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

Xiao Chi Zhang,Hyunjoo Lee,Rebecca Jaffe,Gretchen Diemer,Dimitrios Papanagnou

doi:10.7759/cureus.4014

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.

Highlights

In the United States, medical errors are the eighth leading cause of mortality, with an estimated 44,000 to 98,000 unnecessary deaths occurring each year, and over one million preventable injuries [1]
We propose that exposing incoming interns and residents to various team-based activities on critical patient safety priorities, as well as providing them with the opportunity for guided reflection during a facilitated debriefing, will allow them to 1) identify local patient safety priorities; 2) physically enter an event report using the Jefferson Event Reporting System; and 3) practice using teamwork skills to address patient safety threats
Thematic analysis of the post-activity Critical Incident Questionnaire (CIQ) survey (n = 102, with a 78.5% survey response rate) revealed that the learners were highly engaged by the format of the learning experience (n = 42) and the opportunity to identify safety threats ( n = 30)

Summary

Introduction

In the United States, medical errors are the eighth leading cause of mortality, with an estimated 44,000 to 98,000 unnecessary deaths occurring each year, and over one million preventable injuries [1]. Despite numerous national and institutional efforts to prevent medical errors, reporting errors through mandatory or voluntary means (i.e., patient safety event reporting systems) remain an invaluable tool in identifying and tracking patient safety events and threats to clinical quality. In the groundbreaking report released by the Institute of Medicine’s (IOM) report, ‘To Err is Human: Building a Safer Health System’, the authors found that more than 90% of errors were preventable, and the successful reporting of these errors could provide critical data that would inform future efforts to improve patient safety [4,5,6].

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Discussion

Conclusion