Development and feasibility testing of a novel intervention to implement trauma triage guidelines

摘要 创伤分诊容易导致诊断错误，因为需要在以下条件下做出决策： 不确定性和时间压力。诊断错误会增加死亡率、残疾、疼痛和丧失独立性。 老年患者特别容易受到伤害，因为他们不仅不成比例地经历这些错误 但也缺乏承受次优护理的弹性。缺乏改善诊断的干预措施 过程是减轻伤害给患者带来的负担的关键障碍。在之前的工作中，我们的团队 开发了两个定制的，基于理论的视频游戏，以提高对严重受伤的识别 患者这些游戏在实验室中有中等的效果，尽管在参与方面只有不同的成功率。 任务的参与者。我们的首要假设是，通过增加参与，我们可以放大 干预措施的效力。本R21提案的目的是测试故意使用 实践-在教练在场的情况下进行目标导向的培训，教练可以提供个性化的即时反馈 - 以增加参与度。研究设计包括招募一个全国性的方便样本， 委员会认证的急诊医生将作为学员（n=30），学员与教练配对， 使用现有游戏作为培训任务，提供三个30分钟的辅导课程，并进行评估 在实验室中，联合干预对性能的影响。R21的具体目标是： 1.通过测量教练技能的获得、教练技能的漂移， 和方案依从性。 2.通过比较受训者在经验证的 虚拟模拟与对照组的医生（n=30）。 3.通过使用经确认的仪器和半自动仪器的混合物来评估干预的可接受性， 与受训人员进行有组织的情况汇报访谈，以评估他们对干预措施的参与情况。 结果将为未来的试验提供信息，以比较不同行为干预措施在减少 在创伤分诊诊断错误，并在长期应有助于减轻创伤造成的负担， 老年人的健康和独立。

ABSTRACT Trauma triage predisposes to diagnostic errors because of the need for decision making under conditions of uncertainty and time-pressure. Diagnostic errors increase mortality, disability, pain, and loss of independence. Elderly patients are particularly vulnerable because they not only disproportionately experience these errors but also lack the resilience to tolerate sub-optimal care. The absence of interventions to improve the diagnostic process is a critical barrier to alleviating the burden that injury imposes on patients. In prior work, our team developed two customized, theoretically-based video games to improve the recognition of severely injured patients. The games had moderate efficacy in the laboratory, despite only variable success at engaging participants in the task. Our overarching hypothesis is that by increasing engagement we can amplify the potency of the interventions. The objective of this R21 proposal is to test the feasibility of using deliberate practice – goal-oriented training in the presence of a coach who can provide personalized, immediate feedback – to increase engagement. The research design involves recruitment of a national convenience sample of board-certified emergency physicians who will serve as trainees (n=30), pairing of the trainees with a coach, delivery of three 30-minute coaching sessions using the existing games as the training task, and assessment of the effect of the combined intervention on performance in the laboratory. The specific aims of the R21 are: 1. To assess the fidelity of intervention delivery by measuring coaching skill acquisition, coaching skill drift and protocol adherence. 2. To assess the potential effect size of the intervention by comparing trainee performance on a validated virtual simulation with a control group of physicians (n=30). 3. To assess the acceptability of the intervention by using a mixture of validated instruments and semi- structured debriefing interviews with trainees to assess their engagement with the intervention. Results will inform a future trial to compare the efficacy of different behavioral interventions in reducing diagnostic error in trauma triage, and in the long-term should help to mitigate the burden imposed by trauma on the health and independence of the aging.