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information about an unstandardized emergency event. 4 Conclusion This research set out to identify a problem, devise and implement a solution, and then evaluate the effectiveness of that solution. The needs assessment highlighted the use of both qualitative and quantitative methods to obtain a complete description of the problem, as well as highlight potential solutions. The redesign portion of the project served as a case study to demonstrate the interdisciplinary nature of design, including feedback from clinical domain experts as well as visual design. Finally, the evaluation study demonstrated how the redesign form could be evaluated to assess both its usability and its effect on the accuracy and completeness of data collection during a real-time emergency. In the end, this research employed a wide variety of research and design techniques, from qualitative data collection and participatory design, to experimental design and quantitative analysis of data. Ultimately, this research showed that a redesigned form can improve the real-time usability of documentation in the clinical setting, but a redesign effort is not a complete solution to the problem of incomplete data. 5 Chapter 2 – Identifying the need for optimizing usability & information capture during code blue events Abstract Background: Documentation of in-hospital “code blue” cardiac arrest emergencies supports real-time care, process improvement, and legal accountability. However, existing code blue documentation forms do not capture critical pieces of information, resulting in incomplete documentation. Methods: This study included a thorough review of the information elements collected on 161 cardiac arrest documentation forms received during the 2008 calendar year. These cardiac arrest events took place at a 450 bed regional teaching hospital in the Pacific Northwest. This was supplemented with qualitative data collected through 22 field observations, 36 surveys, and 3 focus group sessions with nurses and members of the patient safety and risk management staff. Results: Critical data elements, like patient identifiers, were consistently collected on code blue documentation forms. However some pieces of important clinical information, such as the patient’s initial heart rhythm, were provided less consistently (only 75% of the time). Supporting details were reported even less frequently, sometimes as low as 45% of the time. Qualitative data revealed that the mismatch between the documentation and the event flow was a primary obstacle to collecting real-time information. In addition to the assessment of current data collection practices, this needs assessment also collected stakeholder recommendations about potential improvements to the documentation form. Although subjects expressed interest in computerized documentation, this study found that paperbased emergency documentation was considered more accessible, reliable, and faster than existing computer-based documentation systems. 6 Conclusions: Many stakeholders within the hospital organization rely on information collected during inhospital cardiac arrest emergencies. In particular, real-time data collection at the bedside has an important impact on patient care. However, this study confirmed that current cardiac arrest documentation is woefully incomplete. This was partly because of the time pressures and chaotic environment during these stressful code blue events. A better alignment between the documentation form layout and the event flow might improve the real-time data collection process. In addition, a stronger emphasis on providing appropriately structured data elements might ease time pressures and highlight the importance of critical data elements. A paper-based redesign of in-hospital cardiac arrest documentation forms is recommended as a straightforward solution to improve the accuracy and completeness of data during these time-sensitive emergencies. Objectives During an in-hospital cardiac arrest, often referred to as a “code blue” emergency, the documentation record provides a real-time account of the medications and procedures used at the bedside. It also fulfills a patient safety role and supports financial and legal accountability. Consequently, inaccurate or incomplete clinical documentation can hamper patient care, interfere with efforts to improve patient safety, and impact hospital operations financially and legally. 1–3 Therefore, it is essential to assess the quality, accuracy, and completeness of code blue documentation and how it accommodates the information needs of the people who rely on it. This needs assessment hypothesizes that there is an information gap caused by incomplete cardiac arrest documentation. This study further hypothesizes that the primary causes of the information gap can be identified and measured through field observations, a records review, a survey, and focus groups with selected stakeholders. 7 Background Within the United States, more than 200,000 cardiac arrest events occur within the hospital in-patient setting. 4,5 Hospitalized individuals are at increased risk of cardiac arrest because they are often in poor health when admitted or while recovering from a surgical procedure. Therefore, the need to recognize and properly treat cardiac arrest within a hospital setting is a 

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