Table 1

Characteristics of the articles included in the review

ReferenceNudging objective and targetImplementation detailsFindings
Bourdeaux et al18Increase prescription of a mouthwash and reduce the prescription of an intravenous fluid among ICU HCPs.Chlorhexidine mouthwash was added as a default prescription to the prescribing template and hydroxyethyl starch was removed from the prescribing template.Patients prescribed chlorhexidine increased while patients prescribed hydroxyethyl starch decreased.
Bourdeaux et al19Increase compliance from ICU HCPs with TVe ventilation.Default ventilator settings were adjusted to comply with low TVe targets and a large dashboard was deployed displaying TVe with alerts when TVe was excessive.In the dashboard intervention, TVe fell more quickly and by a greater amount.
O’Reilly-Shah et al20Improve compliance from hospital HCPs with LPV strategies.Dashboard with compliance metrics were emailed to providers. Additionally, default setting on anaesthesia machines for TVe was decreased.Dashboards and modification of default ventilator settings improved provider compliance with LPV strategies.
Anderson et al21To promote sedation minimisation and ventilator liberation among ICU HCPs.A web-based dashboard with real-time data and text-message alerts once patients met criteria for a spontaneous breathing trial and spontaneous awakening trial.Patients were more likely to be extubated and more likely to be discharged from the ICU at any point.
Caris et al22Increase the use of alcohol-based hand rub among ICU physicians and nurses.Hand hygiene posters were displayed to assess their effect on the use of alcohol-based hand rub, measured with electronic dispensers.Posters displayed next to dispensers increased use of hand rub.
King et al23Influence HHC among ICU HCPsA clean, citrus smell was released in the air and pictures of male or female eyes were placed above a hand gel dispenser to introduce a perception of being watched.HHC was improved with the clean, citrus smell and also when a picture of ‘male eyes’ was placed over the hand gel dispenser.
Kwok et al24Improve HHC among hospital ward HCPs.Nurse unit managers were provided with HHC rates via email and shared them with staff at morning handover meetings. In a second phase teams were asked to set HHC goals and colleagues were encouraged to prompt each other.HHC was improved among those who described themselves as a socially cohesive team.
Birnbach et al25Improve HHC among medical students and graduates.Trainees were randomly assigned so that some encountered a fresh-smelling environment and others a standard setting.The fresh scent group had a higher rate of HHC.
Iversen et al 26Improve HHC among surgical HCPs.An automated monitoring system measured HHC and alcohol-based hand rubbing events. Sensors on dispensers and data-driven performance feedback highlighted HHC of HCPs individually and compared with colleagues.Doctors and nurses increased HHC. Nurses who also received feedback increased HHC even more.
Kim et al27Improve patient influenza vaccination rates.Active choice was implemented in the EHR prompting medical assistants to ask patients about vaccination during check-in and template orders for clinicians to review.Vaccination rates increased compared with pre-intervention period.
Patel et al28Improve patient influenza vaccination rates.EHR confirmed patient eligibility during clinic visit and prompted the physician and medical assistant to actively choose to ‘accept’ or ‘cancel’ a vaccination order.Vaccination rates increased compared with the pre-intervention period.
Lehmann et al29Improve HCP influenza vaccination rates.HCPs were randomly assigned to either an opt-out condition to a pre-scheduled appointment for vaccination (could be changed or cancelled) or an opt-in condition where they had to schedule an appointment if they wanted to get vaccinated. Only opt-out participants were sent a reminder.HCPs in the opt-out condition were more likely to have an appointment for influenza vaccination, which in turn increased the probability of getting vaccinated.
Schmidtke et al30Improve HCP influenza vaccination rates.HCPs received one of four reminder letters: a standard letter encouraging the staff to take up the vaccination, a second letter using peer comparisons, a third letter with an appeal to authority, a fourth letter included a combination.Vaccination coverage in all groups was the same. No evidence was found that the uptake of the seasonal influenza vaccination was affected by reminders using social norms to motivate uptake.
Lorini et al31Increase staff vaccination at nursing homes.A personal letter, signed by a high-profile person, was sent to raise awareness on the professional responsibility of vaccination together with a delivering form, a questionnaire on vaccination intent and an information leaflet.Both vaccination uptake and vaccination intent increased.
Changolkar et al32Improve HCP influenza vaccination rates.The EHR assessed patient eligibility for vaccination and prompted medical assistants to accept or cancel an order for the vaccine. If accepted, the order was templated for the HCP to review and sign during patient visit.Influenza vaccination rates increased.
Meeker et al33Encourage HCP to judicious use of antibiotics for ARIs.Commitment letters with HCP photographs and signatures were displayed in examination rooms stating their commitment to avoid inappropriate antibiotic prescribing.Commitment letter resulted in a reduction in inappropriate antibiotic prescribing.
Meeker et al34Reduce HCP inappropriate antibiotic prescribing.3 interventions implemented alone or in combination: (1) the EHR suggesting non-antibiotic treatments; (2) HCPs needed to justify prescribing antibiotics; (3) emails comparing HCPs antibiotic prescribing rates with ‘top performers’.Mean antibiotic prescribing rates decreased for all interventions.
Yadav et al35Reduce HCP inappropriate antibiotic prescribing.Comparing adapted intervention with provider and patient education, a champion, and departmental feedback to an enhanced intervention with peer comparison feedback and commitment to judicious antibiotic prescribing.Antibiotic prescribing visits dropped. More intensive nudging methods were not more effective in high-performance settings.
Tannenbaum et al36Improve HCP guideline concordance for ARIs.HCPs randomly assigned to simulated EHR displays listing antibiotics individually or grouping them together.A reduction in choosing aggressive treatment options when aggressive options were grouped compared with when listed individually.
Dos Santos et al37Improve HCP dosing for antimicrobials.A window was inserted in the EHR with measurements of patient’s renal function instead of demanding actively clicking.The approach increased appropriateness of dosing.
  • ARI, acute respiratory infection; EHR, electronic health record; HCPs, healthcare professionals; HHC, hand hygiene compliance; ICU, intensive care unit; LPV, lung-protective ventilation; TVe, tidal volume.