Quality and Sustainability Paper: Part 2

Quality and Sustainability Paper: Part 2

Quality care delivery is the ultimate objective and mission of Advent Health-affiliated facilities. In this sense, preventing adverse events emerges as the most profound strategy for safeguarding patient safety, preventing detrimental ramifications, and saving on care costs. Cases of in-hospital cardiac arrests pose significant safety concerns to hospitalized patients and healthcare professionals. According to Fuchs et al. (2021), in-hospital cardiac arrest incidences occur in 0.8 to 4.6 per 1000 patient admissions. Timely and immediate interventions play a significant role in reducing the in-hospital cardiac arrest (IHCA) mortality rate. Fuchs et al. (2021) argue that the current improvements in response mechanisms for cardiac arrests have led to a better chance of patient survival (about 25% in the United States and up to 35% in European countries). Amidst the rationale for early and immediate care strategies for patients, implementing the code blue system provides opportunities for incorporating advanced practices into multidisciplinary interventions for responding to and tackling in-hospital cardiac arrests. Consequently, this paper discusses various aspects of the code blue system as a safety improvement initiative, including evaluating its efficiency, identifying potential obstacles, locating stakeholders within the organization, and elaborating a change management theory that supports its implementation. Further, the paper describes the expected outcomes of code blue system implementation and strategies to ensure the sustainability of the desired outcomes.

An Overview of the Safety Program: An Evidence-Based Design to Improve Care Quality

The current framework for treating cardiovascular conditions in Advent Health-affiliated facilities focuses on various evidence-based interventions, including partnerships with cardiac care specialists, innovative treatments, catheterization staff, regular risk assessments, timely screening, and patient education. According to Advent Health Cardiovascular Institute (n.d.), the primary objective of educating patients on cardiovascular health is to promote their competencies for understanding warning signs of lurking or imminent conditions and promoting self-care. The organization and its affiliated care delivery facilities implement these approaches to safeguard patient safety by preventing mortality and morbidity associated with cardiovascular conditions. Although the current framework for cardiovascular care is consistent with the organization’s goals, objectives, and goals, it is crucial to implement a system that improves early warning modalities and timely response to in-hospital cardiac arrests (IHCAs). Consequently, the code blue system can transform the organizational and unit-level trajectories of communicating and responding to different cardiovascular-related adverse events, including cardiac arrests.

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The effectiveness of the code blue system obtains massive backing from the current scholarly literature. According to Topeli & Cakir (2020), sudden cardiac arrest (SCA) contributes to about 60% of all deaths emanating from cardiovascular disasters and affects approximately 40-100 people in the 100000 population. Although cardiopulmonary resuscitation (CPR) is the most sought-after strategy for reversing cardiac arrest cases since 1960, its efficiency and effectiveness range from 17% to 32% (Topeli & Cakir, 2020). The effectiveness of CPR in reversing incidents of a cardiac arrest depends massively upon multiple variables, including delays in emergency alerts, ineffective team communication, staff shortages, and infrastructural constraints, such as fewer numbers of defibrillators. Healthcare organizations should apply and implement extensive systems, including external defibrillators, standardized CPR education, and interdisciplinary team interventions to improve the patient’s survival rate.

Code blue is a profound communication and alert system that originated in the Bethany Medical Center in the State of Kansas in the early 1990s. According to Monangi et al. (2018), the primary objective of code blue is to ensure the dispatching of trained resuscitators to victims of cardiac arrest incidences in the shortest possible time, without compromising nursing practices and normal hospital functions. Another profound objective of implementing the code blue system is to reduce the mortality rate of in-hospital cardiac arrests. In a study aimed at analyzing the survival rate and factors associated with survival and functioning of a code blue system (CBS), Dhar et al. (2018) revealed that this system increased patients’ survival rate to 26.45%, which is higher than the rate reported in the past scholarly literature.

Despite the plausibility of achieving a higher survival rate, the effectiveness of the CBS relies massively upon its design and components. Dhar et al. (2018) identify three primary parts that make up an ideal CBS system: the afferent limb (input response from the area of emergency to the central processing unit), the department of anesthesia that analyzes calls and locates areas of emergency, and the efferent limb which provides output response through alert systems in various clinical settings, including intensive care unit (ICU) and operation theater (OT). The coordinated response from the code blue team (CBT) is central to the provision of treatment for resuscitation, stabilization of emergency patients, and the subsequent reduction in mortality rates associated with in-hospital cardiac arrests. Consequently, a multi-unit emergency response blue code system can enable AdventHealth facilities to promote patient safety, reduce the severity of adverse events, and save lives.

How will the code blue program improve care outcomes?

The overarching objectives and desired outcomes of the AdventHealth system include safeguarding patient safety, intercepting and preventing adverse events, reducing mortality rates, and cultivating ideal clinical environments for recovery. Although these aspects inform care practices and clinical processes for the AdventHealth system, healthcare professionals should be aware of unanticipated events that can jeopardize patient safety and well-being, including in-hospital cardiac arrests (IHCAs). According to Sherif et al. (2021), more than 135 million people succumb to cardiovascular events annually. Healthcare organizations rely massively upon cardiopulmonary resuscitation (CPR) and timely response to emergencies as profound interventions for reducing mortalities and improving the survival rate of patients grappling with in-hospital cardiac arrests. However, the effectiveness and success of CPR and other timely interventions depend on multiple variables, including the nature of communication patterns, the extent of care coordination, and the existing modalities for incorporating advanced technologies into emergency response systems.

The code blue system (CBS) emerges as an advanced strategy for improving communication among healthcare professionals and across departments, as well as improving organizational interventions for responding to emergency cardiovascular events. Shi et al. (2020) contend that the code blue system entails emergency calls and a management system for timely and rapid response to emergencies in hospitals. Once a healthcare personnel activates a code blue, response teams characterized by members with advanced life support (ALS) qualifications respond rapidly and initiate cardiopulmonary resuscitation (CPR). Other interventions initiated by the code blue team (CBT) include defibrillation and advanced life support.

The code blue team relies heavily on advanced technologies to initiate response interventions, such as CPR, defibrillation, and advanced life support. According to Cleveland Clinic (2022), an interdisciplinary team for responding to in-hospital cardiac arrests uses automated external defibrillators, intubation modalities, and advanced CPR machines to provide emergency care to patients grappling with different cardiovascular events. Equally, highly-qualified and authorized healthcare personnel can administer medications for cardiovascular muscle contractions and airway widening (Cleveland Clinic, 2020). These medications include epinephrine and amiodarone.

Primarily, the goals and objectives of implementing the code blue system are to stabilize emergency victims experiencing cardiopulmonary problems by initiating resuscitation and defibrillation, promote basic life support, and strengthen the organization’s emergency response mechanisms. As a result, this system is central to the realization and fulfillment of the desired outcomes of safeguarding patient safety, reducing in-hospital mortality rates, preventing adverse events, and developing ideal clinical environments that support recovery.

Potential Stakeholders Within the Healthcare Organization

Interdisciplinary collaboration and communication among various stakeholders are central to the successful implementation of the code blue system (CBS). According to Shi et al. (2020), the code blue team should involve qualified healthcare professionals who understand their roles and responsibilities amidst complexities in responding to cardiovascular-related adverse events and emergencies. In this sense, the code blue team includes nurses, the resuscitation team, and medical doctors. Nurses are responsible for developing triage on patients and assisting medical doctors in responding to unintended events and handling emergency patients. On the other hand, the resuscitation team encompasses trained nurses, cardiologists, and doctors who play a significant role in providing basic and advanced life support to emergency patients, as well as performing cardiopulmonary resuscitation and defibrillation. Finally, medical doctors are responsible for identifying the triage of patients, leading the CBT during CPR, and communicating team objectives, while setting new goals.

Although the code blue team (CBT) is central to the organizational mechanisms for responding to adverse cardiovascular events and preventing subsequent mortalities, team members require support from other institutional departments, including the executive branch, the financial department, and the human resource. Firstly, responding to cardiovascular emergencies is a daunting endeavor that is resource intensive. In this sense, team members require adequate financial and human resources, as well as advanced technological infrastructure to ensure coordinated activities. For example, team members use intubation equipment, crash-carts, stretches, defibrillators, and resuscitation drugs like adrenaline, lignocaine, and adrenaline (Anjorin, 2020). Equally, adequate staffing is a predictor of a successful response to cardiovascular emergencies. Consequently, executive leaders and departmental managers should collaborate with the code blue team and support emergency response mechanisms by ensuring adequate human, financial, and infrastructural resources.


A Change Management that will Support the Implementation of Code Blue System

Although the code blue system is effective in enhancing emergency response activities, its success is overly dependent on the level of acceptance and assimilation across all organizational units. In this sense, effective change management is necessary for enabling successful system initiation, implementation, and sustenance. Amidst the need to align resources and the organization’s mission with the code blue system, a comprehensive change management theory can inform interventions for addressing restraining factors for changes.

Kotter’s change management theory is popular in healthcare contexts, considering its emphasis on ideal interventions for initiating, enacting, evaluating, and sustaining change. Carman et al. (2019) argue that this change management model consolidates the eight steps of change and establishes three primary tenets of the change process: creating a climate of change, engaging and enabling the whole organization, and implementing and sustaining change. An interdisciplinary team tasked to ensure effective change implementation and quality improvement should uphold the three tenets of Kotter’s change management theory by cultivating a sense of urgency, building sustainable coalitions and partnerships, creating a vision and strategy, communicating goals, intentions, and change vision, empowering employees, generating short-term wins, and anchoring new approaches in the organizational culture (Carman et al., 2019). The code blue team should use this theory to spearhead change since it establishes a framework for initiating, enacting, evaluating, and sustaining quality improvement interventions and change.

Expected Outcomes of the Program and Ways to Ensure Sustainability of the Expected Outcomes

The expected outcomes of the blue code system include improving organizational interventions for responding to cardiovascular emergencies, enabling healthcare professionals to provide basic and advanced cardiovascular care, and promoting patient safety through rapid response to emergencies and reducing mortalities associated with in-hospital cardiac arrests (Mp et al., 2022). Based on the expectations for the code blue program, the organization should encourage concerted efforts for ensuring the sustainability of the desired outcomes. According to Walugembe et al. (2019), healthcare organizations can enhance the sustainability of public health interventions by encouraging stakeholder participation, integrating new initiatives in the existing programs and policies, training and capacity-building, frequent monitoring, and provision of adequate resources. AdventHealth system should adopt these approaches to strengthen the outcomes of the code blue system.

Potential Obstacles and Strategies to Overcome Implementation Constraints

AdventHealth system may face unprecedented challenges when initiating, implementing, and sustaining the code blue system. These obstacles are primarily human, organizational, and infrastructural. Monteith (2019) argues that healthcare organizations grapple with multiple problems when implementing early warning systems and enabling technologies like code blue systems. These challenges include limited expertise in data management, complex workflows that affect the productivity of healthcare professionals, systems information overload, and siloed applications with compromised interoperability (Monteith, 2019). Other barriers to the effective implementation of the code blue system are staff shortages and ethical issues associated with data management. Finally, Rahmania et al. (2020) identify limited knowledge of such systems as an impediment to the implementation of the code blue system. To address these concerns, organizational leaders and departmental managers should train employees on the system’s functionality, conduct frequent assessments to identify areas of improvement and optimize processes by reducing disparate workflows. Also, it is crucial to tackling staff shortages by implementing ideal staff recruitment and retention policies. Finally, the organization should offset the cost incurred when implementing the blue code system by networking and developing meaningful deals with stakeholders, including affiliated facilities.


Although the AdventHealth system has a functional and comprehensive framework for providing cardiopulmonary services, implementing the code blue system will improve emergency response mechanisms and increase the survival rate of patients grappling with in-hospital cardiac arrests. Also, this system will promote the provision of basic and advanced life support interventions. However, the organizational leadership should understand the challenges and barriers to effective program implementation. These challenges include limited knowledge of the system, data management issues, understaffing, disparate workflows, and resource or structural deficiencies. Some proven interventions for addressing these obstacles are training programs for employees, improved stakeholder participation, effective communication, setting resource priorities, frequent monitoring, and developing meaningful relationships and partnerships with affiliated facilities.


AdventHealth Cardiovascular Institute. (n.d.). Cardiovascular and thoracic programs. Retrieved January 13, 2023, from https://cfl.adventhealthcardiovascularinstitute.com/programs

Anjorin, A. (2020). Code blue. Annals of Internal Medicine. https://doi.org/10.7326/m20-4706

Carman, A. L., Vanderpool, R. C., Stradtman, L. R., & Edmiston, E. A. (2019). A change-management approach to closing care gaps in a federally qualified health center: A rural Kentucky case study. Preventing Chronic Disease, 16(E105). https://doi.org/10.5888/pcd16.180589

Cleveland Clinic. (2022). Hospital code blue: What it means & why it is called. https://my.clevelandclinic.org/health/articles/23532-code-blue-hospital#

Dhar, M., Monangi, S., Setlur, R., Ramanathan, R., & Bhasin, S. (2018). Analysis of functioning and efficiency of a code blue system in a tertiary care hospital. Saudi Journal of Anaesthesia, 12(2), 245. https://doi.org/10.4103/sja.sja_613_17

Fuchs, A., Käser, D., Theiler, L., Greif, R., Knapp, J., & Berger-Estilita, J. (2021). Survival and long-term outcomes following in-hospital cardiac arrest in a Swiss university hospital: A prospective observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1). https://doi.org/10.1186/s13049-021-00931-0

Monteith, M. (2019). Further reducing the rate of code blue calls through early warning systems and enabling technologies. Healthcare Management Forum, 33(1), 30–33. https://doi.org/10.1177/0840470419872770

Mp, A. F., Ginting, C. N., Nasution, S. W., & Nasution, A. N. (2022). An evaluation of factors related to the implementation code blue system in the inpatient room of Hospital Medical Partner Bandar Klippa. Budapest International Research and Critics Institute-Journal (BIRCI-Journal), 5(3). 25576-25588. https://doi.org/10.33258/birci.v5i3.6604

Rahmania, A., Windy Astuti, C. N., Triwijayanti, R., Ulaa, M., Yellisni, I., Trilia, & Fadlillah, M. (2020). Nurse’s barriers when becoming a member of the code blue team. Proceedings of the 1st International Conference on Science, Health, Economics, Education, and Technology (ICoSHEET 2019). https://doi.org/10.2991/ahsr.k.200723.104

Sherif, L., D\’Cunha, R. J., & Fernandes, S. F. (2021). Utility of simulation as a teaching tool for nursing staff involved in code blue management. Indian Journal of Critical Care Medicine, 25(8), 878–880. https://doi.org/10.5005/jp-journals-10071-23912

Shi, Y., Liu, G., Cao, D., Lu, G., Yuan, L., Qian, Y., Xu, J., Sun, C., Ge, M., Lai, L., Wang, X., Lu, Y., Huang, G., & Zhai, X. (2021). Improvement of the functioning and efficiency of a code blue system after training in a children’s hospital in China. Translational Pediatrics, 10(2), 236–243. https://doi.org/10.21037/tp-20-171

Topeli, A., & Cakir, B. (2021). Evaluation of the blue code system established in the health campus of a university hospital. Turkish Journal of Emergency Medicine, 21(1), 14. https://doi.org/10.4103/2452-2473.301912

Walugembe, D. R., Sibbald, S., Le Ber, M. J., & Kothari, A. (2019). Sustainability of public health interventions: Where are the gaps? Health Research Policy and Systems, 17(1). https://doi.org/10.1186/s12961-018-0405-y



Please see the attached Quality

and Sustainability Paper PART 1 for use to continue this assignment which is

Part 2.

Quality and Sustainability Paper: Part 2 (Order for my Friend)

This assignment aims to determine what is needed to promote successful implementation and sustainability of a quality or safety program for your selected health care entity/issue.

General Guidelines:

Use the following information to ensure the successful completion of the assignment:

This assignment uses a rubric. Please review the rubric before beginning the assignment to become familiar with the expectations for successful completion.
Doctoral learners are required to use the APA style for their writing assignments.
This assignment requires that you support your position by referencing six to eight scholarly resources. At least three of your supporting references must be from scholarly sources other than the assigned readings.

Write a paper (2,000-2,500 words) that provides the following:

Incorporate all necessary revisions and corrections suggested by your instructor for Part 1. Synthesize the different elements of Part 1 and Part 2 into one paper using transitions to connect ideas and concepts.
Evaluate current evidenced-based quality and/or safety program designs that can be implemented to improve the quality and/or safety outcomes for your selected quality and/safety issue at your identified health care entity. Based on this evaluation, propose an evidence-based quality and/or safety program to address your selected issue from Part 1. Explain how your proposed design will better improve the outcomes for the selected quality and/or safety issue as compared to the program currently in place at the health care entity.
Identify potential obstacles (such as economics or ethical issues) that may hinder the implementation of the proposed quality and/or safety program and suggest ways to overcome these.
Identify stakeholders within the selected health care entity with whom you may need to collaborate and discuss the role of each stakeholder in the implementation of the proposed program. In the identification of stakeholders, also include specific groups and leaders that are needed.
Identify a change management theory you will use to support the implementation of your quality and/or safety program. Provide evidence that supports the use of this theory within the program you designed.
Discuss the expected outcomes of the implementation of your proposed quality and/or safety program and ways to ensure sustainability of the expected outcomes.


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