382 - Characteristics of Non-Inpatient Code Events at a Tertiary Pediatric Hospital

Poster Number: 382
Publication Number: 382.243

Katherine Rand, Childrens Hospital Los Angeles, Los Angeles, CA, United States; Elizabeth A. Bragg, Childrens Hospital Los Angeles, Los Angeles, CA, United States; Mark H. Corden, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: Hospitals are well equipped with protocols for inpatient emergencies in order to escalate care for patients who have had clinical deterioration. Most hospitals also have protocols in place for emergencies that occur to individuals who are not admitted to the hospital but are within the hospital walls, whether that be a visiting family member, an employee, or a patient visiting for an ambulatory appointment. However, protocols for responding to these non-inpatient codes are much less standardized, and little data exists classifying the types of events, thus making it challenging to develop an evidence-based protocol for the most appropriate response.

Objective: Identify the clinical characteristics of non-inpatient code events at a tertiary children's hospital.

Design/Methods: An online system was developed in 2019 to record non-inpatient code events (NCEs) at Children’s Hospital Los Angeles. After each event, designated personnel recorded pertinent data (date, time, location and outcome of the event with a brief description). This data was retrospectively abstracted and analyzed. Medical emergency activation that occurred anywhere in the hospital aside from the wards and intensive care units was considered a non-inpatient code event (NCE).

Results: Over the course of 18 months, from June 2019 through December 2021, there were a total of 223 NCEs, approximately 12 events per month. The two most common reasons for NCEs were syncope or near syncope (32%) and seizures (17%). Individuals were taken to the hospital’s emergency department in 73% of the cases. There were 0 deaths that occurred during an event. Of recorded data, the median age was 17 years, 57% were pediatric (age < /= 21), and 57% were female. NCEs most frequently occured in the lobby (32%). Other notable locations include subspecialty ambulatory clinics (18%), radiology (8%), general pediatrics ambulatory clinic (5%), the infusion center (5%), cafeteria (5%) and hemodialysis (1.8%). Events occurred at a median time of day of 13:35, with 80% occurring between 9am-5pm (Fig. 1).Conclusion(s): Non-inpatient code events occurred frequently at our tertiary care pediatric hospital and affected individuals ranging from infancy to over 70 years. We were able to identify the most common reasons, locations, and timing for events, which can guide further quality improvement/patient safety investigation as well as development of response protocols and resource allocation.
CV - Kate RandCV - Jan 2022.pdf