Abstract
Background: In-hospital cardiac arrest contributes significantly to inpatient mortality. Code Blue systems vary globally, and data from India are limited. Recent evidence supports integrating pre-medical emergency team (pre-MET) reduce MET call (activated via early warning scores) and Code Blue events. Our hospital is among the first in India to implement a pre-MET system. Additionally, we developed a digital platform to monitor Code Blue performance that tracks key resuscitation step timings.
Aims: To evaluate impact of pre-MET implementation on MET and Code Blue incidence, and to assess efficacy of our digital tool in enhancing response team performance and patient outcomes.
Methods: This retrospective observational study was conducted between January 2022 and May 2025 at a tertiary hospital in Mumbai, India. All adult patients experiencing Code Blue, MET, and pre-MET calls were included. Data for Code Blue events, including chest compression fraction, were collected using the digital software. Primary outcome was return of spontaneous circulation (ROSC).
Results: We analyzed 1016 Code Blue and 1332 MET/pre-MET events. Post-implementation of pre-MET criteria, pre-MET calls significantly increased with corresponding decrease in MET calls (χ²=10.98, p=0.012). With digital Code Blue monitoring, ROSC rates improved from 37.5% (2022) to 56.5% (2025), with ward-specific rates rising from 63.2% to 85.7%. Chest compression fraction improved over time, indicating enhanced cardiopulmonary resuscitation (CPR) quality.
Conclusion: Implementation of pre-MET tier facilitated early identification of clinical deterioration, reducing MET activations. Real-time digital Code Blue assessment, particularly of chest compression fraction, enhanced CPR quality. Our findings support wider implementation of structured escalation protocols and digital Code Blue monitoring to improve patient outcomes in similar healthcare settings.