Geoffrey Lighthall, MD
Professor, Anesthesia and Critical Care
Veterans Affairs Medical Center Palo Alto, United States
Disclosure information not submitted.
Title: A National Survey Describing Diurnal and Weekly Variations of Code Team Composition
Introduction: Among different healthcare institutions, there exist diurnal and weekly variations in hospital staffing. The goal of this study is to describe the variations of code team composition between weekday and weekend coverage, and between nighttime and days among multiple Veteran Affairs (VA) hospitals.
Methods: A multi-question survey was sent to 123 out of 152 active VA hospitals in the United States between 2018 and 2019. The survey asked about the composition of code team, who leads the team, and who performs endotracheal intubations. Demographics of the hospital were obtained by VA national administrative data sources . Descriptive statistics were used to analyze the code team composition, lead of code team, and performer of intubation during four diurnal and weekly time periods.
Results: Responses were received from 93 hospitals, representing a survey response rate of 76%. The attendance of code calls during weekday daytime, weekday nighttime, weekend/holiday daytime, weekend/holiday nighttime are ICU attending(44%, 8%, 15%, 9%), ICU fellow(32%, 9%, 16%, 9%), ICU resident(47%, 4%, 39%, 34%), Medical Officer/Hospitalist(52%, 62%, 61%, 63%), floor resident(33%, 31%, 31%, 31%), Emergency attending(16%, 14%, 12%, 14%), Anesthesiologist(34%, 13%, 13%, 13%), anesthesia resident(16%, 13%, 13%, 13%), respiratory therapist(RT)(92%, 85%, 86%, 85%), first crisis nurse(87%, 85%, 84%, 84%), second crisis nurse(43%, 39%, 39%, 39%), and pharmacist(46%, 24%, 27%, 24%). Medical Officers/Hospitalists are the team leader in half of hospitals(39%, 45%, 48%, 48%). During weekday daytime, intubations are mostly performed by anesthesiologists and RTs(45% vs 42%), while during other time periods, intubations are mainly performed by RTs instead(49%,47%,51%).
Conclusions: There exist diurnal and weekly variations of code team composition. The main variations are the attendance of ICU staff and anesthesiologists. Medical Officer/Hospitalist is the main leader of code teams among half of the hospitals. In more than 40% hospitals, intubations are performed mainly by respiratory therapists throughout all time periods, except for weekday daytime. It seems an important subject of further inquiry whether there is variability in quality of resuscitation and outcomes that can be attributable to team composition and design.