From left: Saima Aftab, Raghu Seethala, Rita Patnode, Michael Prendergast, Karen Griswold, Robert Fine, Janet Gorman, Peter Stone and Claire McGowan

A young child has an allergic reaction while visiting a grandparent who is a patient in the Shapiro building. A new mother in the Connors Center for Women and Newborns cries for help when she sees her baby has a blocked airway. These are some of the medical emergencies that would trigger a Code Blue and, until recently, prompt several different code teams made up of physicians, nurses and other staff to respond—not all of whom specialize in pediatrics or have experience working together.

Although BWH is not a pediatric hospital, some of its visitors and patients are children and infants. And none of them are immune to experiencing a medical emergency within the hospital’s walls.

Recognizing this, the Brigham launched two new code teams on Sept. 1: one dedicated to Code Blue emergencies involving newborns, with the other specializing in children under 15 who are visitors or receiving outpatient care on the Brigham’s main campus. These teams, available 24/7, join the existing Code Blue teams that respond to adult patients and the Code Blue Obstetrics team.

“Even though the likelihood of a pediatric emergency happening is very low, we want to be prepared because we care for everyone who walks through our doors—regardless of their age or whether they are a patient or visitor,” said Saima Aftab, MD, a neonatologist in BWH’s Neonatal Intensive Care Unit (NICU), who worked on the multidisciplinary task force that helped develop the new code teams.

Prior to this, several teams would respond when a Code Blue was called: the adult code teams, a specialized Code Blue Obstetrics team and an internal NICU code team for newborn emergencies in the Connors Center’s inpatient areas.

“We worked with these existing teams to establish tailored responses for younger patients and visitors that will enhance the safety of all of our patients, visitors and staff,” said Karen Griswold, RN, MBA, CPPS, lead program manager for Patient Safety.

Code Blue Pediatrics Response

The ED Code Team and the NICU Code Team are combining their expertise to respond to medical emergencies for children under the age of 15 who are visitors or receiving outpatient care at BWH. The two teams trained together in the BWH’s Neil and Elise Wallace STRATUS Center for Medical Simulation for several months to get comfortable with responding to emergency situations together before being called to a real-life emergency involving a child.

“The teams worked through multiple scenarios that were posed to them in the simulation center, and some great learning came out of it,” said Griswold. “Everyone is focused on doing the best thing for the patient, and that really shined through as they worked through the various scenarios.”

The STRATUS Center offered a safe but realistic environment that helped the two teams identify the best roles for various members of the code teams, said Raghu Seethala, MD, of Emergency Medicine, who was also part of the task force.

“These are two teams that function well, but didn’t have any prior experience functioning together, so we wanted to avoid  having ‘too many cooks in the kitchen’ and figure out the best way to integrate everyone,” Seethala said. “We have the infrastructure to care for every event here, but we had to get the right people in the room to formulate a plan to deal with these rare events.”

Code Blue Newborn

When a mother requires care in the Shapiro Center or the Tower after delivery, her baby is usually brought to her unit to be with her.

If the baby had an emergency, staff on these units would previously call a Code Blue Obstetrics, bringing three code teams to the location: the NICU team, the Obstetrics team and the adult Medical code team.  “You may have 30 people show up, which sometimes made it difficult to coordinate,” Griswold said.

When a Code Blue Newborn is now called, only the six specialized members of that code team will respond. This ensures the other two code teams are available for emergencies elsewhere in the hospital and the right expertise is brought to care for the baby.

Although medical emergencies for children and infants are an uncommon occurrence in the Brigham—only a handful of events occur over a year—having a defined protocol will greatly reduce the risk of human error or logistical issues.

“We created this very highly specialized team that has a very clear-cut protocol,” Aftab said. “Instead of having to figure it out in an emergency situation, we now know exactly what to do.”