Background: Rapid response and code blue events are medical situations that have been designated needing urgent or emergent evaluation by healthcare staff. At their best, these events can represent unfortunate and unavoidable decompensations, but often these situations could have been avoided through earlier recognition of symptoms and signs, intervention, and treatment. This can be especially true on inpatient psychiatric units depending on the level of medical training, support, and vigilance towards medical conditions, which can often be minimal. These events not only impact patient outcomes, but also represent significant work, administrative, and financial burdens due to increased need for transitions of cares and emergent medical treatment. We examined the current rates of medical rapid responses and code blues at a quaternary, level I trauma center with an embedded 70+ psychiatric beds allocated to an adult crisis stabilization unit and inpatient psychiatric units.
Methods: The electronic medical record was queried for all code blue and rapid response events called on our adult crisis stabilization and adult psychiatry units for two academic years (07/01/2024 – 06/30/2025). These units included our adult crisis stabilization unit, three general adult psychiatric units, and the geriatric psychiatry unit. All patient charts and events were reviewed and data concerning the originating unit, date of hospitalization, date of discharge, reasons for calling event, immediate outcome of event, need for transfer to an acute medical floor within 7 days after the event, and 30-day mortality after event were recorded.
Results: A total of 64 events were recorded over our testing period in 47 unique patients, which averages 1 event every 11 days. Of those, only 22 (34%) stayed on the psychiatric unit at the conclusion of the event with 29 (45%) requiring acute medical hospitalization within the next 7 days and an 8% 30-day known mortality rate after event. Our inpatient geriatric psychiatry unit was overrepresented with 30 (47%) of all events in 17 unique patients. For this unit, the rate of staying on the unit after event was only 23% and an elevated 13% 30-day known mortality rate after event was noted. There were 2 code blue events in total and 1 fatality at the conclusion of a recorded event, which occurred on the inpatient geriatric unit.
Conclusions: The medical acuity of inpatient adult psychiatry units can be high. Often, psychiatric units do not have the expertise, resources, or staffing to accommodate acute or highly medically complex patients. Currently, we are conducting further work within our internal medicine and psychiatric departments to provide further medical support and education to our inpatient adult psychiatric units to provide better overall treatment for our patients.