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December 20, 2012

Sometimes a picture is worth a thousand words. I first got inspired to take a different turn in the design of our cognitive aids on a long flight from San Francisco to Paris this May on Swiss Airlines. The flight was long. I had already read through the bilingual inflight SWISS Magazine, and perused their duty-free catalog. Buried somewhere in a stack of reading material was an airline safety card. I have fond memories of reading them since my childhood summer vacations when my mom would take my brothers and I on long flights to visit our relatives in Hong Kong. It was one of the welcome rituals of flying.

Epiphany!

As in our medical cognition work, airline safety cards are also designed to be used during a critical event. And these were done in such a visual manner that very little text was needed to clearly convey complex evacuation and safety procedures. Once land-bound, I would happen upon a blog post where New York Times graphic designer Rami Moghadam describes his passion for collecting airline safety cards. He describes Swiss Airlines’ version as a great example of “International Typographic Style, a graphic design style formed in 1950s Switzerland that promoted simplicity, organization and legibility.” He believes the simple layout and clean illustration style allows people to quickly absorb the information.

En Charrette

I returned to Stanford infused with the idea of bringing a new pictographic approach to medical checklist design. I began the design process by imagining how we might describe the complex tasks associated with critical events in medicine from the mind’s eye. Working with my close collaborator, Dr. Kyle Harrison, we began the process by creating a visual vocabulary (both literal and metaphorical) to explain medical terms and actions. An example of a “literal” visual would be showing the correct depth of chest compression during CPR. An example of a “metaphorical” visual is an empty gas tank indicator to represent the physiologic state of hypovolemia.

We then organized these into logical nodes focused on diagnostic and procedural actions. Finally, we used our medical knowledge and referenced the literature on cardiac resuscitation to produce a visual roadmap to Advance Cardiac Life Support. Taken together as a whole, our intent is to explain advanced cardiac life support in a visually engaging and informative way that empowers the entire medical team to work together following best practices during a critical event in medicine.

Pre-flight Safety Check

On behalf of the Cognitive Aids in Medicine group, Dr. Kyle Harrison and myself are proud to offer these aids to the public under a creative commons license (to share and distribute, but not sell or modify). We look forward to comments from the public about how we can improve them. You can print a copy for your own use without charge. We also plan to offer high quality commercially-printed paper-based aids for sale to the public. An iOS app and Kindle book are forthcoming.

Finally, we invite you to join the CogAIDS community newsletter to stay informed of our progress as we continue to develop more medical cognitive aids. We look forward to the day when awareness of the use of cognitive aids in medicine will be as commonplace as the airline safety card.

Larry Chu, MD, MS
Associate Professor of Anesthesia
Director, Stanford Anesthesia Informatics and Media Lab
Stanford, California, USA

Kyle Harrison, MD
Clinical Assistant Professor of Anesthesia
Core Faculty, Stanford Anesthesia Informatics and Media Lab
Palo Alto Veterans Affairs Hospital, Palo Alto, California, USA

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*By downloading the ACLS Emergency Aids, you agree to comply with the terms of our Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

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