Implementation of medical research findings through insulin protocols: Initial findings from an ongoing study of document design and visual display

Medical personnel in hospital intensive care units routinely rely on protocols to deliver some types of patient care. These protocol documents are developed by hospital physicians and staff to ensure that standards of care are followed. Thus, the protocol document becomes a de facto standing order, standing in for the physician's judgment in routine situations. This article reports findings from Phase I of an ongoing study exploring how insulin protocols are designed and used in intensive care units to transfer medical research findings into patient care "best practices." We developed a taxonomy of document design elements and analyzed 29 insulin protocols to determine their use of these elements. We found that 93% of the protocols used tables to communicate procedures for measuring glucose levels and administering insulin. We further found that the protocols did not adhere well to principles for designing instructions and hypothesized that this finding reflected different purposes for instructions (training) and protocols (standardizing practice).