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

Hdl Handle:
http://hdl.handle.net/10147/207088
Title:
Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.
Authors:
Harewood, G C; Clancy, K; Engela, J; Abdulrahim, M; Lohan, K; O'Reilly, C
Affiliation:
Department of Gastroenterology & Hepatology, Beaumont Hospital Dublin, Dublin,, Ireland. harewood.gavin@gmail.com
Citation:
Aliment Pharmacol Ther. 2011 Jul;34(2):229-34. doi:, 10.1111/j.1365-2036.2011.04703.x. Epub 2011 May 17.
Journal:
Alimentary pharmacology & therapeutics
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207088
DOI:
10.1111/j.1365-2036.2011.04703.x
PubMed ID:
21585410
Abstract:
BACKGROUND: In behavioural economics, a 'nudge' describes configuration of a choice to encourage a certain action without taking away freedom of choice. AIM: To determine the impact of a 'nudge' strategy - prefilling either 3mL or 5mL syringes with midazolam - on endoscopic sedation practice. METHODS: Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3mL or 5mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. RESULTS: Overall, 120 patients received sedation for EGD [59 (5mL), 61 (3mL)] and 86 patients were sedated for colonoscopy [38 (5mL), 48 (3mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2mg) vs. 3-mL group (3.3mg), (P<0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1mg) vs. 3-mL group (3.3mg), (P<0.0001). There was no significant difference in mean meperidine dose (42.1mg vs. 42.8mg, P=0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. CONCLUSIONS: These findings demonstrate that 'nudge' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of 'nudges' in impacting other aspects of endoscopic practice.
Language:
eng
MeSH:
Ambulatory Care; Colonoscopy; Conscious Sedation/*methods; *Endoscopy, Gastrointestinal; Female; Humans; Hypnotics and Sedatives/*administration & dosage; Ireland; Male; Midazolam/*administration & dosage; Middle Aged; Outpatients/psychology; Practice Guidelines as Topic; Treatment Outcome
ISSN:
1365-2036 (Electronic); 0269-2813 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorHarewood, G Cen_GB
dc.contributor.authorClancy, Ken_GB
dc.contributor.authorEngela, Jen_GB
dc.contributor.authorAbdulrahim, Men_GB
dc.contributor.authorLohan, Ken_GB
dc.contributor.authorO'Reilly, Cen_GB
dc.date.accessioned2012-02-01T09:58:55Z-
dc.date.available2012-02-01T09:58:55Z-
dc.date.issued2012-02-01T09:58:55Z-
dc.identifier.citationAliment Pharmacol Ther. 2011 Jul;34(2):229-34. doi:, 10.1111/j.1365-2036.2011.04703.x. Epub 2011 May 17.en_GB
dc.identifier.issn1365-2036 (Electronic)en_GB
dc.identifier.issn0269-2813 (Linking)en_GB
dc.identifier.pmid21585410en_GB
dc.identifier.doi10.1111/j.1365-2036.2011.04703.xen_GB
dc.identifier.urihttp://hdl.handle.net/10147/207088-
dc.description.abstractBACKGROUND: In behavioural economics, a 'nudge' describes configuration of a choice to encourage a certain action without taking away freedom of choice. AIM: To determine the impact of a 'nudge' strategy - prefilling either 3mL or 5mL syringes with midazolam - on endoscopic sedation practice. METHODS: Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3mL or 5mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. RESULTS: Overall, 120 patients received sedation for EGD [59 (5mL), 61 (3mL)] and 86 patients were sedated for colonoscopy [38 (5mL), 48 (3mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2mg) vs. 3-mL group (3.3mg), (P<0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1mg) vs. 3-mL group (3.3mg), (P<0.0001). There was no significant difference in mean meperidine dose (42.1mg vs. 42.8mg, P=0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. CONCLUSIONS: These findings demonstrate that 'nudge' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of 'nudges' in impacting other aspects of endoscopic practice.en_GB
dc.language.isoengen_GB
dc.subject.meshAmbulatory Careen_GB
dc.subject.meshColonoscopyen_GB
dc.subject.meshConscious Sedation/*methodsen_GB
dc.subject.mesh*Endoscopy, Gastrointestinalen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshHypnotics and Sedatives/*administration & dosageen_GB
dc.subject.meshIrelanden_GB
dc.subject.meshMaleen_GB
dc.subject.meshMidazolam/*administration & dosageen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshOutpatients/psychologyen_GB
dc.subject.meshPractice Guidelines as Topicen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.titleRandomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.en_GB
dc.contributor.departmentDepartment of Gastroenterology & Hepatology, Beaumont Hospital Dublin, Dublin,, Ireland. harewood.gavin@gmail.comen_GB
dc.identifier.journalAlimentary pharmacology & therapeuticsen_GB
dc.description.provinceLeinster-

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