Hotspot-Targeted Life Support Training Reduces Code Blue Alarms in a Tertiary Children’s Hospital: A Single-Center Observational Before–After Study

Background Code Blue emergency alarms are activated by hospital staff for life- threatening patient situations. Despite their low frequency in children’s hospitals, ward staff must bridge the first critical minutes until arrival of dedicated emergency response teams. Thus, the aim of this study was to identify hotspots and causes of emergencies, and to evaluate whether a hotspot-specific pediatric basic life support training (PBLS) reduces Code Blue alarms. Methods This analysis included all Code Blue alarms at the University Children’s Hospital Bern before (January 2021–April 2023) and after (January 2024–December 2025) introduction of a hotspot-targeted PBLS program. Following identification of ward-specific hotspots and recurring emergency situations during Period 1, standard PBLS training was reorganized and supplemented by short simulation-based trainings tailored to the most frequent local emergencies. Variables between periods were statistically compared. Incidence rates were calculated per 1’000 patient days. Results 65 Code Blue alarms were analyzed. Respiratory emergencies and seizures were the most common causes, with infants and toddlers being the most affected age group. No weekend but a lunch-time effect was observed. Code Blue incidence decreased from 0.58 to 0.21 alarms per 1’000 patient-days after implementation (IRR 0.36, 95% CI 0.19–0.66, p < 0.001). Fragility analysis confirmed result robustness, with no evidence of bias from missing data, case mix index, PICU transfer rates, or non- Code Blue Medical Emergency Team (MET) consultations. Conclusions Hotspot-specific PBLS training was associated with a marked reduction in pediatric Code Blue alarms. Identification of local emergency patterns may help hospitals develop targeted ward-based training strategies to improve in-hospital emergency management.