With limited time and overcrowded waiting rooms, emergency room (ER) physicians find it quite challenging to balance the demands of patient care. Medical transcription service companies specializing in ER documentation help physicians maintain accurate patient records and charts. However, one important task that healthcare providers have to handle is differentiating patients’ priority levels so that they can get the appropriate care they need. Fast, accurate triage of patients’ needs is crucial to reduce emergency department (ED) wait times. A new study led by the University of Pittsburgh School of Medicine (UPSOM) found that a new video game can help ER physicians identify the level of care patients need quickly and accurately.
In May 2014, the Centers for Disease Control and Prevention (CDC) reported average ED wait times as about 30 minutes and treatment times as about 90 minutes, leading to roughly two hours in the ER. A Huffington Post article on ER wait times in Canada noted that during peak periods, wait times for patients with moderate to less urgent conditions could increase from 15 minutes to as much as 5 hours.
The goal of the ER physician is to see the sickest patients first. For this, they must very quickly assess whether a patient is in need of real critical, time-sensitive treatment versus a patient who is safe to wait. Rapid, accurate triage of the patient is important for successful ER operations. However, a recent JAMA study reported that 30 percent of severely injured patients are not transferred as recommended by clinical practice guidelines.
Hospitals in different regions of the country, university and community hospitals, and teaching and nonteaching sites use the traditional emergency severity index (ESI) during triage to assign a score from Level 1 for patients who are the most critically sick, to Level 5 for patients who are the least sick. A patient’s ESI level determines in which area of the ED that patient will be seen, assigns the patient to a queue, and helps in provider decision-making throughout the patient’s care process.
Under-categorization (under-triage) puts the patient at risk of getting worse while waiting. Over-categorization (over-triage) amounts to a waste of scarce resources, and prevents patients who need immediate care from getting an open ED bed. According to the UPSOM study published in the British Medical Journal, physicians who played the video game could better determine the level of care needed for different patients compared to those who used traditional tools.
Up to 368 emergency medical doctors working primarily in non-trauma centers or level lll/lV centers participated in the study. Half of the participants were instructed to use app-based traditional, didactic education, while the other half played the adventure video game called Night Shift which features a young fictitious ER physician. Players are shown traumatic and non-traumatic complaints from patients. The participants completed a questionnaire to determine how often they failed to send patients with severe injuries for appropriate trauma care. They also see the consequences of their decisions and have to break the bad news to patient’s family members. The team studied the participants’ decisions to admit, discharge or transfer a patient and calculated the proportion of patients under-triaged.
The study found that playing the video game “recalibrated physicians’ brains” with the following outcomes:
- Six months after the initial test, physicians who played the video game for just one hour out-performed their peers in recognizing severe trauma.
- While physicians using traditional didactic educational tools under-triaged 74 percent of the time, those who played the video game under-triaged 53 percent of the time.
However, the team noted that the physicians preferred the educational materials and suggested that improvements to the video game might make it more effective. Also, a lead researcher says that the physician’s diagnostic skills were not the only reason for the under-triage problem. Factors such as not having an ambulance available to a lack of proper diagnostic tools could prevent a severe trauma patient from being transferred to a trauma center. For instance, when ER physicians order tests and scans for a patient, wait times for other patients rise significantly.
Despite these issues, the UPSOM study shows that the game is an important step towards improving on current educational training. Streamlining ED processes can make test results are available more quickly and at all hours. Bringing about improvements to wait times in EDs require collaboration and new approaches between leaders and experts in emergency medicine. As an experienced medical transcription company, we are well aware of the importance of timely and reliable ED documentation. ED notes are distinct from other providers’ notes. In the hectic ER scenario, timely completion of charting is critical if the chart is to be accurate. Delegating this task to a reliable emergency room transcription service provider can help physicians improve speed and efficiency and enhance patient care, which will ultimately help reduce ER wait times.