An interventional study of Night Shift and Usual education in Trauma Injury and Physician's Role, sponsored by University of Pittsburgh. Completed at 1 site in United States. Open to participants aged 25 Years to 70 Years. Per ClinicalTrials.gov, last updated 2026-05-06.
Sponsored by University of Pittsburgh · Not applicable, Interventional, and Health services research
The goal of this clinical trial is to test the effect of a video game on the implementation of clinical practice guidelines in trauma triage. The main question it attempts to answer is whether exposure to the game improves compliance with guidelines by emergency medicine physicians working at non-trauma centers in the US. Participants randomized to the intervention condition will be asked to play a customized, theory-based video game for 2 hours immediately after enrollment, and then return to the game for 20 minutes every three months for the next 9 months. Participants in the control condition will receive usual care.
Transfer of severely injured patients to trauma centers, either directly from the field or after evaluation at non-trauma centers, reduces preventable morbidity and mortality. Failure to transfer these patients appropriately (i.e., under-triage) remains common, and occurs in part because physicians at non-trauma centers make diagnostic errors when evaluating the severity of patients' injuries. The study team developed Night Shift, a theory-based adventure video game, to recalibrate physician heuristics (intuitive judgments) in trauma triage and established its efficacy in the laboratory. The investigators plan a Type 1 hybrid effectiveness-implementation trial to determine whether the game changes physician triage decisions in real-life, and hypothesize that it will reduce the proportion of patients under-triaged.
51 studies on the registry are indexed under Accidental Injuries; 28 are open to participants now.
This study's enrollment of 800 is above the median of 115 across 30 interventional studies indexed under Accidental Injuries.
Browse Accidental Injuries studies →University of Pittsburgh is the lead sponsor of 1,385 studies on the registry; 167 are open to participants now.
Of its 8 completed or terminated interventional studies of FDA-regulated products, 4 (50%) have results posted.
Counted across the registry records on this site, refreshed daily.
- Board certified physicians who work exclusively in the emergency departments (EDs) of non-trauma centers in the US AND triage adult trauma patients
Exclusion Criteria:
Night Shift 2024 is a customized, theory-based adventure video game in which the player takes on the character of Andy Jordan, a young emergency medicine physician who moves home after the disappearance of his grandfather and takes a job at a local community hospital. The investigators will ask participants to play Night Shift for 2 hours upon enrollment (or within 2 weeks), and then come back to the game quarterly to play it again for 20 minute booster sessions. They will unlock additional game content each quarter to make the experience more enjoyable.
Behavioral: Night Shift
Participants will receive their usual continuing medical education, but nothing additional.
Behavioral: Usual education
The player must not only manage the patients who present to the emergency department of the hospital, gaining experience with the consequences of trauma triage, but also solve the mystery of the grandfather, gaining an emotional connection with the character and making the feedback that "Andy" receives more relevant. Embedded within Night Shift 2024 is a mini-game (Graveyard Shift) that contains a series of puzzles that reinforce the lessons of the overarching game: transfer severely injured patients expeditiously.
Standard continuing medical education, including Advanced Trauma Life Support, and the American Board of Emergency Medicine educational modules (e.g., trauma resuscitation).
Under-triage
Number of severely injured patients, treated by trial participants, who are admitted or discharged (i.e., not transferred) after initial evaluation at a non-trauma center as recommended by clinical practice guidelines.
Time frame: 1 year
Mortality and Hospital Readmission
Number of severely injured patients, treated by trial participants, who die or are readmitted to any hospital within 30 days of their initial evaluation at a non-trauma center
Time frame: 1 year
Functional Dependence
Proportion of severely injured patients, treated by trial participants, with 90-day preadmission location at home with discharge to a skilled nursing or rehabilitation facility after initial treatment at a non-trauma center.
Time frame: 1 year
Over-triage
Number of injured patients, treated by trial participants, transferred to a higher level of care after initial evaluation at a non-trauma center with minimal injuries. The Overall Number of Participants Analyzed reflects the number of enrolled physicians. The values in the data table report transferred patients treated by physicians enrolled in the trial.
Time frame: 1 year
We recruited a national sample of physicians who managed injured patients in the Emergency Departments (EDs) of non-trauma centers by distributing information about the trial through social media, word-of-mouth, a healthcare analytics company, and the organizational e-mail distribution lists of several national physician staffing groups. We enrolled participants between November 27, 2023 - February 7, 2024.
| Milestone | Night Shift | Usual Education |
|---|---|---|
| Started | 400 | 400 |
| Completed | 399 | 398 |
| Not completed | 1 | 2 |
Number of severely injured patients, treated by trial participants, who die or are readmitted to any hospital within 30 days of their initial evaluation at a non-trauma center
| Severely Injured Patients | Night Shift | Usual Education |
|---|---|---|
| Composite outcome present — Composite outcome present | 516 | 584 |
| Composite outcome absent — Composite outcome present | 303 | 335 |
| Total number of severely injured patients — Composite outcome present | 819 | 919 |
Proportion of severely injured patients, treated by trial participants, with 90-day preadmission location at home with discharge to a skilled nursing or rehabilitation facility after initial treatment at a non-trauma center.
Results for this outcome have not been posted.
Number of injured patients, treated by trial participants, transferred to a higher level of care after initial evaluation at a non-trauma center with minimal injuries. The Overall Number of Participants Analyzed reflects the number of enrolled physicians. The values in the data table report transferred patients treated by physicians enrolled in the trial.
| Transferred Patients | Night Shift | Usual Education |
|---|---|---|
| Transferred patients with minor injuries (over-triaged) — Patients with minor injuries (over-triaged) | 1038 | 1132 |
| Transferred patients with severe injuries — Patients with minor injuries (over-triaged) | 417 | 392 |
| Total number of transferred patients — Patients with minor injuries (over-triaged) | 1455 | 1524 |
Number of severely injured patients, treated by trial participants, who are admitted or discharged (i.e., not transferred) after initial evaluation at a non-trauma center as recommended by clinical practice guidelines.
| Severely injured patients | Night Shift | Usual Education |
|---|---|---|
| Total number of severely injured patients | 819 | 919 |
| Transferred severely injured patients | 417 | 392 |
| Not transferred severely injured patients | 402 | 527 |
Collected over 1 year. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Night Shift | — | 0/399 (0%) | 0/399 (0%) |
| Usual Education | — | 0/398 (0%) | 0/398 (0%) |
| Age, Continuous(years) | Night Shift | Usual Education | Total |
|---|---|---|---|
| Median | 41 (37 to 49) | 42 (37 to 50) | 42 (37 to 49) |
| Sex: Female, Male(Participants) | Night Shift | Usual Education | Total |
|---|---|---|---|
| Female | 116 | 110 | 226 |
| Male | 281 | 282 | 563 |
| Race (NIH/OMB)(Participants) | Night Shift | Usual Education | Total |
|---|---|---|---|
| American Indian or Alaska Native | 1 | 2 | 3 |
| Asian | 54 | 62 | 116 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 13 | 16 | 29 |
| White | 300 | 288 | 588 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 32 | 32 | 64 |
| Ethnicity (NIH/OMB)(Participants) | Night Shift | Usual Education | Total |
|---|---|---|---|
| Hispanic or Latino | 16 | 16 | 32 |
| Not Hispanic or Latino | 360 | 363 | 723 |
| Unknown or Not Reported | 24 | 21 | 45 |
| Region of Enrollment(Participants) | Night Shift | Usual Education | Total |
|---|---|---|---|
| United States | 400 | 400 | 800 |
Documents are hosted by the registry — open the source record to download them.
Plan to share: Yes — The protocol, primary data, and meta-data (e.g., documentation, protocols used to clean and to manage the data), will be uploaded to the open access Inter-university Consortium for Political and Social Research (open ICPSR) repository at the conclusion of the trial. Of note, data obtained from Medicare will not be shared as part of the results of the trial, because we do not own those records.
Supporting information: Study protocol, Sap, Analytic code
This study is completed, as verified in May 2026. You cannot join it, but the record below documents what was studied.
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