Evaluating Emergency Code Use and Integrating Clinical Codes for Emergency Conditions to Improve Coordination in a Tertiary Care Hospital

Abstract Background Hospital emergency response systems are critical for patient safety, yet traditional models relying solely on generic codes (e.g. Code Blue, Code Yellow) often face communication challenges, delayed responses, and unclear escalation protocols. To address these systemic gaps, a structured set of clinical codes for emergency conditions were introduced, with training, survey and evaluation of these codes. Methods A single-center quality improvement study was conducted in 2024 at a 260-f/bed tertiary care teaching hospital in North India, with ∼23,000 inpatient and 240,000 outpatient visits annually. A cross-sectional survey of 612 frontline staff assessed knowledge and confidence in emergency codes. After baseline assessments, five condition-specific clinical codes (STEMI, FAST, Polytrauma, Vascular, Green for Organ Donation) were implemented hospital-wide. Data from 642 emergency code activations and 74 mock drills were analyzed over 12 months. Specialist response times were tracked via PA system logs, arrival notes, and WhatsApp communications. Primary outcomes included escalation rates from Code Yellow to Blue, ICU transfers, and response times, with results compared to published benchmarks. Results Survey response rate was 91.2% (612/671), with 93.1% reporting awareness of emergency codes and 88.7% confidence in performing first-response actions. Among 642 actual activations, the most frequent were Code STEMI (n = 246, 38.3%), Code FAST (n = 138, 21.5%), and Code Yellow Adult (n = 129, 20.1%); other notable activations included Code Violet (n = 34, 5.3%), Code Polytrauma (n = 30, 4.7%), and Code Blue Adult (n = 28, 4.4%) (with pediatric codes: Code Blue Paeds n = 2; Code Yellow Paeds n = 5). Mock drills (n = 74) emphasized preparedness for mass casualty and resuscitation scenarios, with Code Orange (n = 16, 21.6%) and Code Blue Adult (n = 13, 17.6%) with Mortality remained at 3.3%, most frequently tested. Escalation from Code Yellow to Code Blue occurred in 4.5% of Code Yellow activations (95% CI: 3.6—7.3), lower than published escalation rates of 15—20%. Intensive care transfers occurred in 11.2% (95% CI: 8.7—13.9), while emergency department transfers accounted for 4.5% (95% CI: 3.1 –6.4). Average specialist response time following code activation was 3 minutes across categories. Conclusion Integration of condition-specific clinical codes alongside standard codes improved hospital wide awareness, facilitated rapid specialist mobilization, and was associated with fewer escalations to cardiac arrest compared with published benchmarks. While these findings are promising, this single-center descriptive study is limited by lack of pre-intervention baseline data and absence of patient level outcomes. Future multicenter evaluations with outcome linkage are recommended.