Date of Completion


Embargo Period



patient deterioration, rapid response team, code blue, nursing education

Major Advisor

Thomas Van Hoof

Associate Advisor

Paula McCauley

Associate Advisor

Bernice Coleman

Field of Study



Doctor of Philosophy

Open Access

Open Access


The identification of patient deterioration is significant because, in its absence, adverse events may go unnoticed and quickly escalate in severity. Only 17.4% of patients experiencing in-hospital cardiac arrest are seen by medical response teams, such as a rapid response or code blue team (Chan, et al., 2016). The purpose of this secondary data analysis was to determine if the frequency and rationale for RRT and code blue calls are related to nursing staff exposure to a deterioration recognition education program. Eleven medical surgical and five progressive care units at an urban academic medical center were included in the study. RRT and code blue calls were analyzed before and after the education intervention occurred. The data was analyzed using hierarchal negative binomial regressions. The analysis revealed that as the proportion of nurses that were trained in a unit increased over time, the percentage of RRT calls significantly increased (IRR 0.997, [CI 95%: 0.984, 1.010], p = 0.614). The analysis also indicated that there were significantly more RRT and code blue calls for the cardiac (IRR 1.08 [1.05,1.11], p = 0.001) and respiratory reasons (IRR 1.09 [1.06, 1.12], p < 0.001) in the post ALERT period. These findings imply that trained nurses are identifying deterioration before cardiopulmonary arrest. They also suggest that the simulation training may have bearing on knowledge retention that is effectively used later in practice. More research is needed on deterioration education involving multifaceted educational programs involving simulation. Lastly, further scholarly inquiry is encouraged to explore the impact of proactive educational programs on patient outcomes.

Available for download on Friday, May 13, 2022