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Code Help: An Evolving Process for Improving Patient Safety in the Emergency Center

October 12, 2016 –  When you hear that we have called a Code Help at Lawrence General, you know the Emergency Center is having an extremely busy day. Activated by clinical leadership in the Emergency Center, Code Help means that there are ten or more patients in the EC waiting to be admitted and that no inpatient beds are expected to be available for at least four hours. 

“Essentially, Code Help means we have a bottleneck in the EC and need to take extra measures to improve patient flow,” says Kim Downer, director of emergency services. “We need to do whatever we can to assist the staff in the Emergency Center – and throughout the entire hospital – to better meet the needs of our patients.”

“When we have a back-up in the Emergency Center, it’s not just an EC problem, it’s a hospital-wide problem,” echoes Karen Moore, RN,  senior vice president of clinical operations/chief   nursing officer. “Patient flow is an extremely complex process with a lot of moving parts. Getting it right — especially when you are busy — is essential to maintaining patient safety.”

Emergency department overcrowding is one of the most challenging issues faced by hospitals all across the   country, leading to increased morbidity and mortality rates for patients and extended lengths of stay. 

When a Code Help is called at Lawrence General, a VOLO alert goes out to leadership and clinical and patient support departments send representatives to a team huddle. At this huddle, these representatives share patient census and discharge information in real time and brainstorm ways to redeploy staff and other resources to support patient needs. 

“Our Code Help response is very much a work in progress,” says Karen. “Each Code Help gives us an opportunity to look closely at the systems and processes that contribute to overcrowding and discuss how things can be done differently. We are learning and evolving as we go.”

All hospitals in the Commonwealth were mandated to develop a Code Help policy in 2009 by the Massachusetts Department of Public Health when the State eliminated the option for busy emergency departments to divert incoming ambulances to other hospitals. The goal of Code Help is to eliminate emergency department crowding and improve hospitals’ capacity to accept and manage new patients in a quick and safe manner. If you have questions about your department’s role in a Code Help, please speak with your manager.


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