Plain language alerts help Piedmont Healthcare patients, staff avoid confusion

Over the last four years, Piedmont Healthcare has rapidly grown from five hospitals to 11. But because each new facility had its own emergency alert system, there was confusion among the staff.

Many nurses work at multiple facilities across the Atlanta-area system so they had many different color-coded alerts to keep track of. A code pink at one hospital meant an infant abduction, but at another it was sudden infant cardiac arrest.

“We felt the codes being different colors and everyone using them differently caused a huge amount of confusion for staff and could lead to an adverse outcome as a result,” said Denise Ray, Piedmont’s chief nursing officer.

To avoid the potential for patient harm, Piedmont began efforts about six months ago to transition its alerts to one system using plain language. The new alert system, which went into effect in September, briefly explains the emergency using a few words rather than color codes. For instance, code silver, which usually indicates an armed intruder, was changed to “security alert” along with a description of the threat such as an active shooter and then a location of the threat plus a description of the perpetrator. Operators announce the alerts over the speaker system as was previously done with color codes.

Source: Piedmont Healthcare

Plain language alerts are becoming increasingly common in healthcare with about 25 state hospital associations recommending facilities use them. HHS, the Department of Homeland Security and the Federal Emergency Management Agency also back plain language alerts.

Piedmont received feedback from staff members before implementing the new system. Meetings with chief operating officers at all 11 hospitals were held to talk about the alerts already in place and to build consensus for new ones. Chief nursing officers at each of the hospitals also attended meetings, providing feedback from frontline staff about proposed changes.

Dr. Eric Bour, CEO of Piedmont Newton Hospital, who led the transition to the new system, said clinician insight was key to get buy-in.

“I have learned over my years of administration and clinical work that it’s a whole lot easier to move in a new direction when people are involved in the movement,” he said.

None of the new alerts received much protest from staff members except one: code pink. The code was used at some hospitals to indicate cardiac arrest for an infant. There was an initial proposal that all medical emergencies be changed to simply “code blue,” since its meaning is widely known among both clinicians and laypersons. But both physicians and nurses were concerned that it wasn’t specific enough to know who was in need of assistance.

“They felt like all of their staff had been educated, they had their routine down, their procedures in place, and they didn’t want to do anything that could cause them to not know what to do,” Ray said. The solution was to continue to use “code blue,” but then add whether the patient was an adult, infant or child, and then the location.

Initially, the health system set up nine months of education for staff to adopt the new codes, but Bour said leadership soon realized that wouldn’t be necessary. The codes are so straightforward it only required brief presentations and posters on the walls explaining them. As as a result, the codes were in use about a month after they were finalized.

The changes didn’t cost Piedmont much money because it didn’t change how the alert system operates, Bour said. The system operators were trained on the new codes and staff continue to call them describing the emergency just as they have always done. Piedmont also no longer has to print badges displaying all the codes.

“We expected the conversion to be cost-neutral, but have actually found that it has saved costs across the enterprise,” Bour said.