An Experiment on Nudging Clinicians’ Diagnostic Test-Ordering Decision-Making

Unnecessary diagnostic tests (UDTs) place an increasing burden on the healthcare system and may cause harm to patients. Nudge has proved to be effective in many public health interventions to steer people’s decisions towards a desirable direction but rarely adopted to change clinicians’ behavior and reduce UDTs. The study investigated the effectiveness of three nudge-based clinical decision support (CDS) interventions—in-line reminder, default nudge and salience nudge—in assisting emergency department (ED) clinician’s diagnostic test ordering. A field experiment with 129 ED clinicians was conducted to evaluate the effectiveness of the nudge CDS. The study contributes to knowledge by showing that nudge strategy could be a promising theoretical foundation to inform CDS designs and identifying viable nudge techniques to be incorporated into CDS. The contribution to practice is the demonstration of how the nudge CDS design is achieved and could be implemented in an Electronic Medical Record system.