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| ID | Type | Description | Link |
|---|---|---|---|
| R01AG076499 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute on Aging (NIA) | NIH |
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The goal of this clinical trial is to test the effect of a video game on the implementation of clinical practice guidelines in trauma triage. The main question it attempts to answer is whether exposure to the game improves compliance with guidelines by emergency medicine physicians working at non-trauma centers in the US. Participants randomized to the intervention condition will be asked to play a customized, theory-based video game for 2 hours immediately after enrollment, and then return to the game for 20 minutes every three months for the next 9 months. Participants in the control condition will receive usual care.
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. The study team 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. The investigators 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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Night Shift | Experimental | Night Shift 2024 is a customized, theory-based adventure video game in which the player takes on the character of Andy Jordan, a young emergency medicine physician who moves home after the disappearance of his grandfather and takes a job at a local community hospital. The investigators will ask participants to play Night Shift for 2 hours upon enrollment (or within 2 weeks), and then come back to the game quarterly to play it again for 20 minute booster sessions. They will unlock additional game content each quarter to make the experience more enjoyable. |
|
| Usual education | Active Comparator | Participants will receive their usual continuing medical education, but nothing additional. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Night Shift | Behavioral | The player must not only manage the patients who present to the emergency department of the hospital, gaining experience with the consequences of trauma triage, but also solve the mystery of the grandfather, gaining an emotional connection with the character and making the feedback that "Andy" receives more relevant. Embedded within Night Shift 2024 is a mini-game (Graveyard Shift) that contains a series of puzzles that reinforce the lessons of the overarching game: transfer severely injured patients expeditiously. |
| Measure | Description | Time Frame |
|---|---|---|
| Under-triage | Number of severely injured patients, treated by trial participants, who are admitted or discharged (i.e., not transferred) after initial evaluation at a non-trauma center as recommended by clinical practice guidelines. | 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Mortality and Hospital Readmission | Number of severely injured patients, treated by trial participants, who die or are readmitted to any hospital within 30 days of their initial evaluation at a non-trauma center | 1 year |
| Functional Dependence |
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Inclusion Criteria:
- Board certified physicians who work exclusively in the emergency departments (EDs) of non-trauma centers in the US AND triage adult trauma patients
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Deepika Mohan, MD | University of Pittsburgh | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Pittsburgh | Pittsburgh | Pennsylvania | 15213 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42008277 | Derived | Mohan D, Chang CH, Fischhoff B, Elmer J, Rak KJ, Barnes JL, Peitzman AB, Bendesky B, Carr C, Chapman AC, Forsythe RM, Guyette FX, Hynes AM, Oskvarek JJ, Weingart SD, Weinstock MB, White DB, Angus DC. Using Serious Games to Increase the Implementation of Trauma Triage Guidelines: A Randomized Clinical Trial. JAMA. 2026 May 19;335(19):1672-1683. doi: 10.1001/jama.2026.4079. | |
| 40465299 | Derived | Mohan D, Fischhoff B, Talisa V, Elmer J, White DB, Angus DC, Peitzman A, Bendesky B, Chapman AC, Forsythe RM, Guyette FX, Hynes AM, Oskvarek JJ, Weingart SD, Weinstock M, Chang CH. An Educational Video Game in Trauma Triage at Nontrauma Centers: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2025 Jun 2;8(6):e2513375. doi: 10.1001/jamanetworkopen.2025.13375. |
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The protocol, primary data, and meta-data (e.g., documentation, protocols used to clean and to manage the data), will be uploaded to the open access Inter-university Consortium for Political and Social Research (open ICPSR) repository at the conclusion of the trial. Of note, data obtained from Medicare will not be shared as part of the results of the trial, because we do not own those records.
6 months after publication of the primary manuscript.
We will upload the data to the open ICPSR repository, where other researchers can access it.
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Interested individuals reviewed the trial details. Those who provided consent completed a biographical survey so that we could evaluate eligibility and could characterize the population.
Once we determined eligibility, we contacted participants with their assignment and details on how to complete trial tasks.
We recruited a national sample of physicians who managed injured patients in the Emergency Departments (EDs) of non-trauma centers by distributing information about the trial through social media, word-of-mouth, a healthcare analytics company, and the organizational e-mail distribution lists of several national physician staffing groups.
We enrolled participants between November 27, 2023 - February 7, 2024.
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| ID | Title | Description |
|---|---|---|
| FG000 | Night Shift | Night Shift 2024 is a customized, theory-based adventure video game in which the player takes on the character of Andy Jordan, a young emergency medicine physician who moves home after the disappearance of his grandfather and takes a job at a local community hospital. The investigators will ask participants to play Night Shift for 2 hours upon enrollment (or within 2 weeks), and then come back to the game quarterly to play it again for 20 minute booster sessions. They will unlock additional game content each quarter to make the experience more enjoyable. |
| FG001 | Usual Education | Participants will receive their usual continuing medical education, but nothing additional. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Night Shift | Night Shift 2024 is a customized, theory-based adventure video game in which the player takes on the character of Andy Jordan, a young emergency medicine physician who moves home after the disappearance of his grandfather and takes a job at a local community hospital. The investigators will ask participants to play Night Shift for 2 hours upon enrollment (or within 2 weeks), and then come back to the game quarterly to play it again for 20 minute booster sessions. They will unlock additional game content each quarter to make the experience more enjoyable. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | age (self-reported) |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Secondary | Mortality and Hospital Readmission | Number of severely injured patients, treated by trial participants, who die or are readmitted to any hospital within 30 days of their initial evaluation at a non-trauma center | We report the number of patients treated by trial participants who died in the first 30 days after evaluation or who were readmitted to the hospital within this time period. The Overall Number of Participants Analyzed reflects the number of enrolled physicians. The values in the data table report severely injured patients, treated by physicians enrolled in the trial, who experienced the composite outcome of mortality plus re-admission at 30 days. | Posted | Number | Severely Injured Patients | 1 year |
|
1 year
All-Cause Mortality was not monitored/assessed in enrolled physician participants. The DSMB felt that the risk of the intervention was low enough that we could not plausibly identify a mechanism by which playing the game would result in death and therefore agreed that all-cause mortality did not need to be tracked.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Night Shift | Night Shift 2024 is a customized, theory-based adventure video game in which the player takes on the character of Andy Jordan, a young emergency medicine physician who moves home after the disappearance of his grandfather and takes a job at a local community hospital. The investigators will ask participants to play Night Shift for 2 hours upon enrollment (or within 2 weeks), and then come back to the game quarterly to play it again for 20 minute booster sessions. They will unlock additional game content each quarter to make the experience more enjoyable. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Deepika Mohan | University of Pittsburgh | 4126470860 | mohand@upmc.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Sep 25, 2023 | Mar 30, 2026 | Prot_001.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Mar 6, 2026 | Mar 30, 2026 | SAP_002.pdf |
| ICF | No | No | Yes | Informed Consent Form | Sep 19, 2023 | Mar 6, 2024 | ICF_000.pdf |
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| ID | Term |
|---|---|
| D000081084 | Accidental Injuries |
| ID | Term |
|---|---|
| D014947 | Wounds and Injuries |
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| ID | Term |
|---|---|
| D000073577 | Shift Work Schedule |
| ID | Term |
|---|---|
| D010561 | Personnel Staffing and Scheduling |
| D010559 | Personnel Management |
| D009934 | Organization and Administration |
| D006298 | Health Services Administration |
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Physicians will be randomized in a 1:1 fashion to the intervention condition or to the control condition.
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Participant assignment will be masked within the data with unblinding occurring only after data cleaning has completed.
|
| Usual education | Behavioral | Standard continuing medical education, including Advanced Trauma Life Support, and the American Board of Emergency Medicine educational modules (e.g., trauma resuscitation). |
|
Proportion of severely injured patients, treated by trial participants, with 90-day preadmission location at home with discharge to a skilled nursing or rehabilitation facility after initial treatment at a non-trauma center.
| 1 year |
| Over-triage | Number of injured patients, treated by trial participants, transferred to a higher level of care after initial evaluation at a non-trauma center with minimal injuries. The Overall Number of Participants Analyzed reflects the number of enrolled physicians. The values in the data table report transferred patients treated by physicians enrolled in the trial. | 1 year |
| 38365758 | Derived | Mohan D, Angus DC, Chang CH, Elmer J, Fischhoff B, Rak KJ, Barnes JL, Peitzman AB, White DB. Using a theory-based, customized video game as an educational tool to improve physicians' trauma triage decisions: study protocol for a randomized cluster trial. Trials. 2024 Feb 16;25(1):127. doi: 10.1186/s13063-024-07961-w. |
| BG001 | Usual Education | Participants will receive their usual continuing medical education, but nothing additional. |
| BG002 | Total | Total of all reporting groups |
| Inter-Quartile Range |
| years |
|
| Sex: Female, Male | sex as reported by trial participants | 11 participants chose not to report their sex | Count of Participants | Participants |
|
| Race (NIH/OMB) | participant race (self-reported) | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | participant ethnicity (self-reported) | Count of Participants | Participants |
|
| Region of Enrollment | participant location (self-reported) | Count of Participants | Participants |
|
| OG001 | Usual Education | Participants will receive their usual continuing medical education, but nothing additional. |
|
|
|
| Secondary | Functional Dependence | Proportion of severely injured patients, treated by trial participants, with 90-day preadmission location at home with discharge to a skilled nursing or rehabilitation facility after initial treatment at a non-trauma center. | Not Posted | Dec 2026 | 1 year | Participants |
| Secondary | Over-triage | Number of injured patients, treated by trial participants, transferred to a higher level of care after initial evaluation at a non-trauma center with minimal injuries. The Overall Number of Participants Analyzed reflects the number of enrolled physicians. The values in the data table report transferred patients treated by physicians enrolled in the trial. | Posted | Number | Transferred Patients | 1 year |
|
|
|
|
| Primary | Under-triage | Number of severely injured patients, treated by trial participants, who are admitted or discharged (i.e., not transferred) after initial evaluation at a non-trauma center as recommended by clinical practice guidelines. | The Overall Number of Participants Analyzed reflects the number of enrolled physicians. The values in the data table report severely injured patients treated by physicians enrolled in the trial at a non-trauma center in the year after enrollment. | Posted | Number | Severely injured patients | 1 year |
|
|
|
|
| 0 |
| 0 |
| 0 |
| 399 |
| 0 |
| 399 |
| EG001 | Usual Education | Participants will receive their usual continuing medical education, but nothing additional. | 0 | 0 | 0 | 398 | 0 | 398 |
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| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
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| White |
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| More than one race |
|
| Unknown or Not Reported |
|
| Unknown or Not Reported |
|
| Total number of transferred patients |
|
| Not transferred severely injured patients |
|