A hierarchical modular design for treatment protocols

We view a treatment protocol as a hierarchical structure of therapeutic modules. The lowest level of this structure consists of individual therapeutic actions. Combinations of individual actions define higher level modules, which we call routines. Routines are designed to manage limited clinical problems, such as the routine for fluid loading to correct hypovolemia. Combinations of routines and additional actions, together with comments, questions, or precautions organized in a branching logic, in turn, to define the treatment protocol for a given disorder. Adoption of this modular approach may facilitate the formulation of treatment protocols, since the physician is not required to prepare complex flow charts. This hierarchical approach also allows protocols to be updated and modified in a flexible manner. By use of such a standard format, individual components may be fitted together to create protocols for multiple disorders. The technique is suited for computer implementation. We believe that this hierarchical approach may facilitate standardization of patient care, as well as aid in clinical teaching. A protocol for acute pancreatitis is used to illustrate this technique.