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includes a discussion of specific form elements, including the grid entry area 42 and the use of 30 typography . Even though this redesign was conducted on a paper-based form, this redesign also drew upon human-computer interaction principles. This was done to take advantage of modern design research, which largely focuses on computer-based systems and the pitfalls of introducing new information systems into the clinical setting. 43 The need to combine clinical content with visual design underscores the need for an interdisciplinary approach to documentation form design. 44 Motivation for this research A prior needs assessment of cardiac arrest documentation conducted at the University of Washington Medical Center revealed that existing code blue documentation was incomplete. Stakeholder feedback revealed that documentation was sometimes written on paper towels or hospital scrubs and only transcribed to the official documentation forms after the event was resolved. During the needs assessment, nurses also complained that existing desktop computer systems were too slow and inaccessible to use for computerized documentation tasks during a code blue emergency. This highlighted the need for a redesigned paper-based form. The decision to redesign the code blue documentation form was driven by concerns at all levels of the hospital organization. This widespread support was critical for convincing care providers and administrators to participate in the design process. Even with the interest and need for an improved code blue documentation form, there is a lack of literature describing the process of creating medical forms. This suggests that medical forms are created by clinicians and administrators based on clinical experience and shared templates. Despite the clinical importance of real-time documentation, the form design process is typically allocated only minimal amounts of time or money. 45 This article is a case study, recounting efforts to redesign the paper-based code blue documentation forms at the University of Washington Medical Center. This article guides the reader through the 31 operational process of taking a redesigned form from concept to deployment. Through explaining process, this article also hopes to highlight the benefits of incorporating informatics and design principles. Design overview The redesign was conducted by generating an initial set of prototypes based on general informatics usability recommendations. These recommendations include usability heuristics and medical content considerations. This includes Nielsen’s design heuristics for user interfaces as applied to a paper-based design, including familiar language, ordering of elements, and clear directions. 46 The initial prototype forms were then presented to end users at a series of five focus group meetings conducted with hospital administrators, risk management, the patient safety office, members of nursing community, and the medical forms committee. Hospital administrators wanted to improve patient outcomes through more effective use of real-time medical information. Administrators also wanted to standardize the forms between two hospitals in the care network to simplify training. Risk management was looking for stronger documentation as a legal record of care. The patient safety office was interested in improving the completion rate of code blue forms for external accreditation and internal quality improvement. The physicians and nurses at the bedside wanted more user-friendly documentation. The hospital wanted to review and update the entire code blue process and wanted to ensure that the form contents were consistent with updated practice guidelines. Last but not least, the hospital forms committee provided a set of design requirements based on how the forms are scanned into the patient record. Participant recommendations were then integrated into the design, and new prototypes were developed for presentation during subsequent focus group meetings. As the content 32 design evolved, it was supplemented by input from a visual design expert to produce a polished documentation form. The content and usability changes were supplemented by visual design expertise from a collaborator in the visual design department. The visual design process included an evaluation of spacing and alignment, as well as selection of appropriate typography. These changes were made to improve overall readability and visual clarity, important given the time constraints during a code blue event and the need for rapid comprehension of the form. Prototypes and focus groups Content design was the primary consideration when redesigning the documentation form. The baseline goal of this redesign effort was to ensure that any redesigned form was at least as functional as the existing cardiac arrest documentation form (Figure 3). The existing documentation form was based on a template form published by the American Heart Association, which is itself based on the Utstein-style template for documenting cardiac arrest. 33 Figure 3: Current code blue documentation form, based on the American Heart Association template. Visually, the existing documentation form contains a checkbox entry area at the top of the first page, where the recording nurse is asked to provide details about the time and place of the 

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