The PETE Initiative: Improving Reliability and Boosting Confidence in Emergency Response

Data reveals a concerning pattern of delays in escalating care for patients requiring higher-level medical attention. The ambulatory care division is responsible for a variety of complex patient populations within a large pediatric healthcare system undergoing expansion. This growth drives variability and confusion of expected code response at various locations based on setting, services, scope of practice, training, and equipment. These delays require innovation to standardize code blue response for locations where varying levels of healthcare workers with diverse levels of training without a code team when responding to medical emergencies.
Ambulatory care clinical practice specialists (CPS) and clinical educational specialists (CES) lead multidisciplinary teams of clinical and operational staff in standalone network of care (NOC) locations using quality improvement methodology to eliminate confusion through development of a standardized process and training to emergency response.
An analysis of the current state is conducted through staff surveys, policy appraisal, conducting of site visits, observation of real time and simulation events, staff discussions, incident report reviews, and inventory of supplies. Baseline data reveal both knowledge and skill gaps where less than 50% of 176 respondents reported feeling “very confident” or “somewhat confident” in knowing their role, properly utilizing equipment, and calling a code, which confirms a need for a standardized approach to recognize, activate, respond, and evaluate code response across the system.
To address knowledge gaps related to when to activate a code blue, understanding the variety and complexity of patient situations, an acronym PETE (people, expertise, time, and equipment) provides crucial questions to ask. Does the team have the necessary people, expertise, time, and equipment to provide care? If any answers are no, a code blue is activated. The expectations for team members who respond are clarification of roles and utilization of closed loop communication. A designated leader ensures the important tasks are complete and provides a level of consistency.
Literature supports using simulation training to increase confidence through emergency response. Recognizing the need for a standardized and evidence-based approach, a multimodal curriculum is established. Annual education integrates various strategies including competency on the fly, low-fidelity simulation, and “train the trainer” skills validation. Prior to attending a mock code and skills validation, the learner completes an online module. In-person simulations for multidisciplinary team members, hands-on equipment, use-relevant scenarios, and essential debriefing solidify confidence in code response.
Survey two results during the intervention period shows an improvement to 73% of 176 respondents reports feeling “very confident” or “somewhat confident” in knowing their role, utilizing equipment, and calling a code. Survey three after intervention reveals that 90% of team member respondents reported feeling “very confident” or “somewhat confident” in knowing their role, using equipment, and calling a code.
Ambulatory care teams caring for complex patient populations in a fast-growing healthcare system collaborate to create a standardized approach to recognize, activate, and respond to emergencies. A multimodal curriculum includes low-fidelity simulation to train more than 600 staff, resulting in a significant increase in staff confidence when responding to emergencies.