Theory-Based Game Reduced Undertriage of Older Adults in ER Depts

A randomized clinical trial published in JAMA found that a theory-based serious game improved emergency physicians’ adherence to trauma triage guidelines for severely injured older adults treated at nontrauma centers.

The study enrolled 800 emergency physicians who triaged Medicare fee-for-service patients aged 65 years or older. Physicians were randomly assigned to game-based training or usual education. The intervention consisted of an initial 2-hour tablet session followed by 20-minute quarterly sessions.

During the year after enrollment, participating physicians worked at 1,147 hospitals and treated 41,073 injured Medicare patients, including 1,738 with severe injuries. Nearly all physicians assigned to the intervention completed at least one training session, and 67% completed all four

Undertriage, defined as failure to transfer severely injured patients to trauma centers, occurred in 49% of patients in the game-based training group and 57% in the usual-education group. The model-adjusted difference was −7 percentage points (95% CI, −13 to −0.8; P=.02). No statistically significant between-group differences were found in overtriage or the composite outcome of death or hospital readmission within 30 days.

The investigators concluded that the serious game reduced undertriage among physicians responsible for emergency care at nontrauma centers. The findings suggest that purpose-driven game-based education may offer a low-cost method for improving adherence to time-sensitive clinical guidelines.

Sources: Mohan D, Chang CH, Fischhoff B, et al. Using serious games to increase the implementation of trauma triage guidelines: a randomized clinical trial. JAMA. 2026;335(19):1672-1683. doi:10.1001/jama.2026.4079