Scrub Colors and Safety: Rethinking Role Identification in Critical Events
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 fastpaced 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.
UPCOMING EVENTS
I AM Patient Safety 2026
Executive Director's Choice Award Winner
Mollie Herlehy, UPMC North Central PA Williamsport
A young trauma patient diagnosed with rib fractures, brachial injury, and C-spine fracture was experiencing cognitive deficits, which providers initially believed were related to a concussion. Speech pathologist Mollie Herlehy completed a comprehensive cognitive exam and advocated strongly for additional imaging. Once this was conducted, the team noted the patient had had several embolic strokes and a carotid dissection, requiring emergent transfer to a higher level of care. They acted quickly to provide appropriate treatment.
Published in Patient Safety
A Homegrown Digital Solution for Ebola Healthcare Worker Monitoring: Development and Drill Implementation in an NYC Health System
As global Ebola virus disease (EVD) outbreaks continue to emerge, protecting healthcare workers (HCWs) remains a cornerstone of health security. Lessons from the 2014–2016 West Africa epidemic, during which two U.S. nurses were infected and 10 patients were repatriated to the United States for care, highlighted gaps in post-exposure monitoring. More recently, the 2024 case of travel-associated Lassa fever in Iowa reaffirmed the occupational risks faced by frontline clinicians: Among 180 disease contacts, 172 (96%) were healthcare-associated, and risk classification correlated with personal protective equipment lapses. These events underscore a practical reality in healthcare operations: Even a single uncertainty about an exposure can generate days to weeks of follow-up work across occupational health, infection prevention, and supervisory teams.
To strengthen preparedness, NYC Health + Hospitals developed a homegrown digital solution to monitor HCWs exposed to suspected or confirmed Ebola and other viral hemorrhagic fevers. Built in 2022, the solution automates twice-daily symptom reporting, alerting, and escalation workflows for occupational health services (OHS). A 33-day systemwide drill in 2023 evaluated usability, timeliness, and coordination. The solution achieved >95% compliance, transmitted alerts within one minute, and enabled OHS follow-up within 15 minutes. Users rated the interface intuitive and efficient. In drill use, the system also captured operationally important near miss moments, such as a missed check-in during routine monitoring, that are easy to overlook in manual tracking but often consume disproportionate staff time when discovered late.
The NYC Health + Hospitals Ebola HCW monitoring solution proved operationally feasible, user-friendly, and adaptable, demonstrating a scalable, sustainable approach to biopreparedness for health systems worldwide.
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Insights and Safety Strategies From Pennsylvania Patient Safety Data
In this recent webinar, Myungsun (Sunny) Ro, PharmD; Christine Sanchez, MPH; and Matthew Taylor, PhD, research scientists from PSA's Data Science & Research Team, delve into recent patient safety studies and demonstrate how data-driven insights can support safer care and improve outcomes across healthcare settings.
Data from the Pennsylvania Patient Safety Reporting System (PA-PSRS) offer an unmatched view into patient safety events occurring across the commonwealth. PSA research scientists use this data to develop evidence-based analyses that can help healthcare facilities raise awareness, strengthen safety practices, and implement meaningful improvements. This session highlights key findings from recent research and translates them into actionable strategies for healthcare teams.
Topics covered include:
- Wrong drug events
- Insulin syringe errors
- Hospital falls surrounding discharge
- Language barriers
- Radiation therapy
- Wrong-site surgery
After viewing this webinar, you will be able to:
- Recognize how published data analyses can highlight emerging and ongoing patient safety concerns
- Describe safety strategies identified through PSA research and PAPSRS event report analysis
- Identify where to access Patient Safety journal articles and additional resources
Lessons From Event Reports
Improving MRI Safety
Due to the extreme risks of using high-powered magnets during magnetic resonance imaging (MRI), best practices recommend establishing four safety zones around the MRI scanner, with increasing levels of restriction for personnel and screening for metal objects that could cause harm to patients or staff should they enter a strong magnetic field. Over 18 months at one facility, 37 MRI safety events were reported, 59% of which occurred in Zone IV (the highest level, indicating the room where the magnet is located)—and one of which caused harm to a patient.
In response to this troubling trend, the facility conducted an event review and implemented numerous process changes, including color-coded pocketless scrubs to prevent staff from inadvertently carrying equipment such as phones or scissors into Zone III (the control room) and Zone IV; use of three types of metal detectors; and enhanced multiple screenings
and two time-outs with the entire team for metal screenings. Anyone entering Zone III is screened and Zone III undergoes a daily risk evaluation to search for any metal objects. The culture of the MRI department has also shifted to empower staff to manage all aspects of safety in their locations. All these collaborative efforts by Quality and Safety, the MRI Safety committee, MRI staff, and leadership has improved safety for staff, patients, and their families.
