With mounting pressure in emergency rooms, doctors need to be able to make a quick, accurate triage of patients’ needs. But that doesn’t always happen. In non-acute trauma centers, 30 percent of severely injured patients are not transferred as recommended by clinical practice guidelines.
A new video game aims to tackle this problem by helping emergency room doctors figure out the level of care needed for different patients.
Doctors who played the video game were less likely to under-triage patients than their peers who were given traditional didactic educational tools, according to a new trial led by the University of Pittsburgh School of Medicine. The study, published in the British Medical Journal, found that doctors who played the video game under-triaged 53 percent of the time, compared to didactically trained physicians who under-triaged 64 percent of the time.
"Physicians must make decisions quickly and with incomplete information. Each year, 30,000 preventable deaths occur after injury, in part because patients with severe injuries who initially present to non-trauma centers are not promptly transferred to a hospital that can provide appropriate care,” Dr. Deepika Mohan, assistant professor in Pitt's departments of Critical Care Medicine and Surgery and lead author of the study, said in a statement. "An hour of playing the video game recalibrated physicians' brains to such a degree that, six months later, they were still out-performing their peers in recognizing severe trauma."
The study included 368 emergency medical doctors working primarily in non-trauma centers or level lll/lV centers. Researchers instructed half of the participants to use app-based traditional, didactic education, while the other half to played an adventure video game called Night Shift.
The game allows participants to take on the persona of a young emergency room doctor who moves home and takes a job at the local ED after his grandfather mysteriously disappeared. Players are presented with traumatic and non-traumatic complaints from patients. Players also see the consequences of their decisions and have to break the bad news to family members of the patients. In addition to the medical component of the game, players also have a secondary objective of solving the case of the missing grandfather.
After completing their intervention participants were then given 10 virtual simulation cases to triage, four of which included patients with severe injuries. Participants completed the simulations within four weeks of their intervention. Researchers studied the participants’ decisions to admit, discharge or transfer a patient. The proportion of patients under-triaged was calculated, according to the study.
The results from the study appear to be somewhat long lasting. Six months after the initial test researchers asked a randomized sample of 100 participants to retake the simulations. Again, doctors who initially played the video game outperformed the doctors who completed the traditional intervention.
"There are many reasons beyond the doctor's heuristics as to why a severe trauma patient wouldn't be transferred to a trauma center, ranging from not having an ambulance available to a lack of proper diagnostic tools,” Mohan said. "So, it is important to emphasize that recalibrating heuristics won't completely solve the under-triage problem and that the problem isn't entirely due to physicians' diagnostic skills. But it's heartening to know we're on track to develop a game that shows promise at improving on current educational training."