Hospital emergency codes are critical in enabling hospital staff to ensure the safety and well-being of patients, visitors and other staff. Recently, the Ontario Hospital Association (OHA) added Code Silver to its standardized list of emergency codes, which is an emergency response specific to a violent situation involving a weapon.

Code Silver is distinct from other emergency codes, as it immediately involves the police, something that doesn’t happen with other hospital codes until a later stage of severity. Simon Bridgland, an Emergency Management Specialist at Trillium Health Partners (THP), explains that automatic police involvement is a good thing. “While the police focus on the tactical portion of the incident, our management team can focus on the safety of the hospital, the patients, families, staff, physicians, learners and volunteers. We are also able to coordinate our command centre and improve our communication with internal and external parties.”

While Code Silver is different in many ways, it does have similarities to Code White, an emergency response specific to a violent situation, however Bridgland explains that the staff have to act quickly to make the distinction and ultimately the decision of which code to call. “It’s a quick question you have to answer in your own head – what’s the intent when it comes down to it? Is there intent to cause harm or is this person just someone who’s lost touch with reality and really needs to be handled as a Code White?”

The implementation of Code Silver was important for THP to continue and strengthen its high level of commitment to the safety of patients, visitors and staff. In April 2016, THP became an early adopter and launched Code Silver across the organization. John P. Angkaw, the Director of Enterprise Risk at THP, explains that the need for Code Silver was identified last year as there was a rare gap within the emergency response codes specific to these types of violent incidents. The potential involvement of a weapon is significantly different than other incidents and THP saw the need to equip themselves with different safety techniques, should the situation arise.  As part of the development process, an external review of the adoption of Code Silver in other hospitals across North America was conducted, as well as a comprehensive internal engagement plan targeting front line staff and leadership.

The launch of Code Silver was supported by a hospital-wide communication and education plan, which included outlining policies and procedures at each of THP’s three hospital sites, unit huddles and initiatives to raise awareness on the roles of individuals during a Code Silver, which included a mock exercise with THP’s senior leadership team. Similar exercises targeted at front line staff are also being developed with the assistance of other regional partners, such as Peel Regional Police.