Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice

Area of Science:

• Behavioral Economics
• Medical Practice Optimization
• Sedation Management

Background:

• Behavioral economics defines a 'nudge' as a choice architecture modification to influence behavior without restricting options.
• Nudges are increasingly explored for their potential to optimize medical practices.

Purpose of the Study:

• To assess the impact of a 'nudge' strategy on endoscopic sedation.
• The strategy involved prefilling midazolam syringes in either 3mL or 5mL volumes.

Main Methods:

• A consecutive series of patients undergoing endoscopic sedation (EGD or colonoscopy) were enrolled.
• Midazolam was prefilled into either 3mL or 5mL syringes on alternate weeks.
• Endoscopists administered sedation at their discretion, aiming for moderate conscious sedation.

Main Results:

• Patients receiving 5mL prefilled syringes used significantly higher average midazolam doses for both EGD (5.2mg vs. 3.3mg) and colonoscopy (5.1mg vs. 3.3mg).
• No significant difference in meperidine dosage was observed between groups.
• No adverse sedation-related events or need for reversal occurred.

Conclusions:

• 'Nudge' strategies, like prefilled syringe size, can effectively modify endoscopic sedation practices.
• Further research is warranted to explore nudges in other areas of endoscopic procedures.