Physician's Role, Trauma Injury
Conditions
Keywords
Heuristics, Serious game, Guidelines
Brief summary
The goal of this clinical trial is to test the effect of a video game on the implementation of clinical practice guidelines in trauma triage. The main question it attempts to answer is whether exposure to the game improves compliance with guidelines by emergency medicine physicians working at non-trauma centers in the US. Participants randomized to the intervention condition will be asked to play a customized, theory-based video game for 2 hours immediately after enrollment, and then return to the game for 20 minutes every three months for the next 9 months. Participants in the control condition will receive usual care.
Detailed description
Transfer of severely injured patients to trauma centers, either directly from the field or after evaluation at non-trauma centers, reduces preventable morbidity and mortality. Failure to transfer these patients appropriately (i.e., under-triage) remains common, and occurs in part because physicians at non-trauma centers make diagnostic errors when evaluating the severity of patients' injuries. The study team developed Night Shift, a theory-based adventure video game, to recalibrate physician heuristics (intuitive judgments) in trauma triage and established its efficacy in the laboratory. The investigators plan a Type 1 hybrid effectiveness-implementation trial to determine whether the game changes physician triage decisions in real-life, and hypothesize that it will reduce the proportion of patients under-triaged.
Interventions
BEHAVIORALNight Shift
The player must not only manage the patients who present to the emergency department of the hospital, gaining experience with the consequences of trauma triage, but also solve the mystery of the grandfather, gaining an emotional connection with the character and making the feedback that "Andy" receives more relevant. Embedded within Night Shift 2024 is a mini-game (Graveyard Shift) that contains a series of puzzles that reinforce the lessons of the overarching game: transfer severely injured patients expeditiously.
BEHAVIORALUsual education
Standard continuing medical education, including Advanced Trauma Life Support, and the American Board of Emergency Medicine educational modules (e.g., trauma resuscitation).
Sponsors
University of Pittsburgh
National Institute on Aging (NIA)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Masking description
Participant assignment will be masked within the data with unblinding occurring only after data cleaning has completed.
Intervention model description
Physicians will be randomized in a 1:1 fashion to the intervention condition or to the control condition.
Eligibility
Sex/Gender
ALL
Age
25 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
\- Board certified physicians who work exclusively in the emergency departments (EDs) of non-trauma centers in the US AND triage adult trauma patients
Exclusion criteria
* non-physician healthcare professionals who work in EDs * physicians who work at trauma and non-trauma centers * physicians who work outside the continental US
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Under-triage | 1 year | Number of severely injured patients, treated by trial participants, who are admitted or discharged (i.e., not transferred) after initial evaluation at a non-trauma center as recommended by clinical practice guidelines. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mortality and Hospital Readmission | 1 year | Number of severely injured patients, treated by trial participants, who die or are readmitted to any hospital within 30 days of their initial evaluation at a non-trauma center |
| Functional Dependence | 1 year | Proportion of severely injured patients, treated by trial participants, with 90-day preadmission location at home with discharge to a skilled nursing or rehabilitation facility after initial treatment at a non-trauma center. |
| Over-triage | 1 year | Number of injured patients, treated by trial participants, transferred to a higher level of care after initial evaluation at a non-trauma center with minimal injuries. The Overall Number of Participants Analyzed reflects the number of enrolled physicians. The values in the data table report transferred patients treated by physicians enrolled in the trial. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORDeepika Mohan, MD
University of Pittsburgh
Participant flow
Recruitment details
We recruited a national sample of physicians who managed injured patients in the Emergency Departments (EDs) of non-trauma centers by distributing information about the trial through social media, word-of-mouth, a healthcare analytics company, and the organizational e-mail distribution lists of several national physician staffing groups. We enrolled participants between November 27, 2023 - February 7, 2024.
Pre-assignment details
Interested individuals reviewed the trial details. Those who provided consent completed a biographical survey so that we could evaluate eligibility and could characterize the population. Once we determined eligibility, we contacted participants with their assignment and details on how to complete trial tasks.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 42 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 16 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 360 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 45 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 3 Participants |
| Race (NIH/OMB) Asian | 62 Participants |
| Race (NIH/OMB) Black or African American | 29 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 64 Participants |
| Race (NIH/OMB) White | 300 Participants |
| Region of Enrollment United States | 400 Participants |
| Sex: Female, Male Female | 116 Participants |
| Sex: Female, Male Male | 281 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 399 | 0 / 398 |
| serious Total, serious adverse events | 0 / 399 | 0 / 398 |
Outcome results
None listed