‘Serious’ Video Games May Improve Physician Decision Making in Trauma Triage Situations

An emergency medicine physician working in the field or at a non-trauma center often has minutes to assess a patient’s injuries and decide whether they are severe enough to warrant transfer to a Level I or II trauma center. Under these circumstances—and often with only incomplete or suboptimal information available—emergency physicians rely heavily on their judgment of how closely a patient’s injuries mirror or represent the typical case that would require transfer to a trauma center. Yet, despite continued efforts to improve medical training and systems, 55%-80% of severely injured patients who are initially assessed at a non-trauma center (and who warrant transfer) are not transferred to higher-level center. This fateful  decision is one which could contribute to avoidable disability, pain, workforce dropout, and an estimated 30,000 preventable deaths each year.

In order to help improve this type of physician decision making, known as heuristics, Dartmouth Institute Professor Amber Barnato, MD, the Susan J. and Richard M. Levy 1960 Distinguished Professor in Health Care Delivery, recently worked with researchers from the University of Pittsburgh and Carnegie Mellon University to develop and test two “serious” video game training interventions designed to improve judgment.

Led by Deepika Mohan, MD, associate professor of critical care medicine and surgery at the University of Pittsburgh School of Medicine, the research team recruited a sample of 320 emergency physicians working at non-trauma centers throughout the United States. Study participants were divided into four groups:  One group was asked to play an adventure video game, which required narrative engagement; the second group was asked to play a puzzle-based game emphasizing analogical reasoning. The third group was given a text-based exercise modeled on traditional continuing medical education in trauma; while the fourth group did not engage in any intervention. Study participants were then asked to perform a virtual simulation in which they were presented with case descriptions and asked to triage them. The cases included a mix of representative and non-representative severely injured cases, as well as non-trauma but critically ill cases, and minimally injured cases.

In an article recently published in PNAS, the research team reported that both video games reduced incidence of under-triage (when a patient is not appropriately transferred to a Level I or II trauma center) as compared to the group who didn’t engage in any intervention; whereas the text-based exercise did not. The narrative game had greater improvement with the non-representative cases than with the representative ones. The puzzle game was equally effective with both, and the text-based intervention was equally ineffective.

By complementing physicians’ natural ways of thinking, the researchers say that “serious” video games may help to reduce incidence of under-triage, thereby reducing its cost to patients and society. They also say that the use of “serious” video games could potentially benefit people in other fields who work in high-pressure situations.

 “I am incredibly proud of Dr. Mohan’s innovative work. She is pushing new boundaries in applied behavioral science to improve physician decision making, and it has been a privilege to mentor her,” Barnato said.

POSTED 8/28/2018 AT 12:51 PM IN #news #research #home