Karen Garloch

Attention, please: Plain language replaces color-coded alerts at some hospitals

I was sitting at Carolinas Medical Center last month when an ominous-sounding voice came over the loud speaker:

“Security alert. Threat of violence. Levine Children’s Hospital. 10th floor. Avoid the area.”

The female voice repeated the warning three times, causing everyone in my meeting to stop talking for a few seconds.

We weren’t in the children’s wing, so we went on with our business. And some time later, the voice returned, repeating the message with an “All clear” at the end.

In the past, the message would have been in code: “Code Grey. Levine Children’s Hospital. 10th Floor.”

Employees would have understood there was a threat of violence. But people like me and other hospital visitors probably wouldn’t have known what it meant.

That’s partly why CMC and other hospitals across North Carolina have adopted what hospital officials call “plain language.”

The goal is to reduce errors and promote safety of hospital staff, patients and visitors by using common-sense language instead of color codes that might differ from hospital to hospital, said Barb Bisset, executive safety officer for WakeMed Health & Hospitals in Raleigh.

Bisset was co-chair of a task force created by the North Carolina Hospital Association and the North Carolina Hospital Emergency Management Council to review best practices across the country. The group was created in recent years after State Rep. Donny Lambeth, R-Forsyth, a former hospital administrator, proposed legislation to create a uniform system of codes across the state.

WakeMed had been using “plain language” for emergency alerts since 2007, Bisset said, and the system was working well. “We didn’t want to go back to colors.”

Lambeth agreed to withdraw his proposal because “I don’t really like adding regulations if not needed.” He said he has been impressed by the task force’s work and their plan to reduce confusion and make conditions safer for patients.

Concern about emergency codes grew out of the wide variation in practice across the state that caused confusion for people who work in more than one hospital.

For example, some hospitals used Code Grey to refer to “a serious weather event” while others used it to mean “a very high-risk security event,” Bisset said. At different hospitals, Code Silver might mean “missing person” or “there’s somebody with a gun.” Code Orange is often used as an air quality alert, but some hospitals used it to announce a “chemical contamination event,” Bisset said.

In some cases, hospitals have used fictitious doctor names to communicate alerts. For example, in the 1990s, Novant Health’s Presbyterian Medical Center used “Paging Dr. Heart” to mean a patient was having a cardiac arrest. But the hospital changed that message to avoid confusion with several real doctors whose last names were Hart, Hardy and Harr.

Under the new guidelines, hospitals are advised to announce the type of emergency – security alert, medical alert or facility alert – followed by an explanation of the emergency, such as a missing child, and a description or location.

Changing to plain language is voluntary, but the association has asked hospitals to make the change by the end of 2016.

Every hospital doesn’t have to use the same words, but whatever language they use, it should be understandable and leave no doubt about the action required, according to the hospital association’s resolution.

Three codes can remain. They are: Code Red and Code Blue, which are widely recognized as alerts for a patient who requires resuscitation or immediate medical attention, and Code Pink for a child abduction.

CMC and other hospitals in Carolinas HealthCare System’s Charlotte-area network adopted the new language in July.

Novant Health’s four Mecklenburg County hospitals plan to change by the end of this year, according to emergency preparedness manager Matthew Merritt. That’s when alerts will be announced in “plain language that everyone will understand.”

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