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iterative participatory design methodology. The redesign also incorporated content and formatting directives from physicians and nurses, obtained during a prior needs assessment. Initial redesign prototypes were generated based on usability principles drawn from the information science and software usability literature, as adapted for use with paper-based forms. Early prototypes were enhanced through the addition of visual design feedback regarding the use of typography and visual arrangement. This included careful consideration of the specific order of data elements, and the addition of structured data entry areas to highlight and streamline the data entry process. These prototype documentation forms were presented for feedback at a series of five focus group meetings with nurses, administrators, and other hospital stakeholders who use the cardiac arrest documentation form. Results: The redesigned cardiac arrest documentation form incorporates content changes, layout changes, and visual design changes. This redesign included the rearrangement of information elements to emphasize different pieces of clinical content. This was based on clinical importance and expectations 28 about the availability of medical information. Practical considerations regarding hospital form policy also affected the design process, resulting in specific design requirements to enable their use in the hospital setting. The redesign activity resulted in 10 prototype forms, which were reviewed iteratively through a series of interdisciplinary design group meetings. Prototypes were presented at five focus group presentations over the course of ten months. The final result of the redesign effort was a redesigned code blue documentation form. Discussion and conclusion: This redesign effort serves as a case study for others who may wish to employ a similar methodology to redesign in-hospital cardiac arrest documentation forms. This methodological framework emphasizes participatory feedback and highlights the importance of using information design to combine clinical content requirements, administrative requirements, and visual design recommendations. The redesign process also highlighted the constraints imposed by the need for rapid data entry, and how those concerns were balanced against a request for more writing space. Background When a patient in the hospital suffers from a cardiac arrest, this triggers a “code blue” response prompting immediate medical attention from a team of physicians, nurses, and other clinical specialists. These in-hospital code blue emergencies affect more than 200,000 patients within U.S. hospitals. 4,5 Because these hospitalized people are in a more sensitive health state, the survival rate is only 17% 25,31 and remains unchanged despite advances in medical care. 7 In an effort to boost survival rates and ensure that the best care is being given, care providers rely on real-time information about a patient’s condition, including the patient’s response to medications and procedures. The documentation forms are used to track this real-time information so that it can be used to guide patient care. Documentation forms also enable the hospital to evaluate patient safety trends, and the forms provide a record of care 29 which can be used by the risk management department in case there is a legal dispute about the standard of care. Early efforts to design code blue documentation forms were based on an informal approach of examining existing cardiac arrest literature and sample code blue forms. 32 In an effort to standardize the collection of data during a cardiac arrest, the Utstein-style template was developed 10 . However, even with clear specifications about what information was important, the documentation forms were often incomplete. Some pieces of information were unavailable or inaccessible, 12 while other pieces of information were overlooked or forgotten. 33 In response, the Utstein-style template was reduced to emphasize a smaller set of “core” elements. 15 Although there has been much attention devoted to the clinical content of code blue documentation forms, little attention has been paid to visual design. 34 This is likely because medical forms are designed by clinicians who do not have design training. Clinicians seldom realize the importance of readability and ease of use. These principles are important because collecting information during a code blue event is extremely difficult to the high-stress nature of code blue emergencies. 35,36 This even affects individuals who have received specialized training to deal with cardiac arrest emergencies. 37 Fortunately, the literature indicates that visual design can improve the amount of information collected on clinical forms. 34 There have been some published efforts to improve the readability and clarity of medical forms. However, these efforts focus on improving the way that information is extracted from completed forms, and not how information is entered onto the forms initially. 38–40 Still, the same lessons on readability and clarity are applicable. While every form is different, there are general principles from the design discipline that serve as the basis for form design. This suggests that the inclusion of a designer can improve the overall effectiveness of a form. 41 The visual design literature 

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