HARRISBURG, Pa. Emergency code terminology used to notify staff in healthcare facilities about an event that requires immediate action varies greatly from one facility to another in Pennsylvania. Healthcare facilities are encouraged to standardize codes for increased patient safety, according to the March Pennsylvania Patient Safety Advisory article released today.

Analysis of events reported to the Pennsylvania Patient Safety Authority from July 2004 through 2013 and a northeast Pennsylvania hospital survey found 80 different codes that were grouped into 37 categories. For example, an emergency code for an adult medical emergency at different healthcare facilities could be announced as a "code blue," or "code rescue," "code stat," or "code 99."

"These codes were used in one hundred and fifty-four combinations of terminology and intended meaning," Susan Wallace, MPH, CPHRM, patient safety analyst of the Pennsylvania Patient Safety Authority said. "For example, there were over fifteen different emergency codes used by Pennsylvania healthcare facilities to identify a combative person, including 'code gray,' 'Dr. Armstrong,' 'code manpower,' 'code 12,' 'code control,' and 'code green.'"

Over 25 hospital associations have recommended standardized codes and definitions for healthcare facilities in their states.  

"Several associations support 'plain language' codes based on recommendations from government agencies such as the US Department of Homeland Security," Wallace said. "To help promote consistency for patient safety and decrease 'code confusion,' it is suggested that Pennsylvania healthcare facilities develop a standardized emergency code system." 

Wallace added that plain language systems, instead of systems based on colors, letters, names, or numbers, communicate information in a manner that is easily understood by listeners, which may include patients and visitors in addition to staff.

"A facility using plain language would announce the alert category, the specific code description, and the location of the emergency," Wallace said. "For example, the announcer would state: 'medical emergency, cardiac arrest, room one twenty-three."

Wallace added that such standardization could lead to the reduction of code terminology variations, increase awareness and knowledge of healthcare staff working in multiple facilities, and promote transparency of code meanings. Several hospital associations, including Colorado, Florida, Iowa, Minnesota, Missouri and Wisconsin have recommended the use of plain language.

As quoted in the Advisory article, Pennsylvania does not have a statewide standardized emergency codes system, according to Thomas L. Grace, RN, PhD, vice president, emergency preparedness, of the Hospital and Healthsystem Association of Pennsylvania (HAP). However, Grace said HAP's emergency preparedness staff has encouraged facilities to consider use of plain language announcement in place of codes.

As quoted in the Advisory article, Stephanie A. Gryboski, MS, manager, emergency management, Geisinger Health System, and chair of the Northeast Pennsylvania Regional Task Force's Health, Medical and EMS Committee, said she advocated for uniformity of emergency codes for the facilities she manages and all Pennsylvania healthcare facilities. Gryboski leads emergency management training for eight hospitals, five helicopter transports, 78 clinic and outpatient facilities, and two research centers across the state.

"Standardizing hospital emergency codes can benefit hospital employees and external emergency responders, as well as patients, by reducing code confusion and aiding staff in providing the correct response to emergencies," Wallace added.

For more information about emergency code standardization in Pennsylvania go to the March Pennsylvania Patient Safety Advisory article, "Standardized Emergency Codes May Minimize 'Code Confusion,'" at www.patientsafetyauthority.org.

The Authority's 2015 March Advisory contains other clinical articles for the healthcare provider to improve patient safety. Highlights of the 2015 March Advisory include:

Patient Flow in the ED: Phase II—Diagnostic Evaluation through Disposition Decision: 

The total number of emergency department (ED) visits in the United States increased 35% between 1995 and 2010, according to the Centers for Disease Control and Prevention. However, according to the American Hospital Association between 1991 and 2011, the number of hospitals with EDs decreased by 647, leaving less EDs to manage increased visits. These factors contribute to ED crowding, which causes bottlenecks in patient flow and creates patient safety hazards.  In 2013, Pennsylvania hospitals reported 23,749 events to the Authority in which the ED was selected as the care area.  Of these reports, 2,495 (10.5%) were submitted as no harm events. This article is the second in a three-part series that addresses patient safety related to ED flow, and it focuses on strategies to improve processes of care and patient safety during the  diagnostic evaluation through disposition decision phase of ED care. An educational toolkit and self-assessment questions are also available with this article.

Wrong-Site Orthopedic Operations on the Extremities: The Pennsylvania Experience: The Authority analyzed 83 wrong-site extremity procedures within the domain of orthopedic surgery reported over a nine-year period, representing 15% of the 541 reports of wrong-site operating room procedures in Pennsylvania hospitals and ambulatory surgical facilities from July 2004 through June 2013. The most common body parts involved were the hand (6% of all 541 reports), the knee (5%), and the foot (3%).  The following marking and time-out practices might have prevented specific types of wrong-site extremity procedures: 1) mark the site close to the planned incision and reference it during all steps leading up to an incision, and 2) do separate time-outs for separate procedures on the same patient. An educational toolkit is also available with this article.

Hospital-Acquired Pressure Ulcers Remain a Top Patient Safety Concern for Hospitals in Pennsylvania: Pennsylvania hospitals reported more than 19,000 pressure ulcer events to the Authority in 2013. Hospital-acquired pressure ulcers (HAPUs) are a recognized patient safety concern and meet the definition of a reportable event under the Pennsylvania Medical Care Availability and Reduction of Error Act. An analysis of pressure ulcers reported through the Pennsylvania Patient Safety Reporting System (PA-PSRS) from 2007 through 2013 suggests the need for improvement in identification of pressure ulcers present on admission; accurate staging of pressure ulcers; and prevention of HAPUs, in particular stage III, suspected deep-tissue injury, and unstageable pressure ulcers. Patient safety and quality agencies, as well as wound care specialty organizations, have established evidence-based best practices in pressure ulcer risk assessment and prevention. This article discusses the analysis and the success organizations have had in reducing the number of HAPUs at stage II and greater.

Equipment, Environment, and Ergonomics: An Enigma of Infection Risk: Analysts queried the PA-PSRS database to find common reservoirs and/or processes that could facilitate infection development, outside of the patient's own endogenous flora. Of particular interest were events that put the patient in contact with contaminated equipment.  Analysts identified two specific clusters of patient exposures to contaminated equipment. Equipment, environment, and ergonomics can be combined either in a structured or haphazard format. If a structured format is employed, then opportunities to prevent hospital-acquired infections can be identified and addressed. This article discusses strategies that can be used to optimize the integration of equipment selection, the use environment and equipment cleaning. As a result of the article, an assessment tool has been developed. The tool addresses product/system evaluation that includes a multidisciplinary approach to equipment selection, specifically addressing infection transmission risk, human factors, ergonomic concerns and cleaning.

Quarterly Update on Wrong-Site Surgery: Do You Really Want to Wake the Patient Up and Start Over?: This recurring update discusses the wrong-site surgery events reported to the Authority for the fourth quarter of 2014, as well as any analysis for previous events reported to the Authority. An educational toolkit is available with this article.

Healthcare Providers Committed to Patient Safety Recognized: The Authority held its annual I Am Patient Safety poster recognition contest during the last several months to recognize individuals and groups within Pennsylvania's healthcare facilities who have demonstrated a personal commitment to patient safety. Winners received their photos and patient safety efforts highlighted on posters that can be displayed within their facilities. They also received a certificate and I Am Patient Safety recognition pin from the Authority. Winners were invited to attend the March 2015 Patient Safety Authority Board of Directors meeting for lunch and to meet the Authority board members and staff.