Photo courtesy of Thomas Owen and Teresa Chan.

“Emergency department gridlock is in effect.”

I used to hear this nearly every day as a clinical clerk, but at first, I had no idea what it really meant.

Clinical training starts with an emphasis on the individual patient, as you explore one case at a time to understand what is going on. Over time, you move on to care for multiple patients at once, gaining more responsibility. It is at this point that many students, myself included, struggle. The paradigm changes; it is no longer you and one patient, it is you and three, five, or even twenty patients.

Through trial and error, we learn to better manage our time: we learn to focus on just the pertinent elements of a patient’s history, prioritize tasks by acuity or resource intensiveness, and become more efficient at analyzing information. Some people may develop this skill immediately, for others it may take until late in their residency, and for a few it may never come.

At some point, you begin independent practice, and you are suddenly in charge of managing a whole emergency department, clinic, or ward. As our health care system faces increasing resource pressures, the ability to manage a clinical system is becoming more of a necessity.

GridlockED is a “serious game”—that is, it’s a game intended for more than just fun—that aims to address this educational gap, specifically in the specialty of emergency medicine. As described in a recent Academic Medicine Innovation Report, the game is played on a board representing an emergency department. Each turn you draw two cards, many of which represent new incoming patients. Other cards represent chance events that would be expected in a hospital setting and that can change how the department runs.

As turns progress, the new patient cards fill up the “beds” in your department based on their acuity, and each patient card has a set of tasks that need to be completed before they are stabilized, discharged, or admitted. Your goal is to use the limited human resources at your disposal to address the oncoming wave of patients, ensuring you stabilize each patient in time and avoid getting gridlocked. The game has been spotted on Twitter (@gridlockedgame) at academic half days, conferences, and the occasional weeknight with friends.

My first experience with GridlockED was on a weeknight right around the time I was learning to handle multiple patients at once. It was when we were testing one of our lesson plans for the game that I realized what it meant to be gridlocked. The next day, when I heard the announcement while on my internal medicine core, I knew what it meant and understood the implications it had for ambulances, patients, and consulting services. With this in mind, I adapted to see my patients who were nearly ready for discharge first, so I could do my part in addressing the hospital’s gridlock situation.

As a junior learner, GridlockED gave me early exposure to the systems factors of clinical care. This exposure had a positive impact on how I provided patient care on my core rotations. After hearing many anecdotes similar to mine, our team decided to investigate the impact of GridlockED further, and a few members of the team have recently published about the application of GridlockED in emergency medicine education. Their research showed the game had high fidelity and that respondents endorsed the game as a useful learning tool, particularly among medical students and junior residents still adapting to managing multiple patients at once.

So far, the results are promising and the experiences my classmates and I have had have been strongly positive. But don’t just take our word for it, try it out yourself at www.gridlockedgame.com!

By: Tanishq Suryavanshi

T. Suryavanshi is a final year medical student at McMaster University in Hamilton, Ontario, Canada, interested in emergency medicine and critical care. He also has interests in health innovation and works with a number of stakeholders in the startup space who are studying how to better incorporate innovation into Canadian health care. He is a professionally trained chef and can be found in the kitchen during his time off.

Further Reading

Tsoy D, Sneath P, Rempel J, et al. Creating GridlockED: A serious game for teaching about multipatient environments [published online ahead of print July 3, 2018]. Acad Med. doi: 10.1097/ACM.0000000000002340.