Summary of "Reducing the time to activation of the emergency call system in operating theatres: effect of installing vertical red line indicators"

Summary published June 27, 2024

Summary by Aalok V. Agarwala, MD, MBA

British Journal of Anaesthesia | May 2024

Marshall SD, Rush C, Elliott L, Wadman H, Dang J, St John A, Kelly FE. Reducing the time to activation of the emergency call system in operating theatres: effect of installing vertical red line indicators. Br J Anaesth. 2024 Jul;133(1):118-124. doi: 10.1016/j.bja.2024.03.030. Epub 2024 May 9. PMID: 38724325.

doi: https://doi.org/10.1016/j.bja.2024.03.030

  • This article describes the results of a quality improvement initiative to increase the visibility and reduce time to activation of an operating room-based emergency call system
  • As background, following recommendations from the 7th National Audit Project of the Royal College of Anaesthetists, many hospitals have had purpose-built emergency call systems within perioperative areas for several years.
  • In attempt to reduce the effort and time required to activate the emergency call system during times of intense cognitive stress, as would be true during an operating room crisis, the authors performed a pre/post study examining the impact of painting a vertical red stripe on the wall from the emergency call activation button to the ceiling.
  • After installation of the red lines, the proportion of activations taking more than 10 seconds decreased from 32% to 14%. The longest time to activation before installation of the red lines was 120 seconds and was 35 seconds after installation of the lines.
  • In the discussion, the authors suggest that once the decision has been made that help is needed in a situation that may be rapidly evolving, it should be available as quickly as possible. This simple, human factors-informed intervention successfully reduced time to activation of the emergency response system, a key component of getting timely help into the OR.
  • In an accompanying editorial, Webster comments that cooperating room layout is usually only thought of at the time of initial design, and are typically focused on surgical lighting, infection control, and ventilation. He notes that the simple intervention of painting a red stripe that rises above equipment that may otherwise obscure placement of emergency call buttons is a simple, yet effective intervention that ought to be considered at the design phase of operating rooms.
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