Although some aspects of life may look more like they did before the pandemic, the life of a healthcare worker remains decidedly transformed today, nearly three years after COVID-19 arrived in the United States. United.
After working long hours and seeing so many sick people, the risk of burnout is exceptionally high for clinicians across the United States, said Mr. Kit Delgado, MD, assistant professor of emergency medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania.
Related to burnout-related complications, Delgado highlighted a new study conducted in JAMA open This shows that the rate of patients leaving U.S. emergency departments without being seen has doubled. In the busiest hospitals, 10 out of 100 patients who go to the emergency room can’t get out of the waiting room because the hospital is saturated beyond capacity, the study says.
“This is emblematic of a national problem in which the current demand for acute care far exceeds the capacity of our country’s current health care system and its ability to take preventative public health measures,” Delgado said .
These are some of the challenges Delgado is particularly aware of as he settles into the world. first months of management The famous Penn Medicine Movement unit.
Founded by Mitesh Patel, MD, The Nudge Unit – which focuses on designing gentle nudges that help people make better, healthier, or simply more optimal decisions – has often gained attention for its work in increasing exerciseimproving prescribing practicesAnd improve health screening rates. In the wake of COVID, Delgado hopes to push the Nudge Unit firmly into territory aimed at making life easier for healthcare workers. One of the main goals is to reduce the load they carry.
“There needs to be a focus on interventions that make it easier for clinicians to help patients access the preventative care they need and safely manage their acute care needs outside of the hospital,” Delgado said . “Solutions in these areas will make a difference. »
In the past, the Nudge Unit has implemented measures to reduce clinician workload, which almost always improves patient outcomes. For example, an intervention released earlier this year doubled hepatitis C screenings among eligible patients. Nudges like this provide insight into how Delgado and her team might continue their efforts to make life easier for doctors, nurses and other staff.
Pilot projects: helping hands to facilitate clinicians’ decisions, improve diagnosis and much more
In some of the new pilot projects already announced As part of a tender launched earlier this year, this focus on making clinicians’ work easier can be identified among the clear benefits they are expected to bring to patients.
For example, two projects co-led by Marty Peifer, MD, associate medical director of the Clinical Informatics Primary Care Service Line, and members of her team seek to automate flares to screen for sneaky but treatable conditions that lead to significant health problems such as primary aldosteronism (a cause common cause of uncontrolled high blood pressure) and primary hyperparathyroidism (a common cause of osteoporosis and kidney stones). The plan is to achieve this by using algorithms with data extracted from electronic health records.
A different project led by Alex Fanaroff, MD, assistant professor of cardiology, and Mili Mehta, MD, a cardiovascular disease researcher, seeks to make it easier to increase adherence to statin medications by setting a default prescription amount to cover 90 days (instead of 30 days) in some clinics. The Nudge unit has deployed similar default approaches to succeed in increasing generic prescription rates.
Another project led by Rebecca Hamm, MD, an assistant professor of obstetrics and gynecology, will implement a push to encourage the use of an “evidence-based calculator” that could provide decision support to clinicians. For patients at the lower end of the risk spectrum, use of this calculator may enable the patient and her clinicians to achieve vaginal deliveries and avoid unnecessary cesarean sections. At the higher end of the risk spectrum, the calculator could enable a quicker decision to proceed with a C-section and prevent complications.
Focus on implementation science
Projects like Hamm’s benefit from the work of Delgado’s direct predecessor, Rinad Beidas, Ph.D., the second director of the Nudge Unit, who was also the director of Penn Implementation Science Center at the Leonard Davis Institute for Health Economics. Implementation science is the practice of rapidly implementing and monitoring evidence-based practices to achieve positive change.
“Rinad brought a immense expertise in implementation science, which is very complementary to the basic idea of nudge,” Delgado said. “Early in the Nudge design process, we can leverage implementation science to ensure our interventions scale. And when a nudge is successful, strategies from implementation science can help us promote adoption by clinicians and patients to maximize impact and ensure sustainability. »
Focus on equity
Another goal Delgado hopes to “guide” is achieving equity in the outcomes of the unit’s interventions.
“This will involve prioritizing projects where significant equity gaps exist, designing interventions capable of closing these gaps, and designing evaluation protocols to assess the performance of interventions overall and by demographic group,” a Delgado said.
A project selected for launch in 2023 (led by Sara Ginzberg, MD, a surgical resident, Christine Edmonds, MD, assistant professor of radiology, and Lola Fayanju, MD, associate professor of surgery and chief of breast surgery) that falls into the equity priority category is one that seeks to make ordering a biopsy the default option in the electronic health record when High-risk abnormalities are detected by breast imaging. In addition to reducing the time doctors have to spend in the medical file and improving the time needed for diagnosis, the project seeks to solve the following problems: national racial gaps in the diagnosis of breast cancer and its subsequent outcomes.
Delgado doesn’t let himself be fooled into thinking that things in health care will soon, if ever, reach their pre-pandemic state.
But he believes the Nudge unit is in a unique position to improve the current situation. He has already made progress in areas made worse by COVID-19, such as physician workload, and Delgado. personally work on several projects involving opioids, the epidemic that preceded the pandemic and on which he plans to continue working.
“My mission is to design choice systems or environments that make the best choice the easiest choice,” Delgado said. “I believe the Nudge Unit’s combination of talent and relationships within the health system and university makes it perfectly situated to make a positive impact.”
