Finding the key to a better code: code team restructure to improve performance and outcomes.

Code teams respond to acute life threatening changes in a patient's status 24 hours a day, 7 days a week. If any variable, whether a medical skill or non-medical quality, is lacking, the effectiveness of a code team's resuscitation could be hindered. To improve the overall performance of our hospital's code team, we implemented an evidence-based quality improvement restructuring plan. The code team restructure, which occurred over a 3-month period, included a defined number of code team participants, clear identification of team members and their primary responsibilities and position relative to the patient, and initiation of team training events and surprise mock codes (simulations). Team member assessments of the restructured code team and its performance were collected through self-administered electronic questionnaires. Time-to-defibrillation, defined as the time the code was called until the start of defibrillation, was measured for each code using actual time recordings from code summary sheets. Significant improvements in team member confidence in the skills specific to their role and clarity in their role's position were identified. Smaller improvements were seen in team leadership and reduction in the amount of extra talking and noise during a code. The average time-to-defibrillation during real codes decreased each year since the code team restructure. This type of code team restructure resulted in improvements in several areas that impact the functioning of the team, as well as decreased the average time-to-defibrillation, making it beneficial to many, including the team members, medical institution, and patients.