A young patient died in a small rural hospital in the South West region. The Coroner concluded that treatment had been suboptimal and highlighted the absence of clinical protocols available to staff in the small hospital.
The Health Department responded to the report by inviting a solution that would help smaller hospitals obtain and maintain clinical guidelines and that would ensure that these were readily available, up to date and consistent with those in larger institutions.
As we considered solutions it quickly became evident that this might be an opportunity to address significant issues that bedevilled protocol management in larger hospitals at that time. Back then, different hospital departments independently maintained their own protocols (which were generally paper based, kept somewhere in a ring binder).