Journal of Surgical Simulation 2022; 9: 112 - 119

Published: 13 December 2022


Original article

Evaluating the response of medical emergency teams to operating room code events in a childrens hospital

Sacha A. Williams, Bryce M. Bludevich, Katie Fitzpatrick, Sarah Lewis, Kim Kuperman, Jasmin Matamoros, Christopher W. Snyder, Paul D. Danielson, Jennifer Arnold and Nicole M. Chandler
Corresponding author: Nicole M. Chandler, 601 5th Street South, Suite 611, St. Petersburg, FL 33701, USA. Email:


Introduction: Medical emergency response teams (MET), also known as code teams, consist of health care providers who respond to life-threatening clinical changes in hospitalized patients. The study objective was to determine whether the utilization of simulation-based clinical systems testing (SbCST) and failure mode and effects analysis (FMEA) would sufficiently assess operating room (OR) MET response systems.

Methods: A multidisciplinary team of participants and observers collaborated in the SbCST to evaluate OR MET response to a simulated intraoperative code event, followed by FMEA. The primary outcomes were latent safety threats (LSTs), with mitigation strategies resulting from pre-/post-SbCST participant surveys, and debriefing. Risk priority numbers were calculated for each LST to denote priority; resultant scores of 8–16 were deemed significant on a scale of 1–16.

Results: Participants and observers identified 19 LSTs, 14 of which were high priority. The FMEA further subcategorized LSTs into resource, systems, facility, and clinical performance issues. Pre-/post-survey responses were not significantly different. Participants reported that the SbCST provided a realistic and immersive experience, and effectively tested current OR MET responses.

Conclusion: SbCST adequately recreated and tested an OR code situation; a significant but infrequent medical event. The use of FMEA highlighted potential LSTs that, in turn, could be rectified to enhance performance. All 19 study LSTs were addressed via training and systems improvements. These results demonstrate that clinical systems can be evaluated and ameliorated via the use of SbCST and FMEA.


failure mode and effects analysis; simulation-based clinical systems testing; latent safety threat; medical emergency response team; simulation; operating room