Penn Med Nudge Unit launches four pilot projects to improve patient service

The Penn Medicine Nudge Unit — a behavioral design team that aims to affect medical decision-making — is launching several new pilot projects to improve patient care delivery in areas including alcohol-use treatment and drug screening.  

The projects will rely on "nudging," a behavioral technique of gently pushing patients to make positive health decisions, according to the Penn Med news release. The four projects — which are part of the Nudge Unit's annual pilot program accelerator — relate to alcohol use disorder, urine drug screening, medications for patients with penicillin allergies, and access to translators at hospitals for non-native English speakers. 

Since its launch in 2016, the Nudge Unit has led more than 100 projects for influencing patients, care teams, and the public as a whole toward beneficial outcomes. 

A few years ago, Penn Med researchers found success in treating opioid use disorder with buprenorphine, a medication that addresses withdrawal symptoms and reduces opioid cravings. Due to this strategy’s success, the Nudge Unit is piloting a similar project to address alcohol use disorder. CAMP founding director and professor of Emergency Medicine Jeanmarie Perrone aims to treat AUD with naltrexone, which has been shown to reduce cravings and heavy drinking days. 

Perrone told Penn Medicine News that she hopes that consistently treating AUD with naltrexone will help lower rates of alcoholic liver disease and alcohol-related accidents. 

“We want to use our nudge to prompt clinicians to consider starting naltrexone with the first prescription happening upon discharge from the emergency department,” Perrone said. 

Elizabeth Kravitz, a resident in obstetrics and gynecology, is leading a second pilot project to reevaluate the urine drug screening process for people who are giving birth. Many medical centers have no protocol for ordering such screenings, according to Kravitz.

“This ends up being a big deal because of the social ramifications, and the data across the country shows that Black families are much more likely to become separated as a result of these screenings,” Kravitz said.

Kravitz and her team aim to incorporate a nudge system into the electronic health record to establish a more thorough protocol for requesting urine drug screenings. The system would have clinicians click through an accountable justification, encouraging them to put more thought into their reason for requesting a screening.

Another team is focusing on increasing the accessibility of translators for people giving birth. The project will nudge clinicians toward using translator services for patients who have a preferred language other than English.  

"Our hope is that, in 10 years, Penn is recognized as a leader in providing language-concordant care and systems are put in place to support patients with low English proficiency in all phases of care, including when calling the offices or receiving patient instructions," resident in family medicine and community health Elizabeth Kane, who is leading the project, told Penn Med News.

The final project, led by infectious diseases specialist Amanda Binkley, aims to improve care delivery for patients with an allergy to penicillin. Her team is developing a nudge system to encourage physicians toward prescribing cefazolin, an antibiotic that could help prevent infection after such patients undergo surgery. 

One of the Nudge Unit's previous projects tracked how wellness programs can best nudge individuals toward physical activity. The study found that personal and psychological characteristics influenced their progress in the program over six months.