Dr. David Whitaker – Chair of the EBA Patient Safety & Quality Committee
Outside hospitals in Europe there is a single standard emergency telephone number, 112, that can be dialled free of charge to reach the emergency medical services (EMS).
Inside hospitals in Europe there is no single standard emergency telephone number for “cardiac arrest calls” to summon the resuscitation team to patients. This seems to be an oversight, which if standardised could improve efficiency and patient safety , and be increasingly important as healthcare providers frequently move between hospitals in their own countries and throughout Europe.1
Some European hospitals have a call bell system for cardiac arrests but the majority use a telephone system with over 105 different numbers; some examples are given in Table 1.
Table 1. Some of the wide variety of emergency telephone numbers used in Europe.
A study in Denmark2 showed 74 hospitals using 41 different numbers, and they have since started to standardise the cardiac arrest call number nationally to the single number 2222. The Danish study also reported that 50.5% of healthcare providers did not know the correct number in the hospital where they were working.
Knowledge of the “cardiac arrest call” number should be instinctive for healthcare providers – just like the 112 number is in Europe for the general population. It is common sense that having the same number throughout Europe would reduce the incidence of confusion and delays by staff having to find out the correct number for each hospital when a patient has a cardiac arrest and they try to summon the team. Consideration of human factors tells us that stressful situations like this automatically reduce the human’s ability to accurately and speedily recall information; precious time could be lost and patients’ lives put at risk.
A study of the errors in the management of cardiac arrests showed that miscommunication involving the telephone number occurred in almost 1 in 10 incidents (4/30, 13%).3 The situation is made worse by healthcare staff moving around hospitals in their own country and increasingly throughout the whole of Europe. In Spain in 2007 one in five nurses entering the nursing workforce was foreign-trained or a foreign-national; this reached one in three in Italy in 2008. Thirty-five percent of doctors in the UK and Ireland are foreign-trained, with the UK (42%) and Belgium (25%) experiencing the highest inflows of foreign health professionals.
Against this background, in November 2015 the European Board of Anaesthesiology (EBA) made a recommendation for the establishment of a standard Cardiac Arrest call telephone number in European hospitals4 and recommended the number 2222.
The number 2222 was chosen because it is already the one most commonly used and the standard number in the few European countries that presently have a standard national number, Turkey, Ireland, England, Wales, Scotland, and Denmark; wider success can be built on this. There is also some logic as most hospitals use 4 digit numbers, it is in the middle of the top line of most key pads, could be identified in low lighting, and is memorable. It is unlikely that an alternative number would be any better and debating this would only further delay standardization and the benefits of implementation for patients and staff.
The EBA recommendation is already supported by the European Patient Safety Foundation and representations are being made at National and EU levels to help implementation, but these central processes can take several years.
The wide variety of numbers currently used around Europe suggests that the original choice of the number was probably made in hospitals locally. Therefore, with patient safety in mind, if any of these hospitals wished to act now to standardize their own number to 2222 it should be possible for them to make this new decision locally as well. Any hospital that agrees and wishes to do this may find the action guidance from the National Patient Safety Agency5 and NSS Health Facilities Scotland6 useful. For example, after informing every one of the change they recommend operating the old number and 2222 together for many months until no calls are being made to the old number. Further information and advice can also be obtained by emailing email@example.com
D.K. Whitaker. Establishing a standard “Cardiac Arrest Call” telephone number for all hospitals in Europe—2222. Resuscitation 2016, Published online: May 27 2016 http://www.resuscitationjournal.com/article/S0300-9572(16)30065-X/fulltext [Accessed 3/6/2016].
B. Løfgren et al., Limited knowledge of the crash call number among hospital staff—A call for standardisation Resuscitation 2010;81(2):S28.
S.S. Panesar, A.M. Ignatowicz, L.J. Donaldson. Errors in the management of cardiac arrests: An observational study of patient safety incidents in England. Resuscitation 2014;85(12):1759-1763.
European Board of Anaesthesiology. The European Board of Anaesthesiology recommends a standard Cardiac Arrest call telephone number in European hospitals. 2015. http://www.eba-uems.eu/resources/PDFS/safety-guidelines/EBA-recommendation-on-standardised-cardiac-arrest-call-no-Nov-2015.pdf [Accessed 3/6/2016].
National Patient Safety Agency. Establishing a standard crash call telephone number in hospitals. 2004 http://www.nrls.npsa.nhs.uk/resources/?EntryId45=59789 [Accessed 3/6/2016].
NSS Health Facilities, Scotland. 2007. Safety Action Notice. Establishing extension number 2222 in Scotland as a standard cardiac arrest call in hospitals. http://www.hfs.scot.nhs.uk/publications/PSAN0714.pdf [Accessed 3/6/2016].