(1228) When Code Response Involves Victims of Intentional Violence: A New Frontier for Pediatric Hospitals

Introduction: The number of adults presenting with medical emergencies to the entrance of our children’s hospital has risen dramatically since 2020. A number of these events have involved victims of intentional violence (VoIV). These scenarios presented a multitude of challenges for the code team. The VoIV patients raised significant concerns for team member safety. Many events occur at night and poor lighting led to increased chaos and lack of role clarity between code responders and security officers and guest relations associates(GRAs) that staff the entrance, and there was no clear process to ensure the scene was safe for responders. The goal of this project was to address team member safety concerns, and to optimize code team response to these unique and atypical situations.

Methods: Since 2020, numerous steps were taken to optimize front entrance code response involving VoIV patients and to support the safety of code responders. An algorithm was developed with clear roles for code team responders, security officers and GRAs, including steps for securing the scene, prior to code team responding. Visual aids were developed to indicate when the scene has been secured. Simulations were conducted to test algorithm steps and the new vehicle extrication procedure. The VoIV policy was revised to include scene safety steps and lock down procedures. Video event reviews were implemented to identify ongoing opportunities.

Results: The incidence of code events at the front entrance, including VoIV patients, has risen from an average of 10.8/year in 2020 to 35/year. As a result of this improvement project, the “Overall quality of code response” metric (positive responses on post-code feedback survey) has improved from a baseline of 77.6% for 2020-2022 to 87.5% for 2023. The number of events in which team dynamic issues were identified decreased from 39.7% to 20.8% in 2023. A baseline survey obtained in August 2022 highlighted only 51% of code responders indicated a positive perception of team member safety. A re-survey is planned for fall 2023.

Conclusions: With rising levels of gun violence everywhere, pediatric code response teams must adapt to address the unique challenges these situations present. Addressing the psychologic and physical safety of responders must be parament.