Intraoperative Code Blue: Improving Teamwork and Code Response Through Interprofessional, In Situ Simulation

Published:September 02, 2022DOI:


      An intraoperative cardiac arrest requires perioperative teams to be equipped with the technical skills, nontechnical skills, and confidence to provide the best resuscitative measures for the patient. In situ simulation (simulation conducted in health professionals’ work environment, such as a patient care unit, and not in an off-site location) has the potential to improve team performance. The research team assessed the effects of in situ simulation on code response, teamwork, communication, and comfort in intraoperative resuscitations.


      This study included seven interprofessional teams consisting of RNs, anesthesiologists, surgical technologists, and patient care technicians working in the operating room of a community hospital in New Jersey. The hour-long interdisciplinary simulation training sessions consisted of a code blue scenario run twice; both times video recorded, retrospectively reviewed, and compared to each other. Technical skills were measured by “time-to-tasks”; nontechnical skills were assessed using the Team Emergency Assessment Measure (TEAM) instrument. Self-reported comfort in skills was collected before the simulation program and after completion of the training.


      A total of 21 perioperative nurses, 7 anesthesiologists, 7 surgical technologists, and 4 patient care technicians participated from January to April 2021. There was a significant (p < 0.05) decrease in time to compressions (by 14 seconds, 53.5% improvement) and in time to defibrillation (by 49 seconds) between the two simulations. Significant improvements were noted in confidence levels of certain CPR–related technical skills. There were statistically significant improvements in TEAM scores in the two teams that performed lowest in the pre-debrief simulation (p < 0.05).


      In the operative setting, where time and space for training are limited, in situ simulation training was associated with improvement in technical skills of individuals and teams, with significantly improved teamwork in teams that required the most training. The long-term effects of such training and its effects on patient outcomes require additional research.
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