ADMINISTRATION & OPERATIONS
Retiring the Memo: A Process Improvement Approach to Real-Time Clinical Guidance SAEM PULSE | SEPTEMBER-OCTOBER 2025
By Nicholas Stark, MD, MBA; Samir Alkhouri; Noe Villavicencio; William Klotzbier; Waseem Musleh; Isaac Kim; Shaista Afzal; Flavio De La Torre; Christopher Peabody, MD, MPH; Karan Bains, MD, MBA; and Terrance Lee, MD, MPH, on behalf of the SAEM Innovation Interest Group
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The Memo Problem in Emergency Medicine
In 2023, our emergency department (ED) leadership worked with a multidisciplinary team to develop a buprenorphine quick-start process. We were proud of what we created, but over time, we realized few clinicians were using it. When we investigated, we found that clinicians had trouble remembering where to access the workflow: Was it in their email? A group chat? A printed page on the wall?
That’s when we realized our process for sharing and updating workflows needed to keep pace with modern medicine. The provoking question — Where does our sitespecific workflow live? — captures a daily challenge in frontline care. Traditional memoranda were designed for nonurgent communication, not high-stakes, time-critical decisions. In the ED, they are slow to create, inconvenient to update, and difficult to locate during the chaos of acute care. Lengthy approval chains can turn a simple algorithm revision into a weeks-long
project, forcing clinicians to rely on outdated guidance instead of the latest evidence-based practices.
Building a Lightweight Digital Solution
In response to this gap, E*Drive emerged at Mercy Medical Center Merced (MMCM). Modeled after work pioneered at the University of California, San Francisco (UCSF), the process is intentionally simple: 1. A uthors draft a single-page flowchart in Google Slides. 2. C olleagues are invited to comment asynchronously.