A joint recommendation to standardise the phone number European hospitals use to alert teams to a cardiac arrest to 2222 is being supported by the European Society of Anaesthesiology, the European Board of Anaesthesiology and the European Resuscitation Council.
“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). Yet inside hospitals in Europe there is no single standard emergency telephone number for ‘cardiac arrest calls’ to summon the resuscitation team to patients,” explains Dr David Whitaker, Member of the ESA Patient Safety and Quality Committee and Chair of the EBA Patient Safety Committee.
“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. Every minute that goes by means that success at resuscitation decreases by 10% and confusion about the cardiac arrest call number can cause delays.”
While some European hospitals have a call bell system for cardiac arrests, the majority use a telephone system with over 105 different numbers. A study in Denmark, the host nation for this year’s Euroanaesthesia, showed 74 hospitals using 41 different numbers, but they have since started to standardise the cardiac arrest call number nationally to the single number 2222. “The Danish study also reported that half of healthcare providers did not know the correct number in the hospital where they were working,” explains Dr Whitaker.
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 inevitably patients’ lives are put at unnecessary 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. Some 35% 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,” says Dr Whitaker. 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 standardisation and the benefits of implementation for patients and staff.
Last year the German Health minister wrote to all German hospitals recommending it and many have started to make the change. In Ireland the Health Service Executive has requested that all public and private hospitals use 2222 by January 2019. Other representations are being made at national and EU levels to help implementation, but these central processes can take several years. Following the promotion of the 2222 number at the Patient Safety Movement Summit in London, other countries around the world are joining the initiative. In Australia where 46 different numbers are used it has gather considerable support and a group has been set up to develop the project. Other countries have expressed interest such as South Africa, Japan and the United Arab Emirates. The UK Department of Health is planning to propose this standardisation to the WHO.
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 standardise 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.
Dr Whitaker outlines how this guidance can help hospitals make the change. He says: “For example, after informing all staff of the change, it is recommended to continue operating the hospital’s own old number and 2222 together for many months until no calls are being made to the old number.”
And he issues this appeal to delegates: “When you go back to your hospital after Euroanaesthesia ask your hospital management if they are aware of this Europe wide patient safety initiative to make the cardiac arrest call number 2222, and see if they will make the change.”
Further information and advice can also be obtained by emailing email@example.com
Dr. David Whitaker – Member of the ESA Patient Safety & Quality Committee and Chair of the EBA Patient Safety Committee. firstname.lastname@example.org
- D.K. Whitaker. Establishing a standard “Cardiac Arrest Call” telephone number for all hospitals in Europe—2222. Resuscitation2016, 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 Resuscitation2010;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. Resuscitation2014;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 3/5/2018].
- 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 3/5/2018].
- D. Whitaker, J. Nolan, M. Castrén, C. Abela, Z. Goldik, Implementing a standard internal telephone number 2222 for cardiac arrest calls in all hospitals in Europe. Resuscitation, June 2017 Volume 115, Pages A14–A15