Table 1 Description of Night Shift 2024
Duration: 3 + h of gameplay possible |
Objective: To increase implementation of clinical practice guidelines in trauma triage |
Behavioral problem: Diagnostic errors result in non-compliance with guidelines |
Theory of behavior: The dual process model of cognition describes judgment (i.e., diagnosis) as the product of heuristics (system 1 processes) and rule-based algorithms (system 2 processes. System 1 processes allow people to solve difficult questions under conditions of time-pressure and uncertainty by providing solutions based on pattern recognition. System 2 processes require effort but provide more accurate answers from rule-based algorithms |
Methods of behavior change: We selected 5 behavior change techniques from the taxonomy published by Michie et al.: demonstration of the behavior; increasing the salience of consequences of behavior; shaping knowledge; providing feedback on behavior, and offering opportunities to practice the behavior. We selected 4 methods of stimulating engagement from a review of the literature: realism, interest, identification, and transportation |
Game concept: The player takes on the role of Andy Jordan, a young emergency medicine physician, who moves home after his grandfather’s disappearance and accepts a job at a local community hospital covering night shifts. Andy encounters a series of patients at the local hospital and must make diagnostic and therapeutic decisions for each case. The player receives feedback on his/her decision making from a variety of in-game characters. Concurrently, the player must resolve the mystery of Andy’s grandfather’s disappearance, which offers the player the opportunity to learn more about the character and the world he inhabits. After completing the main story arc, the player uncovers an embedded mini game (Graveyard Shift), which uses a series of short puzzles to reinforce the triage principles. Each puzzle includes a 5 step-game loop: triage of 10 cases over 90 s, structured case comparison, feedback, structured debriefing, review of the literature |
Game content: • Night Shift includes 5 teaching trauma cases of patients with injuries frequently under-triaged at non-trauma centers (e.g., multi-system injuries). These cases play out longitudinally so that the player experiences the natural consequences of behavior and receives feedback (opprobrium or approval) on their decision making. We also included 2 non-teaching trauma cases, where patients decompensate and players must rescue them, to stimulate realism and interest. Finally, the game has 5 diagnostically challenging cases intended to challenge players • Graveyard Shift has 10 levels, each covering a different decision principle: o Severe injuries belong at trauma centers; markers for severe injuries include shock, intubation, mangled extremities, penetrating injuries to the torso or proximal extremities, paralysis, and multi-system injuries o Moderate injuries in the setting of diminished physiologic reserve belong at trauma centers; markers for diminished physiologic reserve include age > 70 and evidence of frailty o Hospitals that lack resources should transfer all patients with more than minor injuries o Minor injuries never require transfer to trauma centers |
Game mechanics: The user interface includes tap-to-act, connect-the dots, points that unlock in-game rewards (e.g., the opportunity to learn more about the character), music, and time-pressure |