Wounds and Injuries
Conditions
Keywords
decision making, heuristics
Brief summary
The objective of this study is to measure the duration of two different types of interventions to change physician decision making in trauma triage: a video game and an educational program.
Detailed description
Treatment at trauma centers improves outcomes for patients with moderate-to-severe injuries. Accordingly, professional organizations, state authorities, and the federal government have endorsed the systematic triage and transfer of these patients to trauma centers either directly from the field or after evaluation at a non-trauma center. Nonetheless, between 30 to 40% of patients with moderate-to-severe injuries still only receive treatment at non-trauma centers, so-called under-triage. Most of this under-triage occurs because of physician decisions (rather than first-responder decisions). Existing efforts to change physician decision making focus primarily on knowledge of clinical practice guidelines and attitudes towards the guidelines. These strategies ignores the growing consensus that decision making reflects both knowledge as well as intuitive judgments (heuristics). Heuristics, mental short cuts based on pattern recognition, drive the majority of decision making. The investigators developed an adventure video game (Night Shift) to serve as a novel method of recalibrating physician heuristics in trauma triage and compared its efficacy with a standard educational program. This study is designed to measure the degradation of the treatment effect.
Interventions
BEHAVIORALVideo game
Night Shift is an adventure video game with the transformational goal of teaching physicians key characteristics of patients with non-representative severe injuries - injuries classified by the American College of Surgeons as life-threatening or critical but that do not fit the archetype of injuries typically requiring treatment at a trauma center.
BEHAVIORALEducational program
Two commercially available applications designed to teach physicians the trauma triage guidelines disseminated by the American College of Surgeons.
Sponsors
National Institutes of Health (NIH)
University of Pittsburgh
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Group assignment will be masked at the analysis phase.
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Physicians who care for adult patients in the Emergency Department. * Physicians who work at a non-trauma center. * Physicians who work at a Level III/IV trauma center.
Exclusion criteria
* Physicians who work only at a Level I/II trauma center. * Physicians who do not practice in the US.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Undertriage | 6 months after completion of the intervention | Physicians in both arms of the study will be asked to complete an outcome assessment tool - a virtual simulation - six months after completion of their intervention. The virtual simulation replicates the environment of the ED. Physicians have to manage 10 patients that appear concurrently, while also responding to a series of audio-visual distractors. Specifically, they must provide information on whether they will admit, transfer, or discharge the patients home. The investigators will calculate an under-triage rate for each physician (the number of simulated patients with severe injuries not transferred to a trauma center), will summarize the under-triage rate by group (Night Shift v. educational control), and will assess the difference in those rates. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Undertriage for nonrepresentative and representative injuries | 6 months after completion of the intervention | We will categorize severely injured patients on the virtual simulation (the outcome assessment tool) as having representative or non-representative injuries. We will summarize the undertriage rate of representative/non-representative injuries by intervention, and will compare the difference in those rates between groups. |
| Degradation in treatment effect | 6 months after completion of the intervention. | We will compare the undertriage rate of physicians the first and second time they complete the virtual simulation (time zero = initial enrollment; time one = six months post intervention). We will compare the difference in the undertriage rates by intervention. |
Countries
United States
Outcome results
None listed