PDF(Pubmed)
Abstract：
BACKGROUND: 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. We 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. We 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.
METHODS: We will recruit 800 physicians who work in the emergency departments (EDs) of non-trauma centers in the US and will randomize them to the game (intervention) or to usual education and training (control). We will ask those in the intervention group to play Night Shift for 2 h within 2 weeks of enrollment and again for 20 min at quarterly intervals. Those in the control group will receive only usual education (i.e., nothing supplemental). We will then assess physicians\' triage practices for older, severely injured adults in the 1-year following enrollment, using Medicare claims, and will compare under-triage (primary outcome), 30-day mortality and re-admissions, functional independence, and over-triage between the two groups. We will evaluate contextual factors influencing reach, adoption, implementation, and maintenance with interviews of a subset of trial participants (n = 20) and of other key decision makers (e.g., patients, first responders, administrators [n = 100]).
CONCLUSIONS: The results of the trial will inform future efforts to improve the implementation of clinical practice guidelines in trauma triage and will provide deeper understanding of effective strategies to reduce diagnostic errors during time-sensitive decision making.
BACKGROUND: ClinicalTrials.gov; NCT06063434 . Registered 26 September 2023.
METHODS: We will recruit 800 physicians who work in the emergency departments (EDs) of non-trauma centers in the US and will randomize them to the game (intervention) or to usual education and training (control). We will ask those in the intervention group to play Night Shift for 2 h within 2 weeks of enrollment and again for 20 min at quarterly intervals. Those in the control group will receive only usual education (i.e., nothing supplemental). We will then assess physicians\' triage practices for older, severely injured adults in the 1-year following enrollment, using Medicare claims, and will compare under-triage (primary outcome), 30-day mortality and re-admissions, functional independence, and over-triage between the two groups. We will evaluate contextual factors influencing reach, adoption, implementation, and maintenance with interviews of a subset of trial participants (n = 20) and of other key decision makers (e.g., patients, first responders, administrators [n = 100]).
CONCLUSIONS: The results of the trial will inform future efforts to improve the implementation of clinical practice guidelines in trauma triage and will provide deeper understanding of effective strategies to reduce diagnostic errors during time-sensitive decision making.
BACKGROUND: ClinicalTrials.gov; NCT06063434 . Registered 26 September 2023.
摘要：
背景：将严重受伤的患者转移到创伤中心，直接从现场或在非创伤中心评估后，降低可预防的发病率和死亡率。未能适当转移这些患者(即，分诊)仍然很常见，部分原因是非创伤中心的医生在评估患者损伤的严重程度时犯了诊断错误。我们发展了夜班，一个基于理论的冒险视频游戏，重新校准创伤分诊中的医生启发式（直觉判断），并在实验室中建立其功效。我们计划进行1型混合有效性实施试验，以确定游戏是否会改变现实生活中医生的分诊决策，并假设它将减少患者的比例。
方法：我们将招募800名在美国非创伤中心急诊科（ED）工作的医生，并将他们随机分配到游戏（干预）或常规教育和培训（对照）。我们将要求干预组中的人在入组后的2周内玩夜班2小时，然后每季度一次玩20分钟。对照组中的人将只接受常规教育(即，没有补充)。然后，我们将评估医生对老年人的分诊实践，在入学后的1年内严重受伤的成年人，使用医疗保险索赔，并将比较分类不足（主要结果），30天死亡率和重新入院，功能独立，两组之间的超诊。我们将评估影响范围的环境因素，收养,实施，并维持对一部分试验参与者(n=20)和其他关键决策者的访谈(例如，病人,第一反应者,管理员[n=100])。
结论：试验结果将为今后努力改进创伤分诊临床实践指南的实施提供信息，并将更深入地了解在时间敏感决策过程中减少诊断错误的有效策略。
背景：ClinicalTrials.gov；NCT06063434。2023年9月26日注册。
方法：我们将招募800名在美国非创伤中心急诊科（ED）工作的医生，并将他们随机分配到游戏（干预）或常规教育和培训（对照）。我们将要求干预组中的人在入组后的2周内玩夜班2小时，然后每季度一次玩20分钟。对照组中的人将只接受常规教育(即，没有补充)。然后，我们将评估医生对老年人的分诊实践，在入学后的1年内严重受伤的成年人，使用医疗保险索赔，并将比较分类不足（主要结果），30天死亡率和重新入院，功能独立，两组之间的超诊。我们将评估影响范围的环境因素，收养,实施，并维持对一部分试验参与者(n=20)和其他关键决策者的访谈(例如，病人,第一反应者,管理员[n=100])。
结论：试验结果将为今后努力改进创伤分诊临床实践指南的实施提供信息，并将更深入地了解在时间敏感决策过程中减少诊断错误的有效策略。
背景：ClinicalTrials.gov；NCT06063434。2023年9月26日注册。
