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.

Keywords: advedrse event reporting; escape room; gamification; graduate medical education; innovation; medical simulation; medication error reporting.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. Participant flow for the escape room challenge

ETR: escape the room

Figure 2. Schematic diagram of the potential clues and overlay of the simulation for Case #1

Case #1 represented a simulated inpatient hospital room with possible hazards and hidden quick response (QR) codes

Figure 3. Schematic diagram of the potential clues and overlay of the simulation for case #2

Case #2 represented a simulated emergency room with possible hazards and hidden QR codes QR: quick response

Figure 4. Sample QR associated clue and information

Sample QR associated clue and information regarding hand hygiene as a safety hazard QR: quick response

Figure 5. Feedback capture grid for a large group debriefing

Feedback capture grid for large group debriefing. The 'plus' sign represents things that worked well. The 'triangle' shape represents what could have been done differently. The 'lightbulb' represents any new ideas. The 'question mark' represents any new questions that this activity may have raised.