How to Track and Improve Emergency Response Performance in Hospitals

Legacy systems like switchboards and pagers create blind spots that make accurate measurement challenging. Without reliable data, teams can’t identify bottlenecks, recognize patterns, or implement meaningful improvements.

While tracking these metrics has historically been difficult, modernizing code activation workflows offers the fastest, most effective path to measurable improvement. In this article, we’ll discuss the key metrics hospitals must track, why tracking emergency response times matters, and how to improve emergency response performance at your hospital.

While tracking these metrics has historically been difficult, modernizing code activation workflows offers the fastest, most effective path to measurable improvement. In this article, we’ll discuss the key metrics hospitals must track, why tracking emergency response times matters, and how to improve emergency response performance at your hospital.

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Why Tracking Emergency Response Performance Matters

The speed and coordination of your code teams directly determine patient outcomes in the most critical moments of care. Below are a couple of reasons why it’s critical to measure emergency response times at hospitals.

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Delays Directly Impact Survival Rates

In emergency scenarios, every minute without lifesaving measures drastically reduces survival. 

For ST-elevation myocardial infarction (STEMI) patients, door-to-balloon time — the time between hospital arrival and coronary intervention — is critical. Research demonstrates that every 10-minute delay in door-to-balloon time increases mortality risk.

For stroke patients, the recommended door-to-needle time is 60 minutes or less. However, less than 30 percent of US patients are treated within this window.

There’s also “golden hour” for trauma patients, which refers to the first 60 minutes post-injury being the most critical for care. Studies have found that shorter time to definitive care directly leads to a better outcome for trauma patients. 

These code protocols are built around a simple premise: rapid activation leads to rapid action, which leads to better outcomes. Yet achieving this speed consistently requires hospitals to first understand where their current performance stands.

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Most Hospitals Don’t Accurately Measure Their True Response Times

The challenge isn’t just about being fast, it’s about knowing how fast your team actually operates. Most hospitals rely on measurement methods that provide incomplete or unreliable data.

Switchboard logs, when they exist, capture only when an operator received a call and whom they attempted to contact. Depending on the workflow, some may also make note of the call’s duration and indicate whether or not the contact was reached. 

Pagers compound this problem by providing little feedback. Some pagers provide timestamps, but most don’t have delivery receipts. When a page is sent, there’s no confirmation that it was received, no way to know when someone read it, and no record of how long acknowledgment took. 

Additionally, manual debrief sheets, filled out after codes, rely on estimates and memory. In the chaos of an emergency response, accurate recall of the exact times for each step of the activation process is nearly impossible after the fact. The result is that many teams operate on estimates rather than data. Without accurate measurement, there’s no foundation for improvement. 

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Key Metrics Hospitals Should Track

To improve emergency response performance, healthcare organizations must move beyond subjective impressions and focus on objective, measurable indicators. The following emergency response metrics provide a comprehensive view of code team performance and reveal exactly where delays occur.

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Code Activation Time

This is the interval between identifying the emergency and successfully notifying every required team member. While it sounds straightforward, in practice, this single metric reveals the efficiency of your entire notification system.

In legacy workflows, code activation time includes the delay while someone contacts the switchboard, reaches the operator, explains the situation, and waits while the operator pages each team member individually. Modern systems should reduce this to seconds by enabling immediate, simultaneous notification of all necessary personnel with a single action.

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Team Acknowledgment Time

Once alerts go out, how long does it take for team members to confirm receipt? This metric exposes whether your notification methods are actually reaching people or disappearing into voicemail boxes and ignored pagers.

For hospitals that prioritize team acknowledgement time, high acknowledgment times often indicate that alerts aren’t cutting through the noise of a busy hospital environment. Team members might be in a loud environment where pagers don’t vibrate loudly enough, preoccupied in procedure rooms, or notifications might be getting lost among dozens of other messages. When acknowledgment consistently comes up as an issue among team members, your alerting method needs evaluation.

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Team Arrival Time (Call-to-Bedside)

This measures who arrives when and how consistently. It’s not enough to know that the code team eventually shows up. Emergency teams need visibility into whether the first responder arrives within two minutes, whether the full team is assembled within five, and whether these benchmarks are met reliably across all shifts and locations.

Inconsistent arrival times point to underlying issues: unclear protocols, confusion about responsibilities, physical distance challenges, or scheduling problems that leave certain roles uncovered during specific time periods.

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Door-to-Device / Door-to-Balloon Time (D2B)

For STEMI programs, the door-to-balloon metric is nationally tracked and directly tied to patient survival. The recommended benchmark for door-to-balloon time is 90 minutes for primary PCI. However, a 2022 study of US hospitals found that only 17% of STEMI patients were treated within 120 minutes of arrival. 

What’s often missed is how code activation speed affects this downstream metric. If it takes eight minutes to activate the cath lab team because of switchboard delays and missed pages, even the most skilled interventional cardiologists can’t compensate for that lost time. Shaving minutes off the activation process directly improves door-to-balloon performance and patient outcomes. 

For example, one hospital that consistently achieved the 90-minute benchmark cited the following factors as reasons for success: 

• A single code activation
• Arrival of staff within 20 minutes of activation
• Constant presence of an attending cardiologist on-site
• Real-time case feedback
• Interdisciplinary collaboration throughout the process

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Time to First Intervention 

Time to intervention, the period between symptom onset or diagnosis to the start of treatment, is a critical indicator of emergency care quality. This is a particularly important metric for emergency scenarios such as heart attack or stroke.  

In Code Blue situations, the time to first intervention – whether that’s initiating CPR, applying defibrillation, or administering emergency medications – is the metric that matters most for survival. The same goes for Code Stroke. Delays in activating the code can impact the time to first intervention, leading to prolonged hospitalization, increased chance of morbidity, or even mortality.

This isn’t just about how quickly the code team arrives. It includes whether the first responder knows immediately where to go, whether necessary equipment is already available or must be retrieved, and whether everyone understands their role well enough to begin interventions without delay.

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Escalation Failures or Missed Alerts

Modern tracking systems can identify when alerts fail to reach their intended recipients. This can include when someone doesn’t acknowledge within the expected timeframe, when a backup notification isn’t triggered, or when escalation protocols aren’t followed.

Escalation failures represent preventable delays that directly impact patient care. Organizations need visibility into how often primary alerts fail and whether escalation protocols are functioning as designed.

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Why Tracking Emergency Response Is So Difficult Today

Despite the clear importance of these metrics, most hospitals struggle to measure them accurately. The difficulty lies in the fact that traditional emergency response workflows weren’t initially designed with data collection in mind.

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Manual, Multi-Step Processes Create Blind Spots

Traditional code activation typically follows an inefficient path. A clinician identifies the emergency, finds a phone, calls the operator, explains the situation, and waits while the operator sequentially pages each team member. If someone doesn’t respond, the nurse calls back, and the operator tries again. This phone tag continues until everyone is reached or the operator moves to backup contacts.

Each handoff in this chain creates an opportunity for delays and information loss. Additionally, overhead paging amplifies this problem by providing zero confirmation of receipt. An overhead announcement reaches everyone within earshot, but there’s no way to know whether the intended recipients heard it, understood it, or are responding. 

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Siloed Systems Don’t Share Data

Even in hospitals that have implemented digital tools, those systems don’t always communicate with each other. On-call schedules might live in one system, staff contact information in another, and code activation protocols in a third. When these systems don’t integrate, critical information gaps emerge.

Pagers, by design, exist in complete isolation from staff directories and scheduling systems. When someone’s pager number changes or their on-call shift ends, there’s no automated way to update who receives alerts. This leads to misrouted notifications, wasted time, and dangerous delays during actual emergencies.

The lack of integration also means there’s no unified audit trail. Even if individual systems capture some data, assembling a complete picture of what happened during a code response requires manually correlating logs from multiple sources. 

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No Centralized Analytics or Reporting

Without unified analytics or reporting, hospitals can’t identify patterns. It’s hard to know whether yesterday’s slow Code Blue response time was an outlier or part of a broader trend, for example. Teams also can’t compare performance across different times of day, different units, or different team compositions.

This lack of visibility into aggregate performance makes improvement initiatives nearly impossible. Organizations can’t prioritize where to focus training or resources because they don’t know where the consistent bottlenecks are. They also can’t measure whether process changes actually improve outcomes because they have no reliable baseline data.

Quality improvement efforts depend on seeing system-level issues, but legacy emergency response workflows keep teams focused on individual incidents rather than identifying systematic problems that affect many codes over time.

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How Modern Tools Enable Accurate Tracking

For today’s modern hospitals, technology designed specifically for clinical emergencies can eliminate these measurement challenges while simultaneously improving response times.

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Automated Timestamps for Every Step

Modern code activation platforms automatically capture precise timestamps at every critical moment: when the code was initiated, when each team member received the alert, and when they acknowledged it. This creates full end-to-end visibility without requiring any manual documentation during the emergency itself.

Platforms like Hypercare provide comprehensive audit trails that show exactly when messages were sent, delivered, read, and acknowledged. This detailed tracking serves multiple purposes: it enables real-time coordination during the code, provides data for post-event analysis, and creates documentation for quality assurance and regulatory compliance.

The value of automated tracking becomes especially clear during post-code debriefs. Instead of relying on recall and estimates, teams can review exact timestamps to understand what actually happened, identify specific delays, and recognize opportunities for improvement with precision.

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Role-Based Routing Integrations with On-Call Schedules

Modern systems integrate directly with on-call schedules, ensuring alerts automatically reach whoever is currently responsible for each role. When the on-call interventional cardiologist changes at 7 AM, the code activation system updates immediately. There’s no manual updating of contact lists, no risk of outdated information, and no guesswork about who to notify.

This integration eliminates a common source of delay in traditional systems: misrouted alerts. When notifications automatically reach the correct current on-call provider, first-attempt success rates dramatically improve and backup escalations become rarely necessary.

Role-based routing also minimizes alert fatigue by ensuring notifications only reach relevant team members. The orthopedic on-call surgeon doesn’t receive STEMI alerts, and the dermatology resident doesn’t get paged for Code Stroke. This targeted approach keeps alerts meaningful and response rates high.

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Reliable Multi-Channel Delivery

Rather than relying on a single communication method that might fail, modern platforms use multi-channel delivery to ensure alerts are received. A typical sequence might include: an immediate push notification to a secure messaging app, followed within seconds by an SMS if the notification isn't acknowledged, and then an automated voice call if needed.

This multi-layered approach dramatically reduces the single point of failure inherent in pager-only systems. A clinician may receive an app push notification, an SMS alert, or a voice call, ensuring they receive the alert no matter which channel they’re most likely to notice. Critical features like Do Not Disturb overrides ensure that emergency alerts always reach their recipients regardless of phone settings.

Automated escalations provide an additional safety net. If the primary contact doesn’t acknowledge within a defined timeframe, the system automatically notifies backup personnel without requiring manual intervention. This eliminates the delays associated with traditional phone tag and ensures that coverage gaps are immediately addressed.

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Central Analytics Dashboard

Perhaps most transformatively, modern platforms aggregate all code activation data into centralized analytics dashboards that reveal trends, outliers, and patterns invisible in traditional systems.

Hospital leaders can compare performance across departments, identify which teams consistently respond fastest, and spot systematic issues like slower responses during specific shifts. They can track improvement over time as process changes are implemented and measure whether training initiatives actually impact performance.

These dashboards support quality improvement initiatives by providing the objective data needed to justify resource allocation and demonstrate ROI on new tools. Rather than relying on anecdotes about particularly good or bad code responses, organizations can make decisions based on comprehensive data analysis.

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How Hospitals Can Improve Emergency Response Performance

Understanding the metrics and technology is only the first step in transforming emergency response. Follow these concrete, actionable steps to improve your organization’s emergency response performance.

1. Conduct a Baseline Performance Audit

Before implementing changes, establish a clear understanding of current performance. Identify which metrics are most relevant to your organization’s specific emergency protocols, then commit to tracking them consistently for several weeks or months to establish baseline data.

Consider running mock codes specifically designed to expose gaps in your current system. These controlled scenarios reveal where communication breaks down, which roles experience delays, and what failure points exist in your protocols, all without the pressure and consequences of actual emergencies.

Throughout the audit, document everything. These are the metrics to measure and patterns to identify:

• Activation times
• Time to acknowledgement
• Common failure points
• Patterns related to time of day, location, or team composition

This baseline becomes your foundation for measuring improvement and justifying investments in new tools or processes.

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2. Standardize Code Activation Protocols

Inconsistency is a major barrier to improvement. When different units follow different processes, or when protocols vary based on which staff member initiates the code, performance becomes unpredictable and training becomes complicated.

Develop standardized code activation processes that apply across all departments. Define exactly how codes should be initiated, who should be notified for each type of emergency, and what information must be communicated during activation. Create clear documentation that specifies roles and responsibilities for every team member, eliminating ambiguity about who does what during emergencies.

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3. Replace Manual Paging With Automated Code Activation

The most impactful change most hospitals can make to improve emergency responses is eliminating manual switchboard-based paging in favor of automated code activation systems.

Automation directly addresses the three biggest sources of delay in traditional systems: the time it takes to reach an operator, the sequential nature of manual paging, and the lack of confirmation when messages are received. With automated systems, a code can be activated with a single button press that simultaneously reaches all required team members, provides immediate delivery confirmation, and triggers automatic escalations if needed.

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4. Integrate Scheduling & Directory Data Into Alerts

Ensure your code activation system has real-time access to on-call schedules and current contact information. This integration ensures accuracy and dramatically reduces routing errors that waste critical time during emergencies.

When alerts automatically adjust based on current on-call status, you eliminate the manual work of updating contact lists and the inevitable delays when outdated information routes notifications to someone who’s no longer covering that role. Team members receive alerts only when they’re actually on duty, reducing alert fatigue and keeping response rates high.

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5. Use Multi-Channel, Mobile-First Alerting

Modern emergency response should leverage the devices clinicians already carry and rely on sophisticated alerting that cuts through the noise of busy hospital environments.

Start with secure messaging platforms as the primary notification method. These deliver immediate push notifications to mobile devices that clinicians actively monitor throughout their shifts. The messages include all relevant information, including code type, location, and patient identifiers, without requiring recipients to call in for details.

Layer on SMS and voice calling as backup escalation options that trigger automatically if push notifications aren’t acknowledged quickly. This multi-channel approach ensures alerts reach their targets even when the primary method fails due to network issues or other technical problems.

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6. Analyze the Data to Find Bottlenecks

Once your measurement systems are in place, commit to regular analysis that goes beyond simply tracking average response times.

Track delayed activations to understand whether codes are being initiated promptly when emergencies are identified. Sometimes the biggest delays happen before the code is even called, when staff members are uncertain whether the situation warrants activation or who should initiate it.

Search for system-wide issues rather than individual performance problems. Outdated staff directories, confusing protocols, or technical failures might be creating consistent delays that affect everyone but get missed when only individual codes are reviewed.

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7. Train Teams and Run Regular Simulations

Technology and protocols are only effective when teams know how to use them. Implement comprehensive training that covers not just the mechanics of code activation, but the principles behind your protocols and the importance of accurate, timely response.

Regular simulations serve multiple critical purposes: they prove the system actually works in realistic conditions, they build the muscle memory that enables fast, confident responses during real emergencies, and they reinforce adherence to protocols before bad habits can develop.

Run simulations across different shifts, locations, and scenarios to ensure consistent performance regardless of circumstances. Use simulation results to identify training gaps, refine protocols, and recognize teams that exemplify excellent performance. Make simulations a routine part of your quality improvement program rather than one-time events.

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How Hypercare Supports High-Performance Emergency Response

Purpose-built clinical communication platforms address the specific workflow challenges that make emergency response difficult to track and improve. Here’s how Hypercare’s features support faster, more reliable code activations.

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One-Tap Code Activation

Hypercare enables healthcare teams to initiate codes with a single action, eliminating the delays inherent in calling switchboards and explaining situations to operators. This immediate activation simultaneously notifies all required team members, reducing code activation time from minutes to seconds.

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Multi-Channel STAT Alerts and Escalations

The platform delivers alerts through multiple channels, including push notifications, SMS, and voice calls, to ensure messages reach team members regardless of their environment or device status. If primary contacts don’t acknowledge within defined timeframes, automated escalations immediately notify backup personnel without manual intervention.

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Bypass Silent & DND Mode

Critical code alerts override Do Not Disturb settings and silent mode, ensuring urgent notifications always break through. This feature eliminates a common reason team members miss alerts during actual emergencies.

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Integrated Schedules and Directory

Hypercare connects directly with on-call schedules and staff directories, automatically routing alerts to whoever is currently responsible for each role. This integration eliminates misrouted notifications and ensures contact information stays current without manual updates.

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Analytics and Performance Dashboards

The platform captures detailed timestamps for every step of code activations, from initial alert through acknowledgment and arrival. These comprehensive analytics enable organizations to track performance trends, identify bottlenecks, compare teams and shifts, and measure the impact of improvement initiatives with objective data.

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Key Takeaways for Hospital Leaders

Emergency response performance directly impacts patient survival, yet most hospitals lack the measurement tools needed to understand their true response times or identify improvement opportunities.

Improving emergency response requires a systematic approach: 

• Establish baseline metrics through comprehensive audits
• Standardize protocols across all departments
• Replace manual processes with automated code activation 
• Integrate scheduling and directory data to ensure accurate routing 
• Implement multi-channel, mobile-first alerting that reliably reaches team members
• Analyze performance data to identify bottlenecks and patterns
• Conduct regular training and simulations to build consistent, reliable responses

When seconds determine outcomes, you can’t afford to operate without visibility into your actual performance. To learn how Hypercare’s code activation and clinical communication platform can help your organization improve and modernize code activation workflows, book a demo today.