Tuesday, June 10, 2008


In our hospital, we feel that it is very important to confuse everybody with how codes are announced.

Some of them are medical terms (code STEMI, code neuro...)

Some of them are colors (code yellow (trauma), code green (rapid response team), code orange (pt out of control), code chartreuse (35% off sale starting in hospital gift shop), code brown (grab some wet wipes and gown up, we're going in!)...)

Some of them are numbers (code 4 (code blue in every other hospital in the known universe), code 5 (I don't even remember, but I think it's bad)...)

The result, of course, is that every time a code is called, everyone pauses and looks around at each other until someone gets the courage to admit that they have no clue what was just called. Inevitably someone who actually does know spills the beans and finally the other 10 people who didn't want to admit ignorance as to what code (insert obscure number here) means, start running.

Add to that the non-specifics of how codes are called overhead, and things get worse.

At 10:30 pm a code 4 (you know, Code Blue, but we don't want to call it that, because we might scare patients, so instead we give it a random number that means absolutely nothing and just confuses everyone and makes patients ask what is going on) is called overhead to room 413*, so off goes an ER Tech with the airway box and the pharmacist and the respiratory therapists and one of our docs. 5 minutes later a code is called for "4th floor". Is it the same code or are there two patients going down? No way to know, so off goes the other ER doc and another tech and another airway box (leaving none in the ER, which brings up issues of supplies, but that's a story for another day).

Yup. Same patient. So we were left pretty crippled on an evening when we had 15 patients in the waiting room and an ER full of yellow charts. Lovin' it.

This is the third medical system that I have worked in in the past 3 years, and they all have widely varying systems for calling codes. Can we please come up with a national standard for calling codes? Please?

* room numbers changed to protect the innocent.


The first healthcare system that I worked in had a creative solution to the problem of "scaring" patients with code calls. Instead of calling a code blue, they would call a Blue Team. Similar enough for all the staff to know what was going on, but just different enough that a patient who wasn't paying too much attention might let it slide. Might.

But what is more is that the codes actually seemed to make sense - at least to me. A Blue Team was a patient who wasn't breathing (blue=not breathing... good), a White Team was a patient out of control (white=white hot anger... good), a Red Team was a fire (yeah, you can figure that one out), an Orange Team was a chemical spill (a little stretch, but it still seems logical enough to me). The one code that wasn't a color was the "Code 95" which meant a patient or family member who was escalating toward a White Team, with the idea that we might be able to stop it before objects were flying through the air. I can live with one numbered code because is the only one and so everyone knows what it means.

I have heard of hospitals paging strange "doctors" overhead, as in Dr. Pyro or Dr. Firestone, so that patients don't realize what is happening. I hope I never work in one of those hospitals, because I would end up ignoring all the emergency calls, because I was born with the ignore-overhead-pages-to-doctors gene (A114-3GF7 for those of you keeping score). Also, what happens when the hospital employs a Dr. Firestone (a quick white pages search found 79 Firestone families in my region) or a Dr. Cairo or Dr. Milo or some other similar name? Good thought, bad idea.

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Prisca: said...

what??? the code number thing sounds crazy! :)

we just have the REALLY LOUD, very serious sounding woman come on overhead and stated very slowly "CODE BLUE, ICU" (or wherever) about a million times. And always at 4AM. I'm sure my OB patients love that!

Epijunky said...

I love when they call a code (insert your favorite random code here) and you see fifteen ER employees simultaneously reach for their cheat sheets (the back of their ID tags which list the random codes on them).

It's both priceless and a little scary.

Moira said...

My floor has an east and a west. The other night a code 30 (code blue) was called on the east side, and it took me too long to remember what side I was working on.
We do code red for fire -- code yellow for no more fire.
Team 99 for the out of control patient and I think code pink for baby missing.

It's weird that we have a mix of colors and numbers.

david0314 said...

Prior to 9/11, police, fire, and EMS would use codes during radio communication. Different agencies using the same codes for different things made communication extremely difficult, hindering coordination of resources. Interesting that hospitals are still doing it.

I don't know what's worse: scaring patients (with too much information over the PA) or not communicating.

Tracey said...

Love the post. In fact I copied off you and did one of my own. I linked yours to it if you want to check it out. It's over at nighttimenursing.blogspot.com and I titled it "code what?"

NewGradNurse said...

I must say, our system is easy: Code Blue is pretty much the only one every called.

We do have pink, green, and orange. If they were called, staff would sit around quite confused. It would take less time to call all floors and ask them to come help.

I do want to comment on the fire code because I forgot about that one.

We also have a "Dr. Firestone" which ends up sounding funny because after the "firestone" is clear the operator announces three times "Dr. Firestone in cafeteria, all clear. Dr. Firestone in cafeteria all clear. Dr. Firestone in cafeteria all clear." The first one sounds out of place and by the third one it sounds down right psychotic.

Note to self: Never be admitted to Dr. Firestone's service.