Dissemination of Information for a New Protocol: Flow Chart vs Text Based Algorithm

Abstract

Background:

Cleveland Clinic is implementing a new protocol as a decision-making algorithm for oxygen management. The goal of the protocol is for respiratory therapists (RTs) to safely and effectively manage oxygen administration for adult patients. Because of the protocol complexity, we are uncertain about the method of training for implementation. The purpose of this study is to compare two forms of disseminating information; a graphical flow chart or a text based algorithm, both representing the same information content. The first hypothesis was either form of the algorithm would improve knowledge acquisition (test scores). The second hypothesis was that both forms of the algorithm would yield the same results.

Methods:

The study population was volunteer RTs from eight hospitals in the US Cleveland Clinic system. The study was implemented as an on-line learning module with pre-test comprised of 10 patient scenarios to determine baseline knowledge before exposure to the protocol. There were two versions of the post-test (same scenarios); one that provided the decision-making algorithm of the oxygen management protocol as a graphical flow chart and the other the text based version of the algorithm. The pre-test and post-test questions were worded differently but tested the same decisions. Participants were randomly assigned to the two versions of the post test. Outcome data were mean differences between the pre-test and post-test scores hypothesis 1) and percent change between pre- and post-tests (hypothesis 2). Data were compared with t-tests and P < .05 indicated significance.

Results:

Fifteen therapists were in each group. Both groups demonstrated significant knowledge acquisition (flow chart: 43% pre, 68% post, P < .001; text based: 45% pre, 83% post, P < .001). But there was no difference in the change in score between groups (flow chart 25%, text based 38%, P = .08). The power of the latter test was only 0.29 due to the low sample size.

Conclusions:

This pilot study suggests that dissemination of complex protocol algorithms may be achieved with either flow charts or text based tools. However, flow charts may be less effective, perhaps due to therapists’ unfamiliarity with reading flow charts. Further study is required to confirm these results and investigate underlying reasons. For now, we intend to include both methods in the protocol.