Zhang Xiao Chi, Diemer Gretchen, Lee Hyunjoo, Jaffe Rebecca, Papanagnou Dimitrios
Emergency Medicine, Thomas Jefferson University, Philadelphia, USA.
Internal Medicine, Thomas Jefferson University, Philadelphia, USA.
Cureus. 2019 Feb 5;11(2):e4014. doi: 10.7759/cureus.4014.
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 (= 102) revealed that interns were engaged during the immersive learning experience (= 42) and were specifically engaged by having to independently identify patient safety threats (= 30). Participants identified team role assignment (= 52) and effective communication (= 26) as the two most helpful actions needed to successfully complete the activity. Participants were overall surprised by the success of the education innovation (= 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.
医疗差错是美国第八大死因,导致超过100万起可预防的伤害。为了预防医疗差错,报告系统是纵向检测患者安全事件和质量问题的宝贵工具。从历史上看,实习生(即学生和住院医师)很少就遇到的患者安全威胁提交事件报告。作者提出了一种沉浸式学习体验,利用游戏化理论并借助日益流行的“密室逃脱”,来帮助住院医师实习生识别可报告的患者安全重点。托马斯·杰斐逊大学(杰斐逊大学)的所有130名新入职实习医生都参加了患者安全密室逃脱研究,作为他们住院医师入职培训的一部分(2018年6月)。住院医师被随机分成16个小组。每个小组都沉浸在一个模拟的密室逃脱情境中,任务是识别一组预先确定的严重患者安全隐患,并在规定时间内成功手动将其输入杰斐逊事件报告系统,以通过“逃出房间”成功“赢得游戏”。在整个活动中设置了快速响应(QR)码,以提供游戏内说明、解谜线索以及关于杰斐逊大学患者安全重点的关键信息。所有参与者都使用反馈捕获网格方法进行了正式的汇报,并完成了一份自愿的研究后调查问卷,该问卷改编自布鲁克菲尔德的关键事件问卷(CIQ)。该研究获得了机构审查委员会(IRB)的豁免。对活动后CIQ调查问卷(n = 102)的主题分析表明,实习生在沉浸式学习体验中参与度很高(n = 42),特别是通过必须独立识别患者安全威胁而参与度更高(n = 30)。参与者认为团队角色分配(n = 52)和有效沟通(n = 26)是成功完成活动所需的两个最有帮助的行动。参与者总体上对教育创新的成功感到惊讶(n = 45),并报告说这改变了他们对患者安全威胁的看法。改进的方面包括更清晰的游戏说明和使用更简化的事件报告流程。密室逃脱患者安全活动让实习生积极参与到一项创新的入职培训活动中,该活动突出了患者安全隐患的重要性,并为他们提供了实时记录事件报告的机会。下一步将包括纵向跟踪这一队列输入的差错报告数量,以确定这种教育干预的效果。