Related Experiment Video
Updated: May 31, 2026
06:28
E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Nudging Emergency Department Clinicians to Reduce Unnecessary Diagnostic Test Ordering: A Multi-Arm Vignette-Based
Lu Bai1, Shijia Gao1, Frada Burstein1
1Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, Victoria, Australia.
Emergency Medicine Australasia : EMA
|December 9, 2025
Summary
Clinical decision support nudges did not reduce overall emergency department test orders. However, interventions limiting test choices and providing advice reduced non-routine tests, particularly for less experienced clinicians.
Area of Science:
- Emergency Medicine
- Health Informatics
- Clinical Decision Support
Background:
- Diagnostic test overuse is prevalent in emergency departments.
- Clinical decision support (CDS) systems may mitigate unnecessary test ordering.
- This study investigates the impact of nudge-based CDS interventions on clinician test ordering behaviors.
Purpose of the Study:
- To evaluate the effectiveness of different nudge-based CDS interventions in reducing diagnostic test orders among emergency department clinicians.
- To assess the impact of decision structure manipulation and decision assistance on test ordering patterns.
Main Methods:
- A triple-blind, four-arm randomized controlled trial involving 243 clinicians across eight emergency departments.
- Clinicians were presented with a standardized case vignette and randomized to receive different CDS nudges (varying test selection options and advice) or a control.
- Primary outcome: difference in total tests ordered; Secondary outcomes: tests excluding common blood work (full blood examination and urea/electrolytes), stratified by clinical experience.
Main Results:
- No significant difference in total test orders was observed between any nudge intervention and the control group.
- When common blood tests were excluded, Nudge #2 (inline advice) and Nudge #3 (limited test range) significantly reduced test orders compared to control (p<0.01).
- The observed reduction in test ordering was primarily driven by clinicians with less than 10 years of experience.
Conclusions:
- Nudge-based CDS interventions that alter decision structure and provide assistance show potential for reducing specific diagnostic tests (excluding routine blood work) in emergency departments.
- These interventions appear most effective among less experienced clinicians.
- Further research is needed to optimize CDS strategies for broader test reduction and impact across all experience levels.
Keywords:
behavioural economicsdecision support techniquesdecision theoryemergency medicinehealth serviceslow value careMore Related Videos
Related Concept Videos
01:23Methods of Documentation V: CBE
Charting by Exception, or CBE, is a method of documentation used in healthcare, particularly in nursing, that focuses on documenting only significant or abnormal findings rather than recording every detail. This approach aims to streamline the documentation process, improve efficiency, and ensure that healthcare providers can quickly identify deviations from normalcy in patient assessments.
In CBE, healthcare professionals establish predefined standards of practice that define what constitutes...
In CBE, healthcare professionals establish predefined standards of practice that define what constitutes...
01:28Dosage Regimens: Designs and Approaches
Designing a dosage regimen, which refers to the manner of drug administration, is a complex process involving the selection of drug dose, route, and frequency. This process is underpinned by pharmacokinetic parameters derived from tests and population averages. These parameters are then tailored to patient-specific variables such as diagnosis, demographics, and allergy status. Once therapy commences, therapeutic response monitoring is critical and achieved through clinical and physical...