EHR Nudge Intervention Targeting Surgeons Can Reduce Unnecessary Sentinel Lymph Node Biopsy

Jul 26, 2024

A nudge intervention in the electronic health record (EHR) targeting surgeons can reduce sentinel lymph node biopsy (SLNB) among women who meet the Choosing Wisely criteria for SLNB omission, according to a study published online July 17 in JAMA Surgery.

Neil Carleton, Ph.D., from UPMC Hillman Cancer Center in Pittsburgh, and colleagues examined whether an EHR-based nudge intervention targeting surgeons in their first outpatient visit with patients can reduce the rates of SLNB. Data were obtained for female patients meeting the Choosing Wisely criteria for omission of SLNB (aged ≥70 years with cT1 and cT2, cN0, HR+/HER2− breast cancer); a column nudge was embedded into the surgeon’s schedule in the EHR for these patients. The study compared a 12-month preintervention control period with a 12-month intervention period.

The researchers found that unadjusted rates of SLNB decreased by 23.1 percentage points in the intervention period compared with the control period (decrease from 46.9 percent pre-nudge to 23.8 percent after). Following nudge deployment, there was a reduction in the rate of SLNB (adjusted odds ratio, 0.26). The intervention was scored highly by surgeons on acceptability, appropriateness, and feasibility. The intervention helped remind surgeons of potential Choosing Wisely applicability, without the need for additional clicks or actions at the patient visit, which facilitated use.

“Based on these findings, an EHR nudge is an evidence-based solution to deimplement SLNB and may be extended to other practice settings,” the authors write.

One author has a patent for application-specific processing of a disease-specific semantic model instance pending with Caldex.

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