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，因为在以下情况下需要做出决策 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。 老年患者尤其脆弱，因为他们不仅经历了不成比例的这些错误 但也缺乏承受次优医疗服务的韧性。缺乏提高诊断率的干预措施 流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 病人。这些游戏在实验室中有中等的效果，尽管在参与方面只取得了不稳定的成功。 任务中的参与者。我们的首要假设是，通过增加参与度，我们可以放大 干预措施的效力。此R21提案的目标是测试使用故意的 实践-在教练面前进行以目标为导向的培训，教练可以提供个性化的即时反馈 --增加参与度。研究设计涉及招募国家便利性样本 委员会认证的急诊医生，将作为实习生(n=30)，为实习生与教练配对， 提供三次30分钟的教练课程，以现有的比赛为培训任务，并进行评估 联合干预对实验室表现的影响。R21的具体目标是： 1.通过测量教练技能获得、教练技能漂移来评估干预提供的保真度 以及遵守协议。 2.通过比较受训人员在经过验证的 与对照组医生(n=30)进行虚拟模拟。 3.评估干预措施的可接受性，使用经验证的工具和半 对受训人员进行有组织的汇报面谈，以评估他们对干预的参与度。 结果将为未来的一项试验提供参考，以比较不同行为干预在减少 创伤分诊中的诊断错误，从长远来看，应有助于减轻创伤对 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.