256 Improving Access to Clinical Guidelines: Focus on the End User

Abstract

Clinical guidelines are frequently used in the emergency department (ED) to standardize patient care, support clinical decision-making, and ensure quality and safety. While the clinical content of such guidelines is developed and maintained by expert clinicians in collaboration with departments across the health system, key principles of effective graphic design and presentation are not uniformly applied. In our ED, these siloed approaches to guideline design have led to a wide range of formats, from text-based to visual flow charts, that are accessed less than 10 times a month. In interviews with ED clinicians at our institution, we discovered clinical guideline presentation and readability were directly related to ease and rate of use. Therefore, we aimed to create and implement standardized best practices, developed with the end user in mind, to increase the usage of clinical guidelines for patient care in our ED. We assembled a team of designers, frontline clinicians, and leadership to iteratively develop a standardized process for converting ED clinical guidelines to a new, end user-centered format. In this process, we focused on key principles of design including spatial positioning, color, and flow. We developed two templates: a multi- step protocol template with branch points, and a single-step protocol template. Several key qualities arose during our design process: 1) Visualizing information on a single page; 2) Eliminating and condensing text where possible; 3) Utilizing left to right horizontal flow; 4) Standardizing use of color to indicate acuity and urgency of each step. Templates were developed in Google Slides for ease of adaptation, and a rigorous change-control process was formalized to ensure that redesigned guidelines retained clinical integrity. The guidelines were organized into categories: Medical, Trauma, Pediatrics, Geriatrics and Logistics and then uploaded to an open access, mobile-friendly platform, E*Drive (https://edrive.ucsf.edu). Since the launch of E*Drive, we have redesigned over 50 clinical guidelines. User data indicates that standardized guidelines are increasingly accessed compared to prior unstandardized versions, which were accessed a total of 25 times from June 2020 to September 2020. Our redesigned digital platform, which houses the clinical guidelines along with other clinical resources, now averages 343 unique users per month. Usage has grown by 375% since E*Drive site launch in October 2020 (Figure 1). The templated format and clearly-defined best practices have enabled our team to have a <24-hour turnaround time for the creation of new clinical guidelines, which is particularly important for rapidly changing COVID-19 pandemic-related information, including real-time census sharing guidelines. Creating usable clinical guidelines in the ED is particularly challenging given collaboration with siloed departments with varying guideline structure and design. A formal design and change-control process for standardizing clinical guidelines has increased clinicians access to guidelines while retaining clinical integrity of guidelines in our ED.