An Effective Behavioral Nudge in the Operating Room.
An Effective Behavioral Nudge in the Operating Room.
复制标题
手术室中有效的行为推动。
DOI：
10.1097/aln.0000000000003225
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发表时间：
2020
期刊：
影响因子：
8.8
通讯作者：
Sullivan,SeanD
中科院分区：
文献类型：
--
作者：
Khandelwal,Nita;Sullivan,SeanD
电子健康记录中的默认订单条目列表是行为推动的一种形式。选择的框架和顺序通常是有目的的，旨在促使用户做出特定的选择。助推是一个行为经济学概念，定义为选择架构中以可预测的方式影响行为的任何方面，而不限制选择或显着改变经济激励。助推不是命令，而是一种在不强制的情况下影响行为的方式。 1 事实上，宾夕法尼亚大学卫生系统认识到助推对临床医生和患者行为的潜在影响力，设有专门的助推团队（宾夕法尼亚大学医学助推小组），系统地开发和测试助推以改善医疗保健服务。 2在本期《麻醉学》中，Ershoff 等人。利用自然实验来检查氢吗啡酮的默认剂量（一种微推）是否会影响术中施用的氢吗啡酮的量。作者使用间断时间序列分析来评估氢吗啡酮默认剂量从 2mg 更改为 1mg 是否会影响术中给予患者的氢吗啡酮总量。在研究期的前 72 周，研究地点提供 2 毫克小瓶装的氢吗啡酮（n= 10,598，队列 1）；由于药品供应商发生变化，有大约 20 周的时间，氢吗啡酮仅以 1 mg 小瓶形式提供（n = 2,981，队列 2），此后可用单位剂量改回 2 mg（n = 1,431，队列 3）。作者报告说，默认剂量从 2mg 改为 1mg 小瓶（变化点 1）与接受大于 1mg 氢吗啡酮剂量的概率相对下降 49% 相关。重新引入 2mg 小瓶（变化点 2）与服用大于 1mg 剂量的概率相对增加 48% 相关。 3
Default order-entry lists in electronic health records are a form of a behavioral nudge. The framing and order of choices often is purposeful, intended to nudge the user to a specific choice. A nudge is a behavioral economics concept defined as any aspect of the choice architecture that influences behavior in a predictable way, without restricting options or significantly changing economic incentives. Nudges are not mandates, but rather a way to influence behavior without coercion. 1 In fact, recognizing the potential power of nudges to influence clinician and patient behavior, the University of Pennsylvania Health System has a dedicated nudge team (the Penn Medicine Nudge Unit) that systematically develops and tests nudges to improve health care delivery. 2In this issue of ANESTHESIOLOGY, Ershoff et al. take advantage of a natural experiment to examine whether the default dose of hydromorphone (a type of nudge) influences the quantity of hydromorphone administered intraoperatively. The authors used an interrupted time-series analysis to assess whether a change in the default dose of hydromorphone from 2mg to 1mg would influence the total quantity of hydromorphone administered to patients intraoperatively. For the first 72 weeks of the study period, hydromorphone was available in 2mg vials at the study site (n= 10,598, cohort 1); due to a change in pharmaceutical supplier, there was a period of approximately 20 weeks during which hydromorphone was solely available in 1mg vials (n= 2,981, cohort 2), after which the available unit dose was changed back to 2mg (n= 1,431, cohort 3). The authors report the change in default dose from 2mg to 1mg vials (change-point 1) was associated with a 49% relative decrease in the probability of receiving a hydromorphone dose of greater than 1mg. The reintroduction of the 2mg vial (change-point 2) was associated with a 48% relative increase in the probability of administering a dose greater than 1mg. 3