Emergency Room (ER) physicians who play a specially developed video game on trauma triage demonstrably perform better than colleagues who only participate in standard continuing education. This is according to new research. The game could thus serve as an effective and scalable alternative to traditional, often costly and time-consuming programs for (re)certification.
The need for improvement is great. A growing proportion of seriously injured patients is over 65 years of age. It is precisely with this group that things often go wrong in triage: injuries are recognized less quickly and their severity is underestimated. According to lead researcher Deepika Mohan, a trauma surgeon and associate professor at the University of Pittsburgh, subtle symptoms play an important role in this.
Whereas a broken rib in a younger patient may seem relatively harmless, the same injury in an older patient can be life-threatening. Undertriage, assessing a patient’s need for care as too low, occurs in up to 70 percent of cases involving older adults. This can lead to delays in appropriate treatment and increased mortality.
Night Shift video game
The idea for the video game emerged from real-world practice. During her shifts, Mohan observed both overtriage (unnecessary referrals) and undertriage, sometimes with serious consequences. She concluded that doctors often rely on ingrained thought patterns, also known as heuristics. These mental shortcuts are efficient but difficult to change.
In collaboration with behavioral scientist Baruch Fischhoff of Carnegie Mellon University, an innovative solution was devised: a serious game in which doctors can make decisions and learn from them in a safe, simulated environment.
The game, Night Shift, developed with Schell Games, places the player in the role of a young emergency room physician. In an emotionally charged setting, players must make decisions about trauma patients under time pressure. Feedback follows immediately in the form of rewards or corrections. Additionally, the game includes puzzles that must be solved within 90 seconds using limited clinical information.
Measurable impact
The game’s effectiveness was tested in a large-scale study involving 800 ER physicians in the United States working in hospitals without a trauma center. Half of the participants played the game for two hours and then for 20 minutes every quarter. The other half received only the usual continuing education.
The results, published in JAMA, are significant. Physicians who played the game undertriaged seriously injured elderly patients in 49 percent of cases, compared to 57 percent in the control group. Notably, using the game did not lead to more overtriage; both groups scored similarly in that regard.
According to Mohan, this suggests that the game does not simply lead to greater caution, but actually improves diagnostic ability. The combination of storytelling, emotional engagement, and time pressure appears to reprogram existing thought patterns and thus bring about lasting behavioral change.
Temporary effect
The study also shows that the game’s effect is temporary. The highest adherence to triage guidelines was measured within 30 days of playing. After that, the effect diminished until the game was played again.
This raises questions about the optimal “dosage” of this type of training. Mohan suggests that shorter, more frequent play sessions, for example, weekly sessions of one and a half minutes, may be more effective than longer, less frequent sessions. This aligns with broader trends in digital education, where microlearning is becoming increasingly popular.
The next step is to test this hypothesis, as well as to expand the approach to other links in the trauma care chain. Think of ambulance personnel, regional hospitals, and specialized trauma centers. The ultimate goal is an integrated behavioral intervention that contributes to better decision-making at multiple levels.
This development demonstrates that serious gaming can not only serve as an attractive alternative to traditional training but can also make a demonstrable contribution to improved patient outcomes. At a time when pressure on the healthcare system is increasing and the complexity of patient populations is growing, this type of technology can play a significant role in improving the quality and safety of care.
SMART Triage
In 2025, the Dutch ‘Hollands Midden’ region made a significant investment in the development and implementation of the digital triage platform (in Dutch) SMART Triage. This stands for Smart Medical Applications for Regional Use in Triage and is designed to better support ambulance care professionals in assessing the appropriate level of care needed. Through the smart use of data and digital communication, they can assess whether a patient can safely remain at home or must be transported to the hospital, either as an emergency or on a scheduled basis.
A key innovation within SMART Triage is the ability for ambulance care providers to consult with medical specialists in real time, even before arriving at the hospital. Through the platform, vital signs, troponin levels (from a finger prick), and ECG results can be shared immediately. In addition, SMART Triage facilitates a two-way video connection and provides insight into current patient volume in the emergency departments, ensuring that care capacity is utilized optimally.
