse felt that a rapid response would have been adequate. Most hospitals actually have policies in place for what consitutes a rapid response worthy event and what constitutes a code worthy event, this doesnt mean you cant overcall. Just that polices are hospital dependent and usually differenciate between different situations. Yes no one should be able to stop you from calling a code. No one should stop that nurse from giving her input into the call either.

 

[sliceofbread136]

Bolded is incorrect. This varies according to hospital. Rapid response may be a page to the rapid response team which includes RR nurses, maybe a midlevel/resident. A code usually gets more resources - ICU team, respiratory therapy, rapid response nurses, rapid response midlevels, anasthesia. The only logical explaination if a nurse did ask a resident not to call a code is that the nurse felt that a rapid response would have been adequate. Most hospitals actually have policies in place for what consitutes a rapid response worthy event and what constitutes a code worthy event, this doesnt mean you cant overcall. Just that polices are hospital dependent and usually differenciate between different situations. Yes no one should be able to stop you from calling a code. No one should stop that nurse from giving her input into the call either.

100% disagree. At my institution anyone can call a code or rrt, even the patients or parents. No one can simply over-ride it and that’s how it should be.

Nurse is free to give input but cannot stop anyone from doing what they feel is right

 

[libertyyne]

100% disagree. At my institution anyone can call a code or rrt, even the patients or parents. No one can simply over-ride it and that’s how it should be.

Nurse is free to give input but cannot stop anyone from doing what they feel is right

Did you read the response before commenting on it? I never said anyone can override the desire to call a code, or prevent someone from calling a code. I simply pointed out your understanding of what a code vs what a rapid response is incorrect.

 

[sliceofbread136]

Did you read the response before commenting on it? I never said anyone can override the desire to call a code, or prevent someone from calling a code. I simply pointed out your understanding of what a code vs what a rapid response is incorrect.

Don’t agree with that either, for me the only difference between the two is if I need someone there right this second or if I can wait 10 minutes. The concept is still the same

 

[deleted480308]

Don’t agree with that either, for me the only difference between the two is if I need someone there right this second or if I can wait 10 minutes. The concept is still the same

then your hospital uses different terminology, both are immediate at mine....the only difference is how many people show up immediately

 

[Ismet]

Wrong. A code or rapid response or what ever the hospital in question calls it is simply an ICU consult. At worst they give their input and the patient stays on the floor. If anyone at all is concerned and want to call extra help then no one should be able to stop that whether it’s the senior nurse or the hospital ceo. If you think about it like any other diagnostic test, this would be one that needs a high sensitivity and specificity is something that can be sacrificed. Otherwise these things end up in your m+m

A code and a rapid response are different things, at least at both the institutions where I have trained (med school and residency). Both are immediate, people running to the room, except you get more people with a code.

If I want someone from ICU to lay eyes on a patient, I call the ICU resident. If I need extra hands and eyes to get to the room right now, I call a rapid. If the patient is about to circle the drain, I call a code.

 

[sliceofbread136]

then your hospital uses different terminology, both are immediate at mine....the only difference is how many people show up immediately

At my hospital the rrt team has 10 min to arrive by policy. Code team comes much much quicker as well as an alarm sounding overhead to tell everyone on the floor to get their butts over there. There are different staff that arrives (biggest difference is pharmacist). For me the biggest decision making point between the two is can I can stabilize the patient with the personelle I have at hand or do I need a more immediate response. The code serves to get me an immediate response. Staffing wise the rrt team can get more people over including a pharmacist easily enough.

 

[sliceofbread136]

A code and a rapid response are different things, at least at both the institutions where I have trained (med school and residency). Both are immediate, people running to the room, except you get more people with a code.

If I want someone from ICU to lay eyes on a patient, I call the ICU resident. If I need extra hands and eyes to get to the room right now, I call a rapid. If the patient is about to circle the drain, I call a code.

Well then that’s different than my institution. Rrt team generally gets there in ~5 min and no floor alarm sounds. No real running involved. Code on the other hand gets people running

 

[Rendar5]

Code = intubation +/- cpr. Don’t create alarm fatigue by falsely calling codes. There’s a reason that hospitals typically have rapid responses as a separate thing from code blues

 

[Rads4lyfe]

At my hospital the rrt team has 10 min to arrive by policy. Code team comes much much quicker as well as an alarm sounding overhead to tell everyone on the floor to get their butts over there. There are different staff that arrives (biggest difference is pharmacist). For me the biggest decision making point between the two is can I can stabilize the patient with the personelle I have at hand or do I need a more immediate response. The code serves to get me an immediate response. Staffing wise the rrt team can get more people over including a pharmacist easily enough.

I've never heard of a rapid response team like this. At my med school, intern year, and where I'm at for residency, Code team and rapid response both arrive very quickly. The only difference is that code means patient has no pulse/not breathing or about to become that way, and a lot more people show up(including ICU team and intubation team(anesthesia)).

 

[Ismet]

Well then that’s different than my institution. Rrt team generally gets there in ~5 min and no floor alarm sounds. No real running involved. Code on the other hand gets people running

Our rapid response doesn't have an overhead anything. It's a page that goes out just to the people that need to come. And we need to get there rapidly. Codes go overhead AND page the people necessary.

 

[sliceofbread136]

I've never heard of a rapid response team like this. At my med school, intern year, and where I'm at for residency, Code team and rapid response both arrive very quickly. The only difference is that code means patient has no pulse/not breathing or about to become that way, and a lot more people show up(including ICU team and intubation team(anesthesia)).

Shrug, this is how my institutional policy is and how I’ve been encouraged to make that decision during my training. For me it’s not just pulseless arrest or apnea where I would call a code

Our rapid response doesn't have an overhead anything. It's a page that goes out just to the people that need to come. And we need to get there rapidly. Codes go overhead AND page the people necessary.

Like I said by my institutional policy rrt team has limit of 10 minutes to get there. The way I have been trained is that if I can’t wait 10 minutes for the icu team to get there then I should call a code. It’s not like the rrt team sits around for 10 minutes and then shows up but they are certainly not running to get there. Call a code and that’s a different story.

If your institution encourages you to base the decision on staffing then that is fine, go for it. My training has been different and I’ve yet to see an arguement here that will change how I make that decision point.

 

[Tenk]

lol at blaming this on the radiologist and not anyone else who physically saw the patient before they got to the floor...

 

[andrek82]

Bolded is incorrect. This varies according to hospital. Rapid response may be a page to the rapid response team which includes RR nurses, maybe a midlevel/resident. A code usually gets more resources - ICU team, respiratory therapy, rapid response nurses, rapid response midlevels, anasthesia. The only logical explaination if a nurse did ask a resident not to call a code is that the nurse felt that a rapid response would have been adequate. Most hospitals actually have policies in place for what consitutes a rapid response worthy event and what constitutes a code worthy event, this doesnt mean you cant overcall. Just that polices are hospital dependent and usually differenciate between different situations. Yes no one should be able to stop you from calling a code. No one should stop that nurse from giving her input into the call either.

A code and a rapid response are different things, at least at both the institutions where I have trained (med school and residency). Both are immediate, people running to the room, except you get more people with a code.

If I want someone from ICU to lay eyes on a patient, I call the ICU resident. If I need extra hands and eyes to get to the room right now, I call a rapid. If the patient is about to circle the drain, I call a code.

I train in 5 different hospitals in 3 different administrative systems. In one system, codes and rapids mean what they are supposed to mean, and they have "plain language" overheads that tell you what the person who caked it thinks you are getting into. In the VA, everything is a "code blue" followed by rapid response or cardiac arrest, so in practice people just say "call a code." At the last hospital, if you were a patient it was a code or a rapid. If you weren't a patient, everything was a code blue.

 

[Rads4lyfe]

Shrug, this is how my institutional policy is and how I’ve been encouraged to make that decision during my training. For me it’s not just pulseless arrest or apnea where I would call a code



Like I said by my institutional policy rrt team has limit of 10 minutes to get there. The way I have been trained is that if I can’t wait 10 minutes for the icu team to get there then I should call a code. It’s not like the rrt team sits around for 10 minutes and then shows up but they are certainly not running to get there. Call a code and that’s a different story.

If your institution encourages you to base the decision on staffing then that is fine, go for it. My training has been different and I’ve yet to see an argument here that will change how I make that decision point.

You aren't doing anything wrong since it's your institution policy. I just think it's a bad system, since it will lead to unnecessary code blues and waste of resources. Most of the time, the people calling the codes or rapid responses are nurses. Floor nurses usually can't handle most things requiring rapids with their current staffing for 10 minutes. Different story if you're a doctor calling a code or rapid.

 

[Mad Jack]

Wrong. A code or rapid response or what ever the hospital in question calls it is simply an ICU consult. At worst they give their input and the patient stays on the floor. If anyone at all is concerned and want to call extra help then no one should be able to stop that whether it’s the senior nurse or the hospital ceo. If you think about it like any other diagnostic test, this would be one that needs a high sensitivity and specificity is something that can be sacrificed. Otherwise these things end up in your m+m

This depends on the hospital. We had dedicated code/rapid response physicians that were not a part of the ICU team and worked as hospitalists when **** wasn't hitting the fan. Rapids summoned one team, codes summoned another plus the whole hospital, plus we had pedi and airway teams- the former would call up a peds attending and nurses, while the latter was a standard code plus a difficult airway cart. ICU wasn't even involved until after the situation was sorted out.

 

[Rendar5]

Shrug, this is how my institutional policy is and how I’ve been encouraged to make that decision during my training. For me it’s not just pulseless arrest or apnea where I would call a code



Like I said by my institutional policy rrt team has limit of 10 minutes to get there. The way I have been trained is that if I can’t wait 10 minutes for the icu team to get there then I should call a code. It’s not like the rrt team sits around for 10 minutes and then shows up but they are certainly not running to get there. Call a code and that’s a different story.

If your institution encourages you to base the decision on staffing then that is fine, go for it. My training has been different and I’ve yet to see an arguement here that will change how I make that decision point.

If your institution encourages you to base the decision on staffing then that is fine, go for it. My training has been different and I’ve yet to see an arguement here that will change how I make that decision point.

That’s fine and all, but when you get a new job at another place after you graduate residency, you better check to see if there is a difference as that may require a change in your training. At most of the places I’ve worked as an ED physician, except one, if you call a code on the floor I have to leave all of my patients to come to your bedside. One place even had me come to the icu codes because there is no in-house intensivist. Majority of hospitals I have worked at have a meaningful difference, especially outside of academic ivory towers.

 

[sliceofbread136]

That’s fine and all, but when you get a new job at another place after you graduate residency, you better check to see if there is a difference as that may require a change in your training. At most of the places I’ve worked as an ED physician, except one, if you call a code on the floor I have to leave all of my patients to come to your bedside. One place even had me come to the icu codes because there is no in-house intensivist. Majority of hospitals I have worked at have a meaningful difference, especially outside of academic ivory towers.

It is a “meaningful difference” and the patient I can’t do the initial stabilization on my own is usually the patient who will need the intubation team or a pharmacist present.

And your attitude is exactly the one I would be happy to ignore. Sorry to burden you mr big bad ed physician, I’m just a simple academic ivory tower resident who thought my patient was about to die.

 

[Mad Jack]

You aren't doing anything wrong since it's your institution policy. I just think it's a bad system, since it will lead to unnecessary code blues and waste of resources. Most of the time, the people calling the codes or rapid responses are nurses. Floor nurses usually can't handle most things requiring rapids with their current staffing for 10 minutes. Different story if you're a doctor calling a code or rapid.

That was the whole rationale behind us having a separate rapid response team that was specifically designated for non-cardiac/respiratory arrest situations. OP's situation would have merited a difficult airway code at my institution, but things that don't involve the rare difficult airway or an arrest are generally RRT material, which is a much smaller, more organized and specialized four-person team that handles about a dozen emergencies a day (two nurses, physician, and RT).

 

[WingedOx]

Regardless of how accurately OP understood and/or related the story...

One of my huge pet peeves of surgical M&Ms is when they stick the blame on other parties without inviting said parties to come to the conference and discuss/defend their side of the story.

In this case that would mean both radiology and the nursing staff.

That's still better than psych which tends to be completely averse to doing M&M at all (at least relative to other specialties). My residency program's hospital didn't have anything resembling an M&M, which is kind of nuts in an academic department given the acuity that we worked with.

 

[libertyyne]

Agreed. I just find it obnoxious that the mantra for M&M is to accept responsibility for our complications...except when it’s (medicine/anesthesia/ED’s) fault

I am constantly surprised by the lack of oversight and policing physicians do to each other. Peer review and M&M always just felt like people going through the motions without actually taking action or taking responsibility. Maybe that is just me being exposed to not great insitutions, but honestly whenever actions were taken they were usually the result of politics vs actual medicine.

 

[evilbooyaa]

It is a “meaningful difference” and the patient I can’t do the initial stabilization on my own is usually the patient who will need the intubation team or a pharmacist present.

And your attitude is exactly the one I would be happy to ignore. Sorry to burden you mr big bad ed physician, I’m just a simple academic ivory tower resident who thought my patient was about to die.

Your chip on the shoulder is unnecessary (at least in this thread).

None of the following is an attack on you. I understand that you are simply relaying your experiences. But, just to let you know in the majority of the rest of the world, your system is not the same. With that preface, let's get to it:
Your hospital's designation is stupid. Your ICU docs (or whoever responds to codes) are likely developing alarm fatigue. While 10 minutes may be the max amount of time for a rapid response (and may be the official policy at most places), people will be there much before then. If a patient is about to arrest and/or need intubation, that is when a code is called in most hospitals. If you need additional doctors to evaluate the patient rapidly, draw labs, develop a treatment plan, etc. then you call a rapid response.

If you see somebody who you know is going to end up in the ICU right now, then it's not unreasonable to call a code. Calling a code because of an O2 sat of 75% that responds to NC O2 or even mask re-breather without requiring intubation is unnecessary, IMO.

However, you seem to have some personal story in regards to this, so I invite you to share what (if any) clinical scenario where you called a code outside of arrest (either current or impending) or intubation.

 

[sliceofbread136]

Your chip on the shoulder is unnecessary (at least in this thread).

None of the following is an attack on you. I understand that you are simply relaying your experiences. But, just to let you know in the majority of the rest of the world, your system is not the same. With that preface, let's get to it:
Your hospital's designation is stupid. Your ICU docs (or whoever responds to codes) are likely developing alarm fatigue. While 10 minutes may be the max amount of time for a rapid response (and may be the official policy at most places), people will be there much before then. If a patient is about to arrest and/or need intubation, that is when a code is called in most hospitals. If you need additional doctors to evaluate the patient rapidly, draw labs, develop a treatment plan, etc. then you call a rapid response.

If you see somebody who you know is going to end up in the ICU right now, then it's not unreasonable to call a code. Calling a code because of an O2 sat of 75% that responds to NC O2 or even mask re-breather without requiring intubation is unnecessary, IMO.

However, you seem to have some personal story in regards to this, so I invite you to share what (if any) clinical scenario where you called a code outside of arrest (either current or impending) or intubation.

I’ve never called a code only rrts, so no real story. Why would I need the icy team there immediately for a patient that responds to a rebreather? If can perform initial stabilization with the resources I have on the floor I would not call a code for that. If the sats were still tanking and I had no other interventions available on the floor and the rrt team was not yet there it’s at that point I would consider it

 

[Rendar5]

I’ve never called a code only rrts, so no real story. Why would I need the icy team there immediately for a patient that responds to a rebreather? If can perform initial stabilization with the resources I have on the floor I would not call a code for that. If the sats were still tanking and I had no other interventions available on the floor and the rrt team was not yet there it’s at that point I would consider it

So you’re acting like a dick towards me for explaining that there are consequences to calling a code instead of a rapid response in many hospitals (e.g., leaving emergency room patients temporarily without a doc if that is the structure at that hospital) , yet you’ve never called a code before? And then you’re acting smug when you say you’d ignore me in an intubation requiring scenario by calling a code when I actually said that that was the situation calling codes were reserved for? I think that you are inferring way too much about my response. No reason to act that way.

If the patient is crashing and needs ACLS or intubation then I’m happy to run to the code. Periarrest situations need a code team. But I have been called to codes for hypotension requiring an upgrade and hypoglycemia before when the person calling it was unhappy with how long it was taking the RRT to get there.

 

[evilbooyaa]

Fair enough, that all sounds reasonable to me.

 

[Ismet]

I’ve never called a code only rrts, so no real story. Why would I need the icy team there immediately for a patient that responds to a rebreather? If can perform initial stabilization with the resources I have on the floor I would not call a code for that. If the sats were still tanking and I had no other interventions available on the floor and the rrt team was not yet there it’s at that point I would consider it

Aren't you a peds intern? True peds codes are extremely rare outside of the PICU, and the people you need are already in the unit anyway. It can happen, but you very well may go your entire residency without having to "call a code." It's true that you may perform the initial stabilization, but the biggest thing you should learn in situations like this is "call for help." Kids can go down pretty fast. This is why the RR team is ideally a "hey I need some extra hands NOW" call. It's not a code, not that many resources are necessary, but it gets the PICU resident/fellow and attending to you pretty quickly to help you out. It's so you don't have to get to the point you describe above, when the RR team is taking too long and you have no other choice but to call a code, when a code may not actually be necessary.

 

[sliceofbread136]

So you’re acting like a dick towards me for explaining that there are consequences to calling a code instead of a rapid response in many hospitals (e.g., leaving emergency room patients temporarily without a doc if that is the structure at that hospital) , yet you’ve never called a code before? And then you’re acting smug when you say you’d ignore me in an intubation requiring scenario by calling a code when I actually said that that was the situation calling codes were reserved for? I think that you are inferring way too much about my response. No reason to act that way.

If the patient is crashing and needs ACLS or intubation then I’m happy to run to the code. Periarrest situations need a code team. But I have been called to codes for hypotension requiring an upgrade and hypoglycemia before when the person calling it was unhappy with how long it was taking the RRT to get there.

I do apologize for being a bit snarky/aggressive, you are right it was unnecessary. My point was that if someone gave me attitude for raising my concerns or calling a code/rrt the I would ignore it. Not raising your concern is how things get missed and people get hurt.

Aren't you a peds intern? True peds codes are extremely rare outside of the PICU, and the people you need are already in the unit anyway. It can happen, but you very well may go your entire residency without having to "call a code." It's true that you may perform the initial stabilization, but the biggest thing you should learn in situations like this is "call for help." Kids can go down pretty fast. This is why the RR team is ideally a "hey I need some extra hands NOW" call. It's not a code, not that many resources are necessary, but it gets the PICU resident/fellow and attending to you pretty quickly to help you out. It's so you don't have to get to the point you describe above, when the RR team is taking too long and you have no other choice but to call a code, when a code may not actually be necessary.

Yes I am a peds intern. I’ve been in many rrts (black cloud), and ya I grab who I can from the hallway, call an rrt and do my initial ABC stabilization steps. Usually the picu team will be there in around 5 minutes and it all goes fairly smoothly. However if there was rapid decompensation following my initial stabilization steps, I had no further resources on the floor and the rrt team had yet to be there I would escalate.

There was one situation where a colleague of mine was close to a patient in the echo room and the patient had respiratory decompensation likely only needing some high flow, however because they were technically off campus it was very difficult to get the rrt team to come. They called a code because they were not able to get the resources they needed, didn’t matter that it wasn’t pulseless arrest or apnea. Wouldn’t feel bad at all about calling a code there

 

[Rendar5]

I do apologize for being a bit snarky/aggressive, you are right it was unnecessary. My point was that if someone gave me attitude for raising my concerns or calling a code/rrt the I would ignore it. Not raising your concern is how things get missed and people get hurt.

Definitely agree with you. If you’re coming from a place where you’re doing the right thing for the patient and not doing it just because you’re panicking, don’t let someone stop you.

 

[mvenus929]

So, I'm also in pediatrics, and we actually have a big push at my institution to call rapid responses (we call them 'Care Teams') welllll before there is the need for a code. We are told over and over that the Care Team should be called if you need more eyes on the patient, or if you need a more rapid turnover in routine tasks (i.e. this patient needs an albuterol treatment now, and we can't wait until the next dose is due in an hour). The pages for the Care Team go out to all the team seniors (PGY-3s and 1 PGY-2), the PICU charge nurse, and one of the PICU respiratory therapists. Usually the unit charge nurse and an attending also show up during the day, and the expectation is to call the attending of the patient to come as well.

The Code Team consists of the PGY-3 on hospitalist (who is the designated code leader), a designated hospitalist intern (rotates daily), the PICU charge, PICU RT, the nursing supervisor, and whoever is on the floor that wants to respond to the overhead page. Most of the time we end up turning people away.

I've never had to call a code, but I've called multiple care teams, and they aren't necessarily just PICU consults, because sometimes we just need a therapy that was being delayed due to other things happening in the hospital, and the care team facilitates it happening faster, or we need labs now to do a rapid assessment of something that looks off. Other times, we end up transferring the kid to the PICU (but the PICU attending doesn't come up and see the patient to determine whether they are appropriate for the PICU or not--the charge nurse calls and lets them know what's going on and 99% of the time, they accept the patient, then the medical team goes down and signs out to the accepting PICU resident and attending).

Anyway, no one should be prevented from calling for assistance, but we see in multiple M&Ms that if one party is comfortable (either the nurse, the resident, or the attending), they tend to talk people out of calling for help sooner, and the kids get sicker as a result.

 

[pkwraith]

100% disagree. At my institution anyone can call a code or rrt, even the patients or parents. No one can simply over-ride it and that’s how it should be.

What? You are giving people who have no training or understanding in codes or rapid response unfettered ability to call them?
If I was on the code team at the hospital, I would be pissed the tenth time I end up running to the bedside of someone who feels like it's taking too long for their pain medication or for their nurse to get them to the toilet.

 

[KnuxNole]

Where I work, it's usually the nurses that call codes or rapid responses. For our RRT, the ICU nurses, RT, and hospitalists all respond. Usually I've noticed people are leaning more on the safe side rather than wait. I know a lot of the floor nurses say if the doc isn't able to come in 5 minutes, they'll call a rapid response to prevent an eventual code blue. Rapid responses get called for rapid low blood pressure, O2 sats in the 70s, syncopal episode or a seizure. It varies to be honest.

 

[alpinism]

My son's pain is 10/10 and the pain meds aren't working.

OMG I'm calling for a code blue!

 

[sliceofbread136]

What? You are giving people who have no training or understanding in codes or rapid response unfettered ability to call them?
If I was on the code team at the hospital, I would be pissed the tenth time I end up running to the bedside of someone who feels like it's taking too long for their pain medication or for their nurse to get them to the toilet.

It’s actually becoming the norm in pediatric hospitals. I’ve never personally witnessed it being misused, but I’ve heard the occasional story.

I’m guessing you work with adult patient, maybe it would not work there

 

[libertyyne]

It’s actually becoming the norm in pediatric hospitals. I’ve never personally witnessed it being misused, but I’ve heard the occasional story.

I’m guessing you work with adult patient, maybe it would not work there

I have seen this set up at two hospitals as well. I think Joint Comission was influencing educating patient families on when to activate an emergency response. Never saw it abused during my time at those hospitals.

 

[WheezyBaby]

Peds and adult hospitals frequently use codes and rapids differently. It is what it is

What? You are giving people who have no training or understanding in codes or rapid response unfettered ability to call them?
If I was on the code team at the hospital, I would be pissed the tenth time I end up running to the bedside of someone who feels like it's taking too long for their pain medication or for their nurse to get them to the toilet.

Yep. It's not abused

 

[Raryn]

What? You are giving people who have no training or understanding in codes or rapid response unfettered ability to call them?
If I was on the code team at the hospital, I would be pissed the tenth time I end up running to the bedside of someone who feels like it's taking too long for their pain medication or for their nurse to get them to the toilet.

I've never seen the privilege abused.

The only closest absurd thing was at our VA in residency, where if anyone fell down on the first couple floors (the clinic floors), a clerk would call a code blue. Even if they were talking. Turns out it was an asinine policy put in place because "clerks can't make medical decisions". Doesn't mean a trip in the parking lot is a code blue though.

When it wasn't mandated by stupid governmental policy, people understand the gravity of calling a code.

 

[WheezyBaby]

VAs everywhere are notorious for this. I feel like the false code rate at our Va was like 80%. Poor medicine team would be running by Laps for all these non codes.

We don't have the issue with codes at the VA, but the rapids are consistently really painful. On the flip side, at our county hospital, rapids have about a 50/50 chance of turning into a legit code within 30 seconds of being called.

 

[deleted480308]

At my home hospital the rapid response button was on the wall. Literally anyone could call it.

Codes were different, just staff