It’s time to stop overhead Code calls in the Hospital

CPRTonight, after hearing about the 5th overhead call for a Code Blue in the hospital, it occurred to me what an anachronism this overhead announcement practice is, and quite a pointless one. I think it should be stopped, and here’s why.

First, I understand that a code requires a marshaling of resources: in no particular order, the House Supervisor, a Respiratory Therapist, the physician in charge of the patient, or the anesthesia / EM doc in house. With those people, and the nurses and techs available on any inpatient ward in the hospital a very effective code can be run, and the patient can be moved to the ICU if it is successful.

What do all those parties just listed have in common? They are in-house (except the PMD, but their surrogates count here, and the PMD isn’t going to hear the overhead page at home anyway) and they have pagers, at a minimum. They can all be marshaled in mere moments, and a discreet paging for a code would no doubt cut down on the number of gawkers who accumulate in the hallways outside the patients’ room. There’s no reason to disturb the entire hospital for a code call.

This goes double for the ridiculous practice of calling codes in the ICUs (or the totally absurd calling of codes in the ED I once worked in). Look, if you cannot handle a code in one of those places with the people you’ve got, you need to get out of the hospital business.

So, why the overhead pages? I can think of two reasons. The first is historic, the ‘we’ve always done it this way’ model. There is a need to alert a small cadre of people to come and help in a code, but that number is really very small, and with modern technology overhead calls are a disruptive throwback to olden times.

The second reason is just a guess, but I often wonder if this isn’t done on purpose, to let everyone in the hospital know that this is serious business, and it doesn’t get much more serious than a code. (Why do we call them Codes, anyway? Everyone in the hospital over the age of 10 has seen enough TV to know what a Code Blue is, it’s a euphemism).

So, I think we should start pushing our hospitals to join the 21st Century and stop calling codes overhead. I intend to start tomorrow.


  1. I kinda like the overhead system for two reasons. First, it serves as a safe backup guarding against pagers without batteries, pagers misplaced etc. Second, it lets the people in the waiting room know that the reason they aren’t being seen as fast as they want to is because serious stuff is happening. Just my $.02.

  2. Anonymous says:

    As a medical student on an away-elective, I LIVED in a hospital for three months which had overhead pages.

    3AM page: BONGGG, BONGGG…. “Code Blue, 3 South room 52… Code Blue, Three. South. Room. Fifty. Two… Code. Blue. Three. South. Room. Fifty. Two.”
    Me: That’s CCU stepdown. I’m here to study gynecology. And I’m not even on call tonight-though I was last night and got no sleep. And have to do call again tomorrow night. I wonder if the anesthesia resident could give me a pwerful sedative? Shit-he must be at the code.

  3. “Look, if you cannot handle a code in one of those places with the people you’ve got, you need to get out of the hospital business.”

    If we left it up to the operators at my hospital to page the correct people for a code, the chemistry tech away on vacation would get paged, maybe a neurology fellow, and an odd maintenance guy. They never page the right person. Often the only people who answer pages are the medical students, cause they’re so excited that someone actually paged them (incorrectly) Thus the overhead “code blue” is the only thing that works in my hospital.

  4. Besides, when we hear “code blue ICU” overhead, we know that pretty soon we’ll be getting a bed for one of our ICU borders in the ER.

  5. When I was in college, I worked at a major medical center. Yes, I know, that was back in the middle ages, but nevertheless, the overhead page served a purpose. I learned to flatten myself against a wall whenever I heard it, because the “code team” was going to go galloping through whichever corridor I was in when that announcement was made.

    There must have been a lot of them.

    OTOH, I worked IV therapy in a community hospital for a few years. No overhead pages of codes. The code team beepers went off. Reliably. We always had too many people at codes. I even went to a code in the ER once — was told later I wasn’t required to do that, but my nurse manager was glad I’d gone, because I got an IV in a patient nobody else had been able to access. It didn’t matter to the patient one way or the other. He’d been down way too long by then.

  6. A follow up Question:

    Why the hell when I get to the code is there 30 people in the room and not a single person that knows anything important about the patient. When I leave the MI’s and chaos in the ER and make it up to the fifth floor, I want to know the patients diagnosis, recent labs, drips, and a freaking ET tube ready to put down the throat!!!!!!!!!!! Is that too much to ask?

  7. Jerry,
    Though I no longer respond to in-house codes, it used to amaze me when the patients’ nurse, the one who should know the most about the patient, was usually always completely clueless (or panicked, which is worse, IMHO). The big exception was a code in one of the ICUs, when the nurses knew more about the patient than their docs did.

    I don’t miss running then intubating, though it could be an extreme sport.

  8. Amen! In my hospital, they don’t call the codes overhead at night, they call the operator (who happens to be in the ER) who pages the RT stat and tells the ER doc where it is. A quick call to the ICU for a nurse and that’s all they need. Then again, I don’t work in a teaching hospital….

  9. In my hospital, the ER doc doesn’t have a pager and has to respond to codes. Of course, a call to the ER would satisfy.

    I would prefer the hospitalist to respond, but the only hospitalist in our hospital that is comfortable intubating someone is, you got it, I.

    The most unfortunate side-effect of paging overhead is the patient’s family/friends guess what happened and don’t have the opportunity to be told in a sympathetic, supportive environment. All too often, the page includes the room number.

    And if only the ward is called, you have a larger number of people freaking out.

  10. They do that where I work (a code team responds, not the ED), and I’ve been thinking that there must be a better way. Imagine sitting in the cafeteria when you here “code blue B512a”. You know what code blue means: your loved one is dying. It would be better to be not so specific on an overhead page, but it’s not my call.

  11. Recently, in our facility a code blue was called approximately 10 times for the SAME room! Of course, all the patients I had thought we were ignoring the code. How ridiculous! I stopped taking care of my patients to go “make sure” that someone was at the code. Well of course they were! About 20 people had shown up! The problem was that someone was bumping the code button as they were conducting the code and the operator was calling it EVERY time. I called down and asked her why she was repeatedly calling the code and not checking with someone to see why the button was being pulled constantly. She said she didn’t know??? I spent a lot of time reassuring my patients that we had responded appropriately and the patient was okay now.