Beta-lactam Allergies at UChicago Medical Center
Using a human-centered design approach to educate patients about beta-lactam (penicillin) allergies
Healthcare Design
2024
Background
Surgical site infections (SSIs) occur approximately 157,000 times per year in the United States, are associated with excess hospital lengths of stay, and account for $3.2 billion in attributable costs annually in acute care hospitals. The first-choice antibiotics for surgery are drugs in the beta-lactam family. Since its discovery in 1928, penicillin and the 15 related drugs in the beta-lactam family have been among the most important, effective and widely used antibiotics.
10% of the population report having a penicillin allergy; however, when evaluated, more than 95% of patients labeled as allergic can tolerate beta-lactam antibiotics. Because alternative antibiotics are less effective, patients with a reported penicillin allergy are 50% more likely to develop a surgical site infection.
About
This project involved the creation of a new patient education tool to help patients understand the basics of penicillin allergies, the importance of getting the penicillin allergy tag removed from their medical records, and how an allergist/immunologist can test for a penicillin allergy.
This project was part of a larger “beta-lactam allergy history program” proposed at the University of Chicago Medical Center. The program aims to reduce the number of surgical site infections in the hospital, and optimize the prescription of antibiotics prior to surgery. A pharmacist identifies surgical patients with a reported beta-lactam allergy 0-3 months prior to their scheduled procedure. The pharmacist reviews the patient’s medical record, calls the patient to obtain additional history, deletes the allergy label or updates the allergy documentation, makes a referral to Allergy & Immunology (if required), and recommends preoperative antibiotics prior to surgery. The program was implemented by a multidisciplinary team (Pharmacy, Allergy & Immunology, Infectious Diseases, and multiple Surgery Subspecialties) led by Clinical Pharmacy Specialist Cynthia T. Nguyen and Allergy & Immunology professor Dr. Ruchi Singla.
My Role
My role as the human-centered design associate was to work with Dr. Nguyen and Dr. Singla to map out a potential patient journey, identify interactions between the patient and the health system, understand what information a patient might want at each stage of the journey, and design communication tools that would help preemptively answer questions or address concerns.
Through the process, I helped the team think through potential interactions and hurdles, and how we could use different communication tools (flyer, website, MyChart messaging, etc.) to address them. I conducted secondary research to understand how other healthcare organizations were communicating this information, and distilled everything down into a simple, plain-language text that would speak to the intended audience.
The Patient’s Journey
1. A patient is referred to a surgeon, who recommends surgery as part of the treatment plan.
Thinking: "I'm focused on the surgery itself. My allergy from years ago isn't even on my mind."
Needs: Nothing about allergies yet, but this is the first chance to flag that antibiotic history matters before surgery.
2a. During the preoperative assessment, the nurse or medical team reviews the patient's medical history, including checking for any allergies.
Thinking: "I've always said I'm allergic to penicillin. I don't remember why, but it's on my chart."
Needs: A prompt to share details of the original reaction (what happened, when, how old they were), not just a yes or no.
2b. While the medical team has attempted to train nurses to identify allergy tags during preoperative assessments in the past, the system doesn't always capture this critical detail.
Thinking: The patient doesn't know anything has slipped through and assumes the care team has the full picture.
Needs: A way to raise the allergy themselves, such as a MyChart message or flyer that doesn't depend on the right person catching it in the system.
3. When the pharmacy is notified of the upcoming surgery, the pharmacist sees that the patient may have an allergy, which triggers a follow-up call to the patient for more information.
Thinking: "Why is a pharmacist calling me? Is something wrong with my surgery?"
Needs: A clear explanation of who is calling, why, and that the call is routine and meant to make surgery safer.
4. The pharmacist takes time to carefully assess the situation, and asks the patient about any previous reactions to antibiotics. The goal is to determine if there is a true allergy.
Thinking: "I was a kid when it happened. My mom told me I got a rash. I'm not sure I remember the details."
Needs: Reassurance that vague memories are normal and helpful, plus simple questions that jog recall (age, symptoms, timing).
5. The pharmacist works with the patient to assess the situation. The pharmacist ensures that the patient is comfortable and educated about the safety of using different types of antibiotics.
Thinking: "If I was allergic before, isn't it dangerous to take penicillin now?"
Needs: The key fact that most people with a penicillin label aren't actually allergic, and that allergies can fade over time.
6. If the patient's history suggests a higher risk of an allergic reaction, the patient is referred to an allergist/immunologist for further evaluation, including skin testing, or test dosing.
Thinking: "Another appointment? Will this delay my surgery? Will insurance cover it?"
Needs: What the visit involves, how long it takes, how it fits into the surgery timeline, and whom to contact about cost.
7. The penicillin skin test involves pricking the skin with a small amount of penicillin and monitoring the result. If these tests are negative, it's unlikely that the patient is allergic.
Thinking: "Are they going to give me the thing I'm allergic to? What if I react?"
Needs: A plain description of the test (a tiny amount, on the skin surface, closely monitored) and what a negative result means.
8. In some cases, a test dose is given to rule out an immediate allergic reaction. For patients at high risk or with a known severe reaction, the allergist will recommend alternative treatments.
Thinking: "Swallowing a full dose feels much scarier than a skin test."
Needs: Reassurance that it happens under supervision, with staff ready to respond, and that it's the final step to confirming safety.
9. Once the allergy status is confirmed, the pharmacist and surgeon discuss the safest and most effective antibiotics for the surgery.
Thinking: "So am I allergic or not? Does my record say something different now?"
Needs: A clear result, confirmation that their record has been updated, and advice to tell other providers (and pharmacies) about the change.
10. After surgery, the patient is monitored for any signs of an allergic reaction. If there were any concerns about antibiotic use, the healthcare team is prepared to address any issues that may arise.
Thinking: "What should I watch for once I'm home? Whom do I call if something feels off?"
Needs: A short list of reaction signs to watch for and a direct contact number, so they feel supported after they leave the hospital.
Requirements for a new patient educational tool
Versatile
The tool must be adaptable for use in different healthcare settings (e.g., clinics, hospitals, or virtual environments).
Standalone
The tool should be able to function independently, i.e., it can be sent directly to patients without prior interaction with a pharmacist or healthcare provider.
Patient-Friendly Format
The document should be user-friendly, with a clear, legible layout that ensures the message is accessible and easy for patients to read and understand.
Single-Page, Letter-Sized Document
The document must be a one-page, letter-sized document (8.5" x 11") for easy printing.
Inexpensive & Easy to Print
The tool must be designed in black and white to minimize printing costs. It should be easy to print without requiring special equipment or materials (e.g., no cutting, folding, or binding).
Delivery Methods
The tool must be compatible with multiple delivery channels:
Digital version (e.g., a PDF) to be sent via MyChart or other electronic health platforms.
Physical version (printed flyer) for distribution in the clinic.
Patient-Friendly Formatting
Based on prior healthcare design projects at UChicago Medical Center, I followed these steps to ensure the tool would be patient-friendly:
First, the flyer was divided up into sections. The sections were split with the questions on the left, and answers/details on the right. This allows patients to quickly scan the page. It also keeps the line length to 60 characters, making it easier to read.
The text was set in 12-point Gotham, from UChicago Medical Center's brand guidelines, to ensure legibility.
The tool was handed off to the team; implementation outcomes were not available to me.
Citations
Merkow RP, Ju MH, Chung JW, et al. Underlying reasons associated with hospital readmission following surgery in the United States. JAMA 2015; 313:483–495.
Klevens RM, Edwards JR, Richards CL Jr, et al. Estimating healthcare-associated infections and deaths in US hospitals, 2002. Public Health Rep. 2007; 122:160–166.
Zimlichman E, Henderson D, Tamir O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US healthcare system. JAMA Intern Med 2013; 173:2039–2046.
Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370: 1198–1208.
Sacco KA, Bates A, Brigham TJ, Imam JS, Burton MC. Clinical outcomes following inpatient penicillin allergy testing: A systematic review and meta-analysis. Allergy. 2017 Sep;72(9):1288-1296. doi: 10.1111/all.13168. Epub 2017 Apr 26. PMID: 28370003.
Blumenthal KG, Ryan EE, Li Y, et al. The Impact of a Reported Penicillin Allergy on Surgical Site Infection Risk. Clin Infect Dis. 2018 Jan 18; 66(3):329-336.