Presentation
Moving FASTR: Implementing a Focused Assessment and Swift Transport Response (FASTR) Code Team for Medical Emergencies
SessionHE6: Innovations in Methods
DescriptionIntroduction:
Code Blue, also known as a “Code,” is an emergency response team activation for a medical emergency. Code team activations for adults at our children’s hospital continue to rise. In 2024, the code team responded to 287 activations. Of those, 115 (45%) involved adult non-patients. Additionally, 21% of those events involved code activations at entrances and outside areas of our campus, and some involved victims of intentional violence. Previous interventions to improve code activations at entrances and outdoor spaces has included a task analysis of scene safety steps, development of an algorithm for shared understanding of steps, roles, and responsibilities, visual indicators of scene safety status, and limited simulations to identify outstanding gaps. However, scene safety and comfort with code activations at entrances and outdoor spaces continued to trend as an area of opportunity for improvements. In 2023, video reviews of these code activations identified opportunities to clarify roles and responsibilities, streamline code response, prioritize a basic life support (BLS) focus, and reduce redundant or unnecessary roles to support BLS.
Methods:
Key stakeholders included Human Factors/Patient Safety, Codes Program, Nursing leadership & Provider leadership from the Pediatric Intensive Care Unit and Emergency Department, Guest Relations Associates, and Security. Leaders from these areas) completed a comprehensive risk assessment to evaluate changes in code response at entrances and outside areas. As a result, a new code response model was developed, the Focused Assessment and Swift Transport Response (FASTR). FASTR is a nurse-led code team, comprised of a subset of the full code team. The smaller size of the FASTR team allowed for enhanced training with all FASTR responders prior to go-live.
The primary issues identified in the risk assessment included: activation of a new type of code response, focus on Basic Life Support skills (rather than more intensive Advanced Life Support or Cardiac Life Support), use of the defibrillator, administration of medications, and responding to simultaneous or multi-victim activations. Additionally, the risk assessment highlighted the value in understanding roles, responsibilities, and resources with a smaller, more focused code team response.
Human Factors involvement highlighted the value of using the person/task/tool/context framework to fully understand complexities and risks associated with adapting a new type of code response. For example, this helped the team decide there was less risk in using the existing emergency response team activation rather than creating an entirely new alert due to the fuzzy boundaries of response types.
We utilized the risk assessment to directly guide development of a two-hour didactic and simulation-based training to address the riskiest scenarios identified. More than 160 code responders participated in this training, which covered key concepts including scene safety, car extractions, CPR in transit, and other critical content. We also highlighted impact on cognitive load and teamwork. Another focus was on roles and responsibilities, including creating shared situation awareness for other roles.
The codes program sends surveys to code responders following every code blue, regardless of response type. An additional survey to evaluate the effectiveness of FASTR was sent to participants four months after implementation which included Likert-type and free-text response options.
Results:
The FASTR program was implemented in February 2025. There have been 18 activations since go-live. Baseline data from 2024 on the overall quality of code response at entrances or outside areas had 57% positive responses (excellent or good on Likert-type scale). Perception of safety during code response was only 51.2% positive response. When re-surveyed in July 2025, 100% of FASTR responders had positive responses on the overall quality of code response. Additionally, 100% of responders indicated a positive perception of safety. Almost all (98%) indicated they feel the quality of the FASTR response in these scenarios is superior to full code team response, and that FASTR represents a more efficient response (90%), with more rapid disposition to the ED and enhanced role clarity.
FASTR responders had a strong positive response to the training, with the vast majority (96%) feeling better prepared to respond to codes. Quotes about the training included: “I loved my in-person training! It felt very "real-life" and the scenarios were well thought out”; “It was great having so many departments come together to work through this process”; “It’s an easier shared mental model of expedite the patient to the ER were care can begin”; and “Great simulation for code situations”. The biggest feedback given by responders was the request to expand the scope of FASTR to include additional locations and to include staff and families.
Conclusions:
FASTR represents a high quality, more efficient code team response, while allowing critical care expertise (intensivists, pharmacists, and anesthesiology providers) to remain in their respective departments. Focused training has also improved overall perceptions of safety during FASTR activations. Overall, this project highlighted the partnership between Human Factors, Codes Program, Clinical Teams, and support services towards improving safety, satisfaction, and efficiency of a critical process in the hospital environment.
Code Blue, also known as a “Code,” is an emergency response team activation for a medical emergency. Code team activations for adults at our children’s hospital continue to rise. In 2024, the code team responded to 287 activations. Of those, 115 (45%) involved adult non-patients. Additionally, 21% of those events involved code activations at entrances and outside areas of our campus, and some involved victims of intentional violence. Previous interventions to improve code activations at entrances and outdoor spaces has included a task analysis of scene safety steps, development of an algorithm for shared understanding of steps, roles, and responsibilities, visual indicators of scene safety status, and limited simulations to identify outstanding gaps. However, scene safety and comfort with code activations at entrances and outdoor spaces continued to trend as an area of opportunity for improvements. In 2023, video reviews of these code activations identified opportunities to clarify roles and responsibilities, streamline code response, prioritize a basic life support (BLS) focus, and reduce redundant or unnecessary roles to support BLS.
Methods:
Key stakeholders included Human Factors/Patient Safety, Codes Program, Nursing leadership & Provider leadership from the Pediatric Intensive Care Unit and Emergency Department, Guest Relations Associates, and Security. Leaders from these areas) completed a comprehensive risk assessment to evaluate changes in code response at entrances and outside areas. As a result, a new code response model was developed, the Focused Assessment and Swift Transport Response (FASTR). FASTR is a nurse-led code team, comprised of a subset of the full code team. The smaller size of the FASTR team allowed for enhanced training with all FASTR responders prior to go-live.
The primary issues identified in the risk assessment included: activation of a new type of code response, focus on Basic Life Support skills (rather than more intensive Advanced Life Support or Cardiac Life Support), use of the defibrillator, administration of medications, and responding to simultaneous or multi-victim activations. Additionally, the risk assessment highlighted the value in understanding roles, responsibilities, and resources with a smaller, more focused code team response.
Human Factors involvement highlighted the value of using the person/task/tool/context framework to fully understand complexities and risks associated with adapting a new type of code response. For example, this helped the team decide there was less risk in using the existing emergency response team activation rather than creating an entirely new alert due to the fuzzy boundaries of response types.
We utilized the risk assessment to directly guide development of a two-hour didactic and simulation-based training to address the riskiest scenarios identified. More than 160 code responders participated in this training, which covered key concepts including scene safety, car extractions, CPR in transit, and other critical content. We also highlighted impact on cognitive load and teamwork. Another focus was on roles and responsibilities, including creating shared situation awareness for other roles.
The codes program sends surveys to code responders following every code blue, regardless of response type. An additional survey to evaluate the effectiveness of FASTR was sent to participants four months after implementation which included Likert-type and free-text response options.
Results:
The FASTR program was implemented in February 2025. There have been 18 activations since go-live. Baseline data from 2024 on the overall quality of code response at entrances or outside areas had 57% positive responses (excellent or good on Likert-type scale). Perception of safety during code response was only 51.2% positive response. When re-surveyed in July 2025, 100% of FASTR responders had positive responses on the overall quality of code response. Additionally, 100% of responders indicated a positive perception of safety. Almost all (98%) indicated they feel the quality of the FASTR response in these scenarios is superior to full code team response, and that FASTR represents a more efficient response (90%), with more rapid disposition to the ED and enhanced role clarity.
FASTR responders had a strong positive response to the training, with the vast majority (96%) feeling better prepared to respond to codes. Quotes about the training included: “I loved my in-person training! It felt very "real-life" and the scenarios were well thought out”; “It was great having so many departments come together to work through this process”; “It’s an easier shared mental model of expedite the patient to the ER were care can begin”; and “Great simulation for code situations”. The biggest feedback given by responders was the request to expand the scope of FASTR to include additional locations and to include staff and families.
Conclusions:
FASTR represents a high quality, more efficient code team response, while allowing critical care expertise (intensivists, pharmacists, and anesthesiology providers) to remain in their respective departments. Focused training has also improved overall perceptions of safety during FASTR activations. Overall, this project highlighted the partnership between Human Factors, Codes Program, Clinical Teams, and support services towards improving safety, satisfaction, and efficiency of a critical process in the hospital environment.
Authors
Event Type
Oral Presentations
TimeTuesday, March 242:37pm - 3:00pm EDT
LocationMurray Hill West
Hospital Environments