Finding the ‘QR’ to Patient Safety: Applying Gamification to Incorporate Patient Safety Priorities Through a Simulated ‘Escape Room’ Experience

Abstract

Medical errors are the eighth leading cause of mortality in the United States and contribute to over one million preventable injuries. In an effort to prevent medical errors, reporting systems serve as invaluable tools to detect patient safety events and quality problems longitudinally. Historically, trainees (i.e., students and residents) rarely submit incident reports for encountered patient safety threats. The authors propose an immersive learning experience utilizing gamification theory and leveraging the increasingly popular ‘escape room’ to help resident trainees identify reportable patient safety priorities. All 130 incoming intern physicians at the Thomas Jefferson University (Jefferson) were enrolled in the Patient Safety Escape Room study as part of their residency orientation (June 2018). The residents were randomly divided into 16 teams. Each team was immersed in a simulated escape room, tasked with identifying a predetermined set of serious patient safety hazards, and successfully manually entering them into the Jefferson Event Reporting System within the time allotted to successfully ‘win the game’ by ‘escaping the room’. Quick response (QR) codes were planted throughout the activity to provide in-game instructions; clues to solve the puzzle; and key information about patient safety priorities at Jefferson. All participants underwent a formal debriefing using the feedback capture grid method and completed a voluntary post-study survey, adapted from Brookfield’s Critical Incident Questionnaire (CIQ). The study was IRB exempt. Thematic analysis of the post-activity CIQ survey ( n = 102) revealed that interns were engaged during the immersive learning experience ( n = 42) and were specifically engaged by having to independently identify patient safety threats ( n = 30). Participants identified team role assignment ( n = 52) and effective communication ( n = 26) as the two most helpful actions needed to successfully complete the activity. Participants were overall surprised by the success of the education innovation ( n = 45) and reported that it changed how they viewed patient safety threats. Areas for improvement include clearer game instructions and using a more streamlined event reporting process. The escape room patient-safety activity allowed interns to actively engage in an innovative orientation activity that highlighted the importance of patient safety hazards, as well as providing them with the opportunity to document event reports in real-time. Next steps will include longitudinally tracking the quantity of error reports entered by this cohort to determine the effectiveness of this educational intervention.

A review on use of escape rooms in education – touching the void

“…Some also targeted residential programmes and courses for professional practitioners in a field or a mix of these (e.g. Adams et al, 2018;Zhang, Diemer, Lee, Jaffe, & Papanagnou, 2019). Only two of the studies described an escape room used solely in primary school (Duncan, 2020;Huang, Kuo, & Chen, 2020).…”

Educational Escape Rooms For Teaching

“…3) ADVANTAGES AND CHALLENGES OF EDUCA-TIONAL ESCAPE ROOMS: Educational escape rooms have been identified to foster teamwork and cooperation, as well as to produce high levels of enjoyment and engagement [13], [14], [15]. The learning benefits and improved motivations were seen among the students as they find learning more exciting by play [16].…”

Assembly Line Education: A Novel Educational Technique for Today's Learners

“…Gamification refers to using game design elements in an effective way to augment the traditional medical education approach to patient safety and competency-based education in a way that limits learner burnout while creating a sense of fun that promotes ongoing participation and engagement [7][8]. Several forms of gamification reported in the literature include using social media platforms such as Twitter, Kahoot!, 'escape rooms', team-based skills, ultrasound, and trivia competitions [9][10][11][12][13][14]. Another published method of increasing learner engagement and retention is for senior residents to collaborate with faculty to create interactive workshops and shape curriculum development [15].…”