Choice architecture in the hospital

For those who weren’t reading the New York Times last May.

Medical researchers know that people on ventilators should have the heads elevated because it keeps bacteria from traveling up from the stomach to the breathing tube and into the lungs. But “when you have to rely on someone to do it, it’s not going to happen every time,” Dr. Michael Gropper, of UCSF Medical Center, told the paper.

So Dr. Gropper made a new rule. Unless there was a written order from a doctor saying that a patient should be lying down, every patient on a ventilator had to be sitting up.

The rule was one small part of a common-sense campaign to reduce infections in the intensive care unit over the last two years. None of it was cutting-edge science, but it has made a big difference: the incidence of ventilator-associated pneumonia has fallen more than 40 percent since 2005.


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