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lack of familiarity with portable computing options. This indicates that existing computer-based systems are not well suited for real-time emergency documentation tasks. 24 For short-term storage of information, pen and paper was preferred for a number of reasons. For example, paper is “always on” and grants the note-taker essentially unlimited space. In addition, subjects complained that carrying a dedicated electronic device was burdensome, and that the ubiquity of paper made it more convenient to locate spontaneously when a note was needed. While electronic documentation can assist with retrieving information later, the literature supports the notion that pen and paper is timely and convenient. 30 However, computing technology continues to improve, and computer-based systems may eventually be able to overcome these shortcomings. Conclusion The overall needs assessment process highlighted difficulties with collecting data in the emergency setting, which may indicate why there is relatively little existing literature that examines cardiac arrest documentation. Therefore, this needs assessment was conducted to identify major considerations that affect the documentation of in-hospital cardiac arrest. The needs assessment described the information needs and motivations for several key stakeholders within the hospital organization. These stakeholders included care providers at the bedside, patient safety staff who use the documentation forms to assess hospital-wide care practices, and risk managers seeking to minimize medical liability. Through a combination of multiple methods, the major themes identified include a workflow match between cardiac arrest care and the form used to document it, as well as an assessment of potential ways to improve the documentation form. Because this research was conducted at a single institution, the feedback was focused on a particular set of work practices and expectations. This included institutional policies to determine the assignment of recording duties, which limited the potential for a training-based program to improve documentation usage. However, similarities among emergency documentation forms at multiple hospitals suggest that 25 the methods and findings from this research may be generalizable to other institutions, particularly concerning suggested changes to the documentation form. The other major limitation of this research was access to care providers, both during and after emergency events. The clinical care setting is not ideal for observation research. While individuals expressed interest in research and refinement of work practices, survey and focus group response was limited to a small fraction of the potential pool of participants. As a result, only a portion of the potential event recorder population participated in this research. This is somewhat offset by recruiting highexperience users who interact with emergency documentation more frequently than the average care provider, but a larger number of responses would have helped to confirm the trends identified through this work. Despite an interest in computer-based documentation, the results from this needs assessment show that paper is an acceptable technology for emergency documentation. Based on comments and ratings from participants, mobile computers were well-received and are becoming more ubiquitous within hospital settings. However, such systems would have to demonstrate portability, accessibility, and reliability. These issues were cited as the main problems with existing computer-based systems in the crowded emergency setting. Automated capture of patient telemetry also offers the potential for reducing the documentation burden placed on the recording nurse. Some hospitals are also experimenting with barcode systems for tracking medications. However, for the moment, there are still many types of data that are best collected manually by a live recorder, and paper-based documentation remains an inexpensive and convenient option for collecting real-time data about code blue events. 26 This research lays the foundations for a redesign of emergency documentation forms. By identifying key issues with the existing forms, changes can be made that reflect the concerns about the contents and layout, particularly as they affect the workflow of individuals tasked with recording information in the emergency setting. The investigation of potential technologies also suggests that paper-based documentation is still viable. These findings form the basis for a redesign of the cardiac arrest documentation forms. 27 Chapter 3 – Redesign of an in-hospital cardiac arrest documentation form Abstract Background: The design of in-hospital cardiac arrest “code blue” documentation forms affects the ability of recorders to collect real-time clinical information. The design of medical documentation forms has traditionally focused on managing the clinical information content of the form, with little emphasis on visual design. This redesign project focuses on both clinical content and visual design, because the timesensitive nature of emergency events emphasizes the importance of rapid data entry. In addition, the redesign must balance the need for data flexibility with the benefits of structured data entry. Methods: This redesign effort uses an 

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