Hospital Staff Respond More Favorably to Nonclinical Overhead Announcements When Plain Language Is Used

Hospitals across the country frequently use coded language to announce
both clinical and nonclinical emergencies like severe weather, a chemical
spill or an active threat of violence. A new nurse-led study explores nurses’
perceptions about converting to an emergency announcement system.

Inspired by an unsettling experience they shared, investigators Ashley Hall, MSN, RN, CMSRN, and Elizabeth Cai, MSN, RN, CMSRN, examined the pitfalls of using coded language in situations where every second counts. When walking through the hallways of Cleveland Clinic Medina Hospital, where they both serve as Assistant Nurse Managers, Hall and Cai heard a coded overhead announcement for a “Code Silver.”

“The phrase ‘Code Silver’ was repeated several times, followed by ‘This is not a drill, take action to protect yourself and others,’” recalls Hall. “I knew what a Code Silver was, but I had never heard it called overhead.”

Although Hall and Cai understood the announcement, they inexplicably hesitated to take action. “We knew we needed to respond immediately, but panic set in,” says Hall. “For the first several moments, we didn’t move. We just stood there in disbelief as we processed what we were hearing and translated the two-word code in our heads.”

When reflecting months later about why they were slow to react to the warning, Hall and Cai decided to examine how nurses would respond to direct, more descriptive nonclinical emergency announcements.

“We believed that if the overhead announcement had been in plain, simple language rather than in coded language that needed to be deciphered, valuable time may have been saved because clinical caregivers would have understood the nature of the threat and reacted more quickly,” explains Hall.

“However, since a plain language announcement could prompt nursing caregivers to panic, stifling their ability to initially act as expected, it was important to understand how nurses interpreted emergency announcements and their preference for plain language or coded messages.”

Actionable results

In their study, Hall and Cai focused on an announcement to indicate a weather-related emergency. The researchers recorded two announcements: one using a coded term (“Code Gray”) and one using plain language. Nurse participants were asked to listen to both announcements and answer questions about their perceptions and the strengths and limitations of each version.

“The hospital’s policy outlines eight steps for responding to a weather emergency,” explains Hall. “When we played the coded announcement, not a single participant could identify all eight components — no matter how long they had worked at the hospital. "Overall, less than 50% of participants were able to identify the type of emergency indicated by a Code Gray.

When Hall and Cai played the plain language announcement, participants’ ability to describe an appropriate response to the emergency increased dramatically. Participants explained that the coded language failed to convey the urgency of the emergency as effectively as the plain language version.

“Plain language was more helpful because it took out the guesswork by describing exactly what needed to happen,” explains Cai. “Not only could staff members understand and immediately respond to the situation, but patients and visitors could also take action without guidance from hospital staff. Emergency codes, even when standardized across hospitals, may not be explicit enough to prompt necessary action.”

The researchers hope their findings will inspire other healthcare organizations to use plain, nonclinical language when making their own emergency announcements. When an announcement may potentially frighten visitors, Hall suggests hospitals describe any immediate actions that should be taken.

“The study was an important reminder of how a simple change can make a world of difference — and potentially decrease confusion and stress in employees, patients and visitors within the hospital setting,” says Hall. “Many of our participants asked us why plain language announcements weren’t standard practice — a question that has strengthened our resolve to help translate our findings on a large scale in clinical practice.”