Table 2

Included studies with reported interventions and outcomes

StudyDesignInterventionInvestigated outcomeBaseline measurementPostintervention
measurement
P valueOR95% CI
Andreatta et al 26 A 4-year prospective research studyIn situ simulationsPaediatric CPA survival rate33%56%0.000
Steinemann
et al 27
6-month prospective studyIn situ simulationsAbsolute number of mortalities84Reported as NS, p>0.050.67
Mean hospital LOS days (survivors)5.13.4Reported as NS, p>0.05
Mean ICU days (survivors)1.90.3Reported as NS, p>0.05
Riley et al 28 A 4-year prospective studyTeamSTEPPS didactic training alone or in combination with in situ simulationWeighted Adverse Outcome Index1.15 (full intervention)0.72P<0.05
1.46 (didactic only)1.45P>0.05
1.05 (control)1.5P>0.05
Knight et al 29 A 5-year prospective observational studyDefine and teach institution-specific code roles and responsibilities. Familiarisation with and training on emergency equipment for resuscitation team.
Monthly in situ high-fidelity cardiac arrest simulation with video debriefing. BLS for pharmacists and security. ACLS for paediatric residents (PALS), hospitalists, PICU fellows and attendings in-house pharmacists. Lab-based code blue simulation for acute care and ICU nurses
Paediatric CPA survival rate40.3%60.9%2.301.15 to 4.60
Braddock et al 30 A 1-year prospective interventional study was conducted, followed by a 6-month sustainability phaseIn situ simulation training. Debriefing of medical emergencies. Monthly patient safety team meetings. Patient safety champion role. Interdisciplinary patient safety conferences. Recognition programme for exemplary teamwork.Hospital-acquired severe sepsis/septic shock complications per 1000 discharges1.781.21 and 0.64 (intervention and sustain period)0.040.530.29 to 0.96
Acute respiratory failure complications per 1000 discharges2.442.10 and 0.430.030.580.35 to 0.96
Number of unplanned transfers to higher level of care (HLOC)715763 and 7640.081.270.97 to 1.66
Weighted risk-adjusted mortality observed-to-expected ratio0.50.44 and 0.40<0.0010.950.94 to 0.97
Sodhi et al 31 A 6-year prospective and retrospective observational studyACLS and BLS refresher courses. In situ simulation drills. Optimisation of the environment
(eg, crash carts placed
in each ward, etc).
Code blue team restructuring.
ACLS and BLS algorithms placed on crash carts and critical areas.
Modification of code blue sheets for better documentation and postanalysis.
More efficient public address system. Formulation of postresuscitation care protocol.
Return of spontaneous circulation (ROSC)26.7%40.8%<0.05
Survival-to-discharge rate


23.4%66.6%<0.05
Riley et al 32 A 7-year prospective studyStandardisation of evidence-based care. Interdisciplinary teamwork training through in situ mock codes. Routine education with performance feedback.Adverse Outcome Index0.0550.0470.32
Weighted Adverse Outcome Index1.1921.0810.1
Severity Index21.8822.620.46
Patient Safety Index 170.00190.00160.163
Theilen et al 33 Prospective cohort over three 1-year periodsIntroduction of PMET team. Weekly team training with mock codes (for registrars and senior nurses as well)Absolute number of PICU mortalities72 and 2 (intervention and sustain period)0.3
Number of PICU bed days527336 and 196<0.001
Hospital deaths per 1000 admissions2.91.4<0.001
Gibbs et al 34 6-month prospective studyIn situ simulationsAbsolute number of MRSA-infected infants180
  • ACLS, Advanced Cardiac Life Support; BLS, Basic Life Support; CPA, cardiopulmonary arrest; ICU, intensive care unit; LOS, length of stay; MRSA, methicillin-resistant Staphylococcus aureus; NS, not significant; PALS, Paediatric Advanced Life Support; PICU, paediatric intensive care unit; PMET, paediatric medical emergency team.