Transition to Plain Language Overhead Emergency Announcements: An Experiential Account

Established practice in many hospitals, health care settings, and other public environments is to alert people through use of overhead announcements when emergency response is required. These announcements historically used a corresponding color to inform which personnel were to respond. As the number and type of incidents have increased, so have the numbers of colors used to designate events. This has resulted in inconsistent use of colors across organizations and communities to designate the same type of event. For example, Code Green may signify combative person at one location but may signify mass casualty or bomb threat at another. This disparity may lead to preventable risk to patients, staff, and facilities because of misunderstanding. Plain language is communication an audience can understand the first time they read or hear it. This article aims to outline the journey of a federal agency to improve safe care delivery through transitioning from overhead emergency alerts using color codes to plain language.

Subject matter experts across disciplines were solicited to define the scope and scale of issues and determine courses of action (COAs). The Delphi method was employed with votes in the group tallied after each round of questions. This same pattern was repeated over several weeks as the team continued debate. The optimal course of action was deduced through their clinical and leadership expertise and research. Implementation plans were developed and supported by a logic model to guide implementation. Ten pilot sites were identified in the National Capitol Region with 3 returning feedback. Products and actions to support implementation were designed and additional team members in specialized areas were solicited to support development. The dissemination plan included a "begin implementation" date as opposed to a fixed date to avoid conflicts at facilities that could inhibit adoption at a pre-defined date.

Four COAs ranging from standardizing color codes, several variations of a mix of color and plain language, and plain language were determined. Pilot testing was conducted at 10 facilities. Feedback from the initial products was received from 3 facilities. This information was evaluated and used to inform modifications to the products before greater distribution. Deliverables included script cards for announcements, posters, badge buddies, a 6-minute computer-based training course, frequently asked questions, talking points, and an implementation guide.

Significant findings were the wide variance of color codes used to signify various events across facilities and challenges faced when considering change to long-established practice. This work demonstrates the strength of collaboration with experts across disciplines to generate workable solutions to meet requirements and improve safety. The gap in this work was length of time to overcome mindsets that color codes were the only solution and time intervals required to obtain approvals. Overall impact of the work is enterprise adoption of standard plain language emergency alerts so personnel, regardless of the facility or location, will recognize and respond to respective threats. Areas for future study include retrospective project evaluation and feedback from external partners about effects and impacts.