In addition to the success of the nudge project promoting generic prescribing, the Penn Medicine Nudge Unit has implemented numerous successful nudge initiatives targeting both providers and patients. Several examples are captured below with more available at https://nudgeunit.upenn.edu/portfolio.
Opioid Prescribing in Emergency Medicine
In an effort to decrease opioid prescription quantities, the Nudge Unit facilitated an intervention with the emergency medicine team to use a new electronic health record in the emergency department. In the electronic health record, they set a default prescribing option of 10 pills listed first, 20 pills listed second, 28 pills listed third, and then provided an option for manual entry of the pill count. Following implementation, the team observed a 22.8% increase in the proportion of prescriptions written for 10 pills, while seeing a 13.3% decrease in the proportion of prescriptions from 11-19 pills and a 6.7% decrease in the proportion of prescriptions for 20 pills. They did see a 5% decrease in the proportion of prescriptions for less than 10 pills, which indicated to prescribers the default prescription could be set even lower in the electronic health record. The success of this nudge project pilot formed the basis for a much larger intervention that is currently ongoing.8
Unnecessary Imaging in Palliative Radiotherapy
Clinical practice guidelines recommend that patients undergoing curative radiotherapy undergo daily imaging to augment positioning during treatment. However, for those undergoing palliative radiotherapy, daily imaging is considered unnecessary and can increase treatment time and expense for patients. This nudge project implemented a default imaging order in the electronic health record that specified no daily imaging during palliative radiotherapy. Physicians could opt out and select another imaging frequency, but the intention was to reduce unnecessary care for these patients. This project results in a significant reduction in daily imaging (P=.004) and demonstrated that simple nudges have the potential to reduce unnecessary care.9