Confusion Abounds Over Emergency Codes

By Jonathan Springston, Editor, Relias Media

When researchers surveyed healthcare workers, respondents struggled to correctly identify the meaning of an emergency code, raising questions about training, along with code complexity and uniformity.

Investigators anonymously surveyed 304 employees at five medical facilities in Georgia about their knowledge of codes for 14 emergencies. Researchers pulled information from emergency operation plans to help craft their survey. Often, hospitals use colors to correspond to various situations (e.g., “Code Blue” usually indicates a patient needs resuscitation). Other times, codes are a simple phrase or plain text (e.g., “Code John”).

For each emergency, survey respondents had to indicate if the code type was a color, plain language, other, or none identified (respondents also could indicate if they did not know). If a respondent picked color code, then he or she chose from a selection of 20 colors. If participants picked plain language or other, researchers provided a free-response box respondents could use to type the code. If the respondent did not know or indicated there is no code, they moved to the next question.

Although 69% of respondents said they were familiar with the procedure for activating emergency codes and 64% said they were not confused about codes while working their jobs, investigators reported survey participants correctly identified the code 44% of the time. Respondents seemed well-versed in codes for cardiac arrest, fire, and infant abduction, but struggled with codes for less common events (e.g., hostage situation, internal disaster).

The authors also reported there seemed to be wide variation in codes across the five facilities from which survey respondents worked. For example, “Code Pink” could mean missing child or infant abduction. “Code Gray” might mean a bomb threat or severe weather.

Two-thirds of respondents said they would prefer using color codes, mainly to prevent visitor panic and to maintain discretion. Perhaps it is better to announce “Code Gray” than to announce there might be a bomb in the building. Some respondents said some emergencies always should be color coded, while others said they would be fine with changing to plain language. Perhaps it is easier for some to remember code words than to remember which color associates with which event.

These researchers concluded that transitioning from color codes to plain language codes would reduce confusion (aligning with the conclusions of previously published research). They also advocated for better education and ongoing training for healthcare employees on this information.

For more on this and related subjects, be sure to read the latest issues of ED Management.