Variable effectiveness of stepwise implementation of nudge-type interventions to improve provider compliance with intraoperative low tidal volume ventilation

O’Reilly-Shah, Vikas N; Easton, George S.; Jabaley, Craig S.; Lynde, Grant C.

doi:10.1136/bmjqs-2017-007684

Cited by 22 publications

(25 citation statements)

References 49 publications

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“…Of the 11 community‐based studies, five (45%) were randomized controlled trials, 38,45‐48 one was cluster‐randomized, 43 one was quasi‐randomized (alternate weeks), 39 and the remaining four (36%) were pre‐post studies40‐42,44: two single‐site and two multi‐site with controls (one with randomized allocation to intervention, the other unclear). Of the 11 hospital‐based studies, seven were single site pre‐post comparisons, 49‐52,54,56,59 one was a two site pre‐post comparison without a control, 53 one was a multi‐site pre‐post with one site non‐randomly allocated to intervention, 57 one was a multi‐site with multiple interventions rolled out at different times (non‐uniformly) across sites, 58 and one was a qualitative study 55 . We summarize the study types in Table 3.…”

Section: Resultsmentioning

confidence: 99%

“…Nudges that sought to utilize predispositions to social norms also reported varied results ranging from no statistically significant differences through to an absolute change of 20%. Two audit and feedback studies 52,58 reported changes ranging from non‐significant through 16%. Two commitment message studies 41,52 were associated with similar changes ranging from not statistically significant through to 20%.…”

Section: Resultsmentioning

confidence: 99%

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Nudging clinicians: A systematic scoping review of the literature

Lamprell

Tran

Arnolda

et al. 2020

Evaluation Clinical Practice

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Background While the quality of medical care delivered by physicians can be very good, it can also be inconsistent and feature behaviours that are entrenched despite updated information and evidence. The “nudge” paradigm for behaviour change is being used to bring clinical practice in line with desired standards. The premise is that behaviour can be voluntarily shifted by making particular choices instinctively appealing. We reviewed studies that are explicit about their use of nudge theory in influencing clinician behaviour. Methods Databases were searched from April 2008 (the publication date of the book that introduced nudge theory to a wider audience) to November 2018, inclusive. The search strategy and narrative review of results addressed the Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews. Results 22 studies were identified. Randomized trials or pre‐post comparisons were generally used in community‐based settings; single‐site pre‐post studies were favoured in hospitals. The studies employed eight intervention types: active choice; patient chart redesign; default and default alerts; partitioning of prescription menus; audit and feedback; commitment messages; peer comparisons; and redirection of workflow. Three core cognitive factors underpinned the eight interventions: bias towards prominent choices (salience); predisposition to social norms; and bias towards time or cost savings. Conclusions Published studies that are explicit about their use of nudge theory are few in number and diverse in their settings, targets, and results. Default and chart re‐design interventions reported the most substantial improvements in adherence to evidence and guideline‐based practice. Studies that are explicit in their use of nudge theory address the widespread failure of clinical practice studies to identify theoretical frameworks for interventions. However, few studies identified in our review engaged in research to understand the contextual and site‐specific barriers to a desired behaviour before designing a nudge intervention.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Nudging clinicians: A systematic scoping review of the literature

Lamprell

Tran

Arnolda

et al. 2020

Evaluation Clinical Practice

View full text Add to dashboard Cite

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“…Much more effective (and likely more sustainable) was changing the default ventilator setting to a lower set volume. 21 When done correctly, PDSA cycles will also give important insights into barriers to implementation and sustainability of the 'active ingredient(s)' mentioned above. One notable example comes from an intervention intended to improve timely delivery of antibiotics to febrile, immunocompromised children in the emergency department.…”

Section: Planning For Sustainment In Practicementioning

confidence: 99%

Sustaining quality improvement efforts: emerging principles and practice

Burke

Mheen

2021

BMJ Qual Saf

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“…All national and international guidelines have reported how adequate LN yield could significantly improve survival in patients with oral cancer, however there is no recommended intervention for clinical practice. Interventions based on the theories of behavior economics are summarized by the acronym NUDGE and has been explored in the healthcare field [ 21 – 23 ]. Penn Medicine, for example, has used this strategy widely.…”

Section: Discussionmentioning

confidence: 99%

Association of a multiple-step action with cervical lymph node yield of oral cancer patients in an Asian country

et al. 2021

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Background High quality lymph node (LN) yield could increase survival, however strategies to improve LN yield have been seldom reported. This study aimed to assess the multiple-step action to promote quality of neck dissection in oral cancer. Methods A total of 400 patients with oral cancer who underwent primary tumor resection and neck dissection, including elective and radical neck dissection, were recruited after propensity score matching by clinical T and N categories between January 2009 and September 2018. Patients were treated by two independent departments in our institute. A multiple-step action was initiated in October 2015 in one department, and another department was as a control group. The impact of multiple-step action on LN yield and regional recurrence were analyzed using multivariate analysis and difference-in-differences (DID) linear regression analysis. Results The mean patient age was 55.2 + 11.1 years, and 92% were male. A total of 180 (45%) patients had T3-4 disease, and 129 (32%) patients had N2-3 disease. The multivariate linear regression and DID analyses revealed that multiple-step action had a positive effect on LN yield. A net improvement of LN yield with a coefficient of 13.78 (p < 0.001) after launching multiple-step action (since October 2015) was observed. A borderline protective effect of multiple-step action for cN0 patients with a reduced regional recurrence rate of 11.6% (p = 0.072) through DID analysis was noted. Conclusions Multiple-step action was associated with increased LN yield and decreased regional recurrence in patients with oral cancer. The observed activity may promote surgeons to improve the quality of neck dissections, is feasible, and could be applied to a widespread patient population.

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Variable effectiveness of stepwise implementation of nudge-type interventions to improve provider compliance with intraoperative low tidal volume ventilation

Abstract: Audit and feedback tools in conjunction with default changes improve provider compliance.

Cited by 22 publications

References 49 publications

Nudging clinicians: A systematic scoping review of the literature

Nudging clinicians: A systematic scoping review of the literature

Sustaining quality improvement efforts: emerging principles and practice

Association of a multiple-step action with cervical lymph node yield of oral cancer patients in an Asian country

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