quality improvement project / print / educational marketing

calorie count card

While working at UCSF Medical Center, my colleagues and I discovered that we were often encountering a problem that affected our workplace efficiency: we were getting too many requests for inappropriate calorie counts. A calorie count is a 24-hour count of calories and grams of protein a patient eats in the hospital, obtained with the help of diet technicians and nursing staff. The purpose of this is to determine whether a patient would benefit from initiating nutrition support (such as intravenous nutrition or tube feeding formulas) if he or she is not taking in sufficient amounts of nutrition, or alternatively, to determine whether a patient can be weaned off of nutrition support if he or she is eating enough.


The nutrition department was receiving an excessive amount of calorie count requests for patients. Sometimes some of these patients would not even have nutrition support as part of their clinical care plan, whereas other times the timing of the calorie count request would not allow the patient to demonstrate accurate or realistic results due to medical interruptions. Based off of these observations, we wondered — did the medical team know the purpose of calorie counts and when it would be appropriate to order them?



Educate the medical team (doctors, nurse practitioners, residents, interns) on the appropriate use of calorie counts.


Create and distribute a visual that would facilitate the decision-making process for the medical team when deciding to order a calorie count. 


My role in this project was in the marketing aspect. I first researched the different avenues that we could use to spread the word about our project and reach the medical team. We realized that it would be difficult to host a formal educational in-service session due to the sheer number of medical professionals at UCSF. We also realized that utilizing existing promotional avenues such as the medical center newsletter may be too weak to make a large impact. Thus, we decided to make a pocket-sized card with the information; pocket-sized so that the card could be easy to carry and fit nicely into doctor's coats and clipboards. 

We decided that the best way to help guide the medical team on the decision-making process would be a decision-tree. The project leaders created a first draft of the decision tree, which I redesigned as shown below.


Draft of Calorie Count Decision Tree (created by project leaders)

Lack of overall balance with too much text on one side

Flow of decision tree is not intuitive as the symbols sometimes contradict the "yes" and "no" statements. Flow could be simplified.

What do the final "yes" and "no" mean? What is the action item, now that I have reached the end?

Revised Calorie Count Decision Tree (created by myself)

Re-phrased the questions to make all the "yes" statements lead to one overarching decision: Calorie count IS appropriate.

Organized questions and their respective answers in a one-directional pattern to make them flow diagonally and create more balance within the page.


Now that we had the calorie count decision tree ready, we wanted to make the most of having a card to distribute by sharing additional important information about the nutrition department. Our team was a bit too ambitious at first and we wanted to include all of the topics shown in the first draft below. Of note, I utilized UCSF's branding guidelines to create the card.

Card Draft 1: Front

Card Draft 1: Back

I then printed this out in the expected card size of 4.25" x 5.5" and realized that the card looked too crowded. The front side especially appeared text-heavy, which would detract from the main purpose of having the medical team refer to the card when necessary and easily find information. Thus, I revised this draft into my second and final version:

Card Draft 2 (Final): Front

Card Draft 2 (Final): Back



We printed 500 of these cards and distributed them to different medical teams across the UCSF Medical Center. The response was overwhelmingly positive, as many residents thanked us for creating a useful tool for future patient care. I have already started to see the effect of the card, as I have been receiving fewer requests for calorie counts and the requests that I do receive seem more clinically appropriate. It has been rewarding, to say the least, to see doctors and nurse practitioners in the hallways with this card in their coat pockets and whip them out to reference our calorie count decision tree.

 © Sofia Moon 2020 

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