Testing the Efficacy of Two Behavioral Interventions at Recalibrating Physician Heuristics in Trauma Triage

University of Pittsburgh

Status: Completed

Conditions: Wounds and Injuries

Treatments: Behavioral: Control; Behavioral: Educational program; Behavioral: Graveyard Shift; Behavioral: Night Shift

Study type: Interventional

Funder types: Other

Identifiers

NCT03279575

PRO17090094

Details and patient eligibility

About

The objective of this study is to compare the efficacy of two behavioral interventions at recalibrating physician heuristics.

Full 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 have developed two separate behavioral interventions to recalibrate physician heuristics in trauma triage, and will compare the effect of these interventions, an educational program, and no intervention on physician performance on a virtual simulation.

Enrollment: 320 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• Emergency medicine physicians who work at a non-trauma center.
• Emergency medicine physicians who work at a Level III/IV trauma center.

Exclusion criteria

• Emergency medicine physicians who work only at a Level I/II trauma center.
• Emergency medicine physicians who do not practice in the US.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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320 participants in 4 patient groups, including a placebo group

Night Shift

Experimental group

Description:

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. Players take on the persona of Andy Jordan, a young emergency physician who moves home after the disappearance of his estranged grandfather (Robert Jordan) and takes up a job in the local Emergency Department (ED). In the preamble, players learn they have two explicit objectives. First, they must diagnose and treat patients who present to their ED. Second they must solve the mystery of Robert's disappearance: was he murdered or has he simply chosen to disappear?

Treatment:

Behavioral: Night Shift

Graveyard Shift

Experimental group

Description:

Graveyard Shift is a puzzle video game with the transformational goal of helping physicians derive key triage decision principles for themselves. They complete a three-step game loop to obtain case information, compare cases to determine similarities and differences between cases, and then explicitly state the decision principle that should drive decision making.

Treatment:

Behavioral: Graveyard Shift

Educational program

Active Comparator group

Description:

The educational module consists of two separate apps, both commercially available. myATLS includes a review of each chapter of the Advanced Trauma Life Support (ATLS) textbook, a series of videos demonstrating common trauma procedures, and clinical resources including checklists for use at the bedside. Trauma Life Support MCQ Review includes 550 multiple-choice questions with correct answers and explanations. The investigators will ask physicians to review the myATLS app and then com

Treatment:

Behavioral: Educational program

Control

Placebo Comparator group

Description:

Physicians in this arm will not be asked to complete any intervention.

Treatment:

Behavioral: Control