Post by Rick Dasilva
A patient is being discharged, where the patient does not need antibiotics. A family member who is bedside tells you “well why does my family member not need antibiotics they haven’t been feeling well”. This would be an example of a source of nudge. Nudge theory is the influence to decisions for a desired outcome without prohibiting the person from making the alternate decision. The goal of a Nudge is to make doing the right thing as simple as possible. These decisions being made are not always ones with the right intentions. In this episode we have all of our hosts of Em Over Easy with Tanner, Andy, Drew and John to discuss nudge theory.
What is nudge theory or a nudge unit?
- In essence, it’s using behavioral science to experiment and see if we can help people make a certain choice decisions. (Note: not always a good choice)
- The goal of a Nudge is to make doing the right thing as simple as possible.
- The fastest way to explain Nudge Theory is by citing an example like this: Putting healthy food at eye level is a Nudge, banning junk food is not. Another example would be instead of having to opt in to something (like retirement), make it an opt out process. For emergency medicine, it would be what is the default dose of a medication in your EMR? How often do you use that dose? Do you know if it’s even correct?
- In 2010 – british prime minister Cameron created a group called the Nudge Unit. It was designed to use behavioral science and actual data from small experiments to help create opportunity for people to make better choices.
Nudging in Emergency Medicine
- Parking the ultrasound machine next to trauma/resuscitation room
- More likely to use it for US guided procedures or Fasts
- Placement of hand sanitizer outside of the patient rooms
- PPE gear outside of a central area of patient rooms
- Healthcare workers will more likely use the PPE gear with the easier access
- Looking up imaging through shortcuts while charting
- Dosing of medications in the EMR charting system
- How often you’re using specific dosing
- Is the dosing even correct
Nudge theory in Daily Lives
- Helps in making better eating choices and habits
- Healthier foods at stores being at eye level
- John’s example of placing out your workout clothes for the week
- Improving the environment in which people make decisions (Choice Architecture)
- Nudge Theory is designed to use behavioral science to help people make better decisions.
- Healthcare is FULL of opportunity for this. From EMR settings to opt ins vs opt outs, significant impacts are likely ready to be made if we start looking for them.
- Nudge can even assist us in our daily lives like making healthier decisions and better choices.
Listen to the Episode
- The Rise of the Nudge Units https://medium.com/goods-services/the-rise-of-the-nudge-unit-6e40d4a7181#:~:text=A%20Nudge%20Unit%20within%20governments,deep%20breath%20to%20examine%20reality.
- Science Mag – Nudge, not Sludge https://science.sciencemag.org/content/361/6401/431
- Patel MS, Volpp KG, Asch DA. Nudge Units to Improve the Delivery of Health Care. N Engl J Med. 2018;378(3):214-216. doi:10.1056/NEJMp1712984
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