Color-coding and color differentiation have been used in healthcare to facilitate the identification of healthcare personnel1–3 and support patient safety.4–7 Color-coding assigns a specific meaning to a given color,8,9 such as using red to signal “stop” or assigning scrub colors to specific staff roles. In contrast, color differentiation uses color to signal differences between items or bring attention to something without assigning a fixed meaning,10 for example, using a colored sticker to bring attention to a warning label.

Although color-coding and color differentiation can support rapid recognition, these strategies have limitations from a human factors perspective.11–13 Color can be a useful cue; however, relying on color alone is insufficient and can introduce confusion, particularly in environments where lighting, stress, visual overload, or individual differences in color perception affect how colors are interpreted.12 Because color cues require individuals to notice, process, and correctly interpret each color, they are considered a low-leverage risk mitigation strategy and vulnerable to human error.13 These vulnerabilities become evident when color cues fail to support accurate role identification in fast-paced environments, especially when cues must be remembered or transferred across contexts.11

A recent review of events submitted to the Pennsylvania Patient Safety Reporting System (PA-PSRS) included an event report that described a scenario that highlights how different groups of healthcare professionals wearing the same scrub colors can cause confusion and possibly compromise patient safety in an emergent situation. In this example, a group of clinical students were in a patient’s room when the patient deteriorated and a code was called. These students’ scrubs were the same color that was designated for a specific group of licensed healthcare professionals in this facility. The color overlap made it difficult to determine who had responded to the code and who still needed to be present to attempt resuscitation, creating conditions that could have affected patient safety.

This example illustrates that reliance on scrub color alone to identify key staff during a code or other type of emergency may not be sufficient and can lead to delays in care or treatment. Students can be instructed to wear a unique scrub color1,2,4,14,15 or be given a list of colors to avoid; however, facilities can implement other strategies that may have a stronger impact on patient safety. These strategies include:

  • Designing staff badges to clearly display the individual’s role16 (e.g., RN, MD, RT) in a large, standard, easy-to-read format, and requiring badges be worn and legible at all times

  • Establishing and assigning predefined roles17,18 to staff for codes, traumas, etc.

  • Assigning a designated team leader18–20 to verbally assign roles, check in personnel, and manage team structure

  • Using callouts and check-backs to strengthen communication21–23 and ensure all roles are present

These approaches highlight that effective role identification in emergent situations requires more than color cues; it demands layered, reliable systems that support clear communication and situational awareness. By implementing multiple, complementary strategies, organizations can reduce confusion, enhance teamwork, and promote patient safety.

Notes

Artificial intelligence (Copilot Chat) was used only to improve sentence clarity. No AI was used for generation of original content. The author takes full responsibility for the accuracy and integrity of the newsletter.

Disclosure

The author declares that they have no relevant or material financial interests.

About the Author

Christine E. Sanchez (chrsanchez@pa.gov) is a research scientist on the Data Science & Research team at the Patient Safety Authority. She is responsible for utilizing patient safety data, combined with relevant literature, to develop strategies aimed at improving patient safety in Pennsylvania.