Testing the Efficacy of Two Behavioral Interventions at Recalibrating Physician Heuristics in Trauma Triage
8 janvier 2018 mis à jour par: Deepika Mohan, University of Pittsburgh
Testing the Efficacy of Two Behavioral Interventions at Recalibrating Physician Heuristics in Trauma Triage: a Randomized Clinical Trial
The objective of this study is to compare the efficacy of two behavioral interventions at recalibrating physician heuristics.
Aperçu de l'étude
Statut
Complété
Les conditions
Intervention / Traitement
Description détaillée
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.
Type d'étude
Interventionnel
Inscription (Réel)
320
Phase
- N'est pas applicable
Contacts et emplacements
Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.
Lieux d'étude
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Pennsylvania
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Pittsburgh, Pennsylvania, États-Unis, 15213
- University of Pittsburgh
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Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
- Enfant
- Adulte
- Adulte plus âgé
Accepte les volontaires sains
Non
Sexes éligibles pour l'étude
Tout
La description
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.
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Seul
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
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Expérimental: Night Shift
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?
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Physicians in this arm of the trial will be asked to play Night Shift, an adventure video game, for two hours.
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Expérimental: Graveyard Shift
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.
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Physicians in this arm of the trial will be asked to play Graveyard Shift, a puzzle video game, for two hours.
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Comparateur actif: Educational program
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
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Physicians in this arm of the trial will be asked to use myATLS, an app designed by the American College of Surgeons to serve as an adjunct to the ATLS course, and Trauma Life Support MCQ Review, an app designed to help students prepare for the ATLS exam.
They will be asked to spend at least two hours on the combined tasks.
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Comparateur placebo: Control
Physicians in this arm will not be asked to complete any intervention.
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Physicians in this arm will serve as a no-contact control group.
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Incidence rate of successful triage
Délai: One month after completion of the intervention
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Physicians in all arms of the study will be asked to complete a virtual simulation, upon completion of the intervention, ideally within one month of enrollment. The virtual simulation replicates the environment of the ED. Physicians have to manage 10 patients that appear concurrently, while also responding to a series of audio-visual distractors. Specifically, they must provide information on whether they will admit, transfer, or discharge the patients home. The investigators will categorize severely injured patients as successfully transferred (transferred to a trauma center or died in the ED) or not (admitted). We will use a Poisson regression to estimate the association between successful transfer and exposure to the different interventions (Night Shift v. Graveyard Shift v. educational program v. control). |
One month after completion of the intervention
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Collaborateurs et enquêteurs
C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.
Parrainer
Publications et liens utiles
La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.
Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude (Réel)
29 octobre 2017
Achèvement primaire (Réel)
11 décembre 2017
Achèvement de l'étude (Réel)
11 décembre 2017
Dates d'inscription aux études
Première soumission
7 septembre 2017
Première soumission répondant aux critères de contrôle qualité
11 septembre 2017
Première publication (Réel)
12 septembre 2017
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
9 janvier 2018
Dernière mise à jour soumise répondant aux critères de contrôle qualité
8 janvier 2018
Dernière vérification
1 janvier 2018
Plus d'information
Termes liés à cette étude
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- PRO17090094
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
OUI
Description du régime IPD
De-identified data will be made available on application to the investigator team.
Type d'informations de prise en charge du partage d'IPD
- PROTOCOLE D'ÉTUDE
Informations sur les médicaments et les dispositifs, documents d'étude
Étudie un produit pharmaceutique réglementé par la FDA américaine
Non
Étudie un produit d'appareil réglementé par la FDA américaine
Non
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