Variety of overhead pages can pose safety risk
Overhead pages are a common sound in any hospital, but no one seems to use the same terminology or codes. Is code red a fire in this hospital, or is it a violent incident requiring security staff?
Variations in the use of overhead paging in hospitals can cause confusion among caregivers, staff, and patients and can lead to adverse patient safety events, says Tania Daniels, PT, MBA, vice president of patient safety at the Minnesota Hospital Association (MHA) in St. Paul. MHA conducted a survey in 2010 and found 22 codes for patient abduction; 18 codes for a security alert; code green indicated four different emergencies; and code yellow had five meanings.
"Communication failures are the top reason for adverse events to happen, and this is definitely a communication problem," Daniels says. "It obviously is a patient safety issue."
Staff members often do not know all the color or name codes for various emergencies within their own facility, and the problem can be much worse for healthcare professionals who work in more than one hospital, Daniels says.
A primary strategy should be reducing the use of overhead paging altogether, she says. With the use of cell phones, computer stations, and other devices, it might be possible to eliminate many overhead pages, she says. That elimination will improve patient safety simply by eliminating much of the noise pollution in the hospital, she notes.
When using overhead paging, reducing the use of codes could solve much of the problem, Daniels says. Minnesota hospitals are making efforts to implement plain language for overhead codes, and many hospitals are minimizing overhead pages by communication through other means. MHA developed an Emergency Overhead Paging Tool Kit to help hospitals move toward the use of plain language in overhead pages and to determine which emergency situations need to reach the patients’ and all staff awareness. (The tool kit is available online at http://tinyurl.com/pagingtoolkit.)
An example of a plain language announcement would be "Fire alarm, fourth floor, west wing. No action is required of patients and visitors at this time." Another would be "Rapid response team to room 412."
Plain language paging can be better than patients and visitors hearing a coded announcement, Daniels says. The previous thinking was that hospitals should not alarm patients by openly announcing a fire emergency or a cardiac arrest, for example, but Daniels says current research is showing that the coded announcements can be worse. "When a code red or code blue is called, that can create anxiety because they know something dire is going on but they don’t know what it is or how it affects them," Daniels says. "Transparency is the better option, and that means stating plainly what is happening and whether action is needed by the people who may hear the page."
An MHA study of 322 consumers found that people overwhelmingly favor plain language announcements. These were some of the results:
- 87% stated that patients and visitors should hear a fire announcement;
- 94% stated that patients and visitors should hear a medical emergency announcement;
- 67% stated that patients and visitors should hear a "person with a weapon" announcement;
- 90% stated that patients and visitors should hear a missing person announcement;
- 94% stated that patients and visitors should hear a severe weather announcement.
Security announcements pose the most challenge, Daniels says. Even hospitals that favor plain language paging might balk at openly announcing a security problem. She suggests including security leaders, including local law enforcement, in making that decision. It is possible that plain language will not be the solution in this case, but there might be a need for consistency.
"In many communities, law enforcement has a standard way they refer to certain situations, and they have worked this out with other departments and schools, for instance," she says. "If that is the case, you will want to be consistent so that there is never any confusion about your situation and how you need people to respond."
- Tania Daniels, PT, MBA, Vice President of Patient Safety, Minnesota Hospital Association, St. Paul, MN. Telephone: (651) 641-1121. Email: tdaniels@