{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T15:05:51Z","timestamp":1789657551626,"version":"4.0.1"},"reference-count":33,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T00:00:00Z","timestamp":1740960000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T00:00:00Z","timestamp":1740960000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Hypocalcemia following severe injury is common. Current institution\u2010specific guidelines recommend calcium (Ca\n                      <jats:sup>++<\/jats:sup>\n                      ) supplementation during blood product resuscitation. We hypothesize that a nudge intervention would improve clinician adherence to Ca\n                      <jats:sup>++<\/jats:sup>\n                      \u2010specific guidelines.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study at an urban Level I trauma center evaluated compliance with Ca\n                      <jats:sup>++<\/jats:sup>\n                      \u2010specific guidelines during trauma resuscitations. A baseline assessment of guideline awareness preceded four\u2010month pre\u2010intervention and four\u2010month post\u2010intervention periods from July 2021 to February 2022. Nudge signs prompting clinicians to administer Ca\n                      <jats:sup>++<\/jats:sup>\n                      were placed throughout all phases of care. Administration of \u22651 dose of Ca\n                      <jats:sup>++<\/jats:sup>\n                      after four blood products was the primary endpoint. Aggregate ionized calcium (iCa\n                      <jats:sup>++<\/jats:sup>\n                      ) levels and percent time within a normal iCa\n                      <jats:sup>++<\/jats:sup>\n                      range were secondary outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline assessment of\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200941 trauma team members indicated 83% were uncertain or unaware of current Ca\n                      <jats:sup>++<\/jats:sup>\n                      recommendations. Of 86 screened patients, 25 met inclusion criteria. These were median ([IQR] 34 [25\u201343]) years old with an Injury Severity Score of 18 [14\u201026] and 84% penetrating injuries with\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911 pre\u2010intervention and\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914 post\u2010intervention. The absolute difference (95% CI) in Ca\n                      <jats:sup>++<\/jats:sup>\n                      guideline adherence post\u2010intervention compared to pre\u2010intervention was 6.5% (\u221211.9% to 24.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.755). In aggregate, iCa\n                      <jats:sup>++<\/jats:sup>\n                      levels were no different between groups, although the distribution of levels post\u2010intervention trended toward the normal range with less extreme hypocalcemia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Signs prompting clinicians to give Ca\n                      <jats:sup>++<\/jats:sup>\n                      were associated with a modest, non\u2010statistically significant increase in adherence to institution\u2010specific guidelines and a slight shift in the distribution of iCa\n                      <jats:sup>++<\/jats:sup>\n                      values toward normal. Future work to optimize resuscitation should evaluate larger cohorts of acutely injured patients and more potent nudges.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/trf.18180","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T16:54:30Z","timestamp":1741712070000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The simplest solution may be good, but is it good enough? Evaluating the effect of a nudge to administer calcium during blood product resuscitation for traumatic injuries"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6069-9197","authenticated-orcid":false,"given":"Daniela","family":"Schmulevich","sequence":"first","affiliation":[{"name":"Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Cleveland Clinic Lerner College of Medicine  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M.","family":"Joergensen","sequence":"additional","affiliation":[{"name":"Penn Acute Research Collaboration (PARC) University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8198-7905","authenticated-orcid":false,"given":"Alea I.","family":"Zone","sequence":"additional","affiliation":[{"name":"Penn Acute Research Collaboration (PARC) University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen E.","family":"Bishop","sequence":"additional","affiliation":[{"name":"Penn Acute Research Collaboration (PARC) University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea P.","family":"Morlok","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Penn Presbyterian Medical Center University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa A.","family":"Colyar","sequence":"additional","affiliation":[{"name":"Department of Nursing, Penn Presbyterian Medical Center University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyson D.","family":"Hinkle","sequence":"additional","affiliation":[{"name":"Department of Nursing, Penn Presbyterian Medical Center University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6056-6071","authenticated-orcid":false,"given":"Rinad S.","family":"Beidas","sequence":"additional","affiliation":[{"name":"Department of Medical Social Sciences Feinberg School of Medicine, Northwestern University  Chicago Illinois USA"},{"name":"Penn Medicine Nudge Unit University of Pennsylvania Health System  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2248-8401","authenticated-orcid":false,"given":"M. Kit","family":"Delgado","sequence":"additional","affiliation":[{"name":"Penn Medicine Nudge Unit University of Pennsylvania Health System  Philadelphia Pennsylvania USA"},{"name":"Penn Implementation Science Center at the Leonard Davis Institute of Health University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Emergency Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2969-9316","authenticated-orcid":false,"given":"Jeremy W.","family":"Cannon","sequence":"additional","affiliation":[{"name":"Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Penn Acute Research Collaboration (PARC) University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Surgery Uniformed Services University of the Health Sciences  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,3]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002570"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2015-205096"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2015.12.036"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002312"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.16965"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2017-206717"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002614"},{"issue":"6","key":"e_1_2_10_9_1","article-title":"Behavioral nudges are used widely to steer clinicians and patients alike","volume":"4","author":"Volpp K","year":"2023","journal-title":"NEJM Catal Innov Care 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