Speeding Up Emergency Call Activation

New protocol helps nurses and call center operators

At Cleveland Clinic’s 165-acre main campus near downtown Cleveland, an average of 1,500 onsite medical emergencies are called in to the main call center each month. Two direct telephone lines are available to activate medical emergency teams (METs). The lines are for patients who are unresponsive, not breathing or pulseless, and all other medical emergencies that require rapid response.

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“We have learned that our operators need very specific information to make sure that the right team responds to the right location as quickly as possible,” says Karen Graves, BSN, RN. “They don’t, for example, need the ‘chief complaint’ or other details since the operators do not have a medical background. The wrong information can delay activation of the emergency team.”

To help ensure that caregivers remember exactly what they need to report to operators, Graves came up with the “LEAN” acronym in 2016:


E=Event (code or rapid response)

A=Adult or Child

N=Number to call back if more information is needed

“The four LEAN points facilitate the most expeditious medical emergency team activation,” explains Graves, who serves as the Clinical Program Manager for the Critical Response and Resuscitation Committee in the Anesthesia Institute. LEAN is now part of call center protocol.

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The call center

In 2017, 1.6 million calls came in to 23 operators at the main campus call center. And while medical emergency calls made up a small percentage of all calls, their importance in saving lives was critical.

“With so many types of calls coming in both externally and internally, we try to standardize processes as much as we can for our operators,” says Call Center Support Services Director Geraldine Brinn. “The LEAN protocol has improved our ability to expedite the activation of emergency response teams.”

Today, when a call comes in to a MET line, operators use the following script:

“Medical Emergency Line, [Operator Name], is this for a Code or Rapid Response?”

“Is this for an Adult or Child?”

“What is your location?” (Building, Unit/Floor, and Bed)

“What is your callback number?”

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From there, automatic programming allows the operator to dispatch the emergency.

“It can be very stressful when caregivers need to activate an emergency response,” says Shannon Pengel, MSN, RN, Associate Chief Nursing Officer in Cardiac Nursing at main campus. “The LEAN acronym prepares nurses ahead of time for these events.”


Since implementing LEAN in December 2016, the average work time has gone down substantially as has the average call time. “This process has reduced the anxiety experienced by both our caregivers and the operators receiving our calls,” says Pengel. “In an emergency situation, our caregivers are the lifeline between the patient in need and our emergency responders.”

Graves emphasizes that this initiative was a team effort by nurse and physician leaders on the Critical Response and Resuscitation Committee. “Keeping the call simple has made a difference,” she says.

The LEAN protocol was submitted as part the “2017 Innovation Inventory.” This program encourages nursing institute caregivers to share patient care innovations implemented in the previous year. The program is managed by Cleveland Clinic’s Office of Research and Innovation.

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