Feasibility and acceptability of a serious game to study the effects of environmental distractors on emergency room nurse triage accuracy: a pilot randomized controlled trial

Abstract

Abstract Background: Emergency room nurse triage entails complex clinical decision making under stress and time constraints. Workplace distractors, such as noise and task interruptions, have been pointed to as possible reasons for triage inaccuracy, though studies have not borne this out. To train nurses to perform the task, a serious game was developed to simulate the triage process and environment. A pilot study was undertaken to evaluate the acceptability and feasibility of the serious game and to collect preliminary data on the effects of two distractors—noise and task interruptions—on emergency room nurse triage accuracy. Methods: A 2 × 2 factorial randomized controlled trial was designed for the study. A sample of 70 emergency room nurses was randomly assigned to four groups: three experimental groups exposed to different distractors (noise, task interruptions, and both) and one control group exposed to none. The nurses in each group had two hours to complete a series of 20 clinical vignettes where they had to establish a chief complaint and assign an emergency level. Their responses were then compared against a gold standard predetermined by experts. Results: Among 70, 55 nurses completed about 15 vignettes each in the allotted time. No inter-group differences emerged in terms of triage performance. Only a few minor technical issues arose during the sessions. Nurses had a very favorable appreciation of the serious game on triage as measured through a semantic differential scale. Conclusions: Results show that both the structure of our study and the serious game on triage can be used to carry out a future RCT on a larger scale. Two minor technical bugs were identified and corrected, the series of vignettes to complete in two hours must be shortened to 15, and the test should be held during work hours to support recruitment and reduce the possible impact of nurse fatigue on triage performance. The absence of a distractor effect raises questions about whether distractors have an effect and at what frequency and intensity of noise and task interruptions might have an impact on triage performance and whether this dose is realistic.