Video Game Improves Trauma Triage in EDs
In a secondary analysis of a trial, exposure to an educational video game on trauma triage was associated with a moderate increase in emergency department (ED) physicians' willingness to transfer injured patients to trauma centers and a smaller improvement in their ability to recognize severely injured patients.
METHODOLOGY:
Researchers conducted a process evaluation of a randomized clinical trial that involved 800 physicians (mean age, 43.7 years) responsible for trauma triage at EDs in levels III-V trauma centers and nontrauma centers across the US.
Participants were randomly assigned to receive either usual education (control group) or a customized video game intervention designed to recalibrate trauma triage heuristics. Those in the intervention group played the game for 2 hours, after which all participants completed a 36-case virtual simulation to assess decision-making.
Researchers used the signal detection theory and analyzed: Perceptual sensitivity, defined as the ability to distinguish between patients who meet vs do not meet criteria for transfer; and decisional threshold, defined as tolerance for false-positive or false-negative decisions.
TAKEAWAY:
Exposure to the video game was associated with a significant reduction in undertriage rates (22% vs 38%; P < .001) and a slight increase in overtriage (39% vs 34%; P < .001).
< .001) and a slight increase in overtriage (39% vs 34%; < .001). Video game intervention led to a moderate increase in tolerance for false-positive decisions (intervention standard deviation [SD] units, 0.14; control SD units, 0.53) and a moderate (Cohen d = 0.60) increase in willingness to transfer.
The intervention group was also associated with a higher perceptual sensitivity (1.00 SD units vs 0.87 SD units; P < .001), indicating a small improvement (Cohen d = 0.20) in recognizing severely injured patients.
< .001), indicating a small improvement (Cohen d = 0.20) in recognizing severely injured patients. The intervention's effect was more pronounced among physicians working ≥ 10 shifts per month, who showed a greater reduction in undertriage (40% in the control group vs 22% in the intervention group; P = .05).
IN PRACTICE:
'The results of this secondary analysis of a randomized clinical trial suggest that educational adventure video games have the potential to improve physician performance in time-sensitive conditions and appear to act by increasing physicians' willingness to implement clinical practice guidelines,' the study authors wrote.
SOURCE:
This study was led by Deepika Mohan, MD, MPH, Department of Surgery, University of Pittsburgh School of Medicine in Pittsburgh. It was published online on June 4 in JAMA Network Open .
LIMITATIONS:
The use of simulation for process evaluation may not fully reflect real-world decision-making. Physicians exposed to the intervention may have had an advantage in completing the virtual simulation. Additionally, the differences in response rates between intervention and control groups, potentially due to perceived differences in honoraria value, could have introduced bias.
DISCLOSURES:
This study was supported by grants from the National Institutes of Health. Two authors reported receiving grants from various sources. One author reported receiving $250 to participate in a stakeholder meeting.
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