Code Blue, by Richard E. McDermott, PhD, and Kevin D. Stocks, PhD, CPA. Syracuse UT: Traemus Books; 2003. 287 pages, soft copy, $24.95

Code Blue is intended as a textbook for anyone interested in hospital administration, government health care reimbursement policies and regulations, materials management, hospital finance, and hospital politics. This book, with accompanying CD, introduces readers to the major departments and administrative positions typically found in hospitals, and it provides a good overview of the organizational hierarchy typically seen in hospitals.

Code Blue is primarily intended for college students interested in pursuing careers in hospital administration, hospital finance, health economics, or related health care fields. This book would also benefit direct care managers, supervisors, and other employees who are responsible for ordering supplies and staffing. Written in the form of a novel, the book's key players are health care professionals and administrative staff, and the major drama focuses on their efforts to keep their hospital from pending bankruptcy.

The novel opens with a terse scene involving the Hospital Administrator and the Assistant Controller. The reader learns of the hospital's precarious finances, the administrative dynamics, and the plans for change. During a ride in a small plane flown by the hospital CEO with the accountant also on board, these 2 discuss the poor hospital finances. The plane crashes, killing the CEO and leaving the accountant in critical condition. The hospital board convenes to decide on an interim replacement for the CEO. At this point, the reader becomes involved in the ensuing drama. The story unfolds around the hospital board, the interim director, managed care, a malpractice suit, a corrupt pharmacist, and romance. A recent study by the Healthcare Advisory Board found that most hospital bankruptcies result from small cumulative losses sustained by a number of different hospital departments rather than one major financial loss. Code Blue shows how this can happen as members of different hospital departments unwittingly contribute to the hospital's financial losses. Words primarily used in health care are printed in bold and each section includes a glossary and learning objectives.

Code Blue holds the reader's interest in the way that a traditional book on health care finances could not. For instance, the hospital is fined for not complying with Medicare billing regulations, and the changes required by managed care are emphasized. Corporate compliance, cost containment, hiring practices, infection control, and related topics also make their way into the story. The key theme is that hospitals must adapt to certain changes in order to survive.

Code Blue provides a good understanding of hospital economics, billing regulations, and compliance issues. The text is weaker in areas pertaining to direct patient care and contains several minor inaccuracies. For instance, the authors use formaldehyde rather than formalin to describe the odor emanated by a stereotyped pathologist, and they refer to pseudoephedrine as an amphetamine when it is a sympathomimetic amine rather than an amphetamine.

Although the book is somewhat dated in terms of regulations, it emphasizes the importance of adhering to government regulations. Code Blue was written before the introduction of the Health Care Insurance Privacy and Portability Act (HIPPA) in April 2004. In several instances, employees in Code Blue perform actions in direct violation of the HIPPA although many hospitals have had regulations to protect patient privacy in effect before HIPPA regulations became mandatory. Some of the events depicted in this book are also not feasible today because of the widespread use of computerized pharmacy systems and the requirement for using diagnostic billing codes in the laboratory. Some of the information would be more relevant to a small rural hospital.

Code Blue provides a good overview of hospital administration and of the billing changes and other regulations associated with managed care. Its intent is to teach readers new to healthcare about health economics, federal regulations and the importance of cost containment.

Elaine Moore is a medical technologist (ASCP) currently working as the night shift supervisor in the laboratory at Memorial Hospital in Colorado Springs, Colorado. She is also a medical writer.