VHA SimLEARN

Escape to Simulation: How a COVID-19 Escape Room provided Interdisciplinary Team Building

By: Janet Sprehe, DNP, APRN, CVRN, RN-BC | Program Director of Simulations, James A. Haley Veterans’ Hospital, Tampa, FL
Sherri Boisvert, PhD, MSN, RN | Simulation Nurse Instructor, National Simulation Center, SimLEARN, Orlando, FL
Michelle Regragui, MSHS, BSN, RN | Field Based Simulation Nurse Instructor, National Simulation Center, SimLEARN, Orlando, FL

Together with VHA SimLEARN, the Tampa Advanced Simulation Center piloted a COVID-19 Escape Room to bring an innovative methodology to enforce and prepare new employees with our COVID-19 policies in donning and doffing and proper transfer of a positive COVID-19 patient. After several Microsoft Teams meetings with the VHA SimLEARN creators of the COVID-19 Escape Room simulation Sherri Boisvert, and Michelle Regragui, Tampa learned the process for this new learning methodology. "Escape rooms have been used for a few years now in simulation, but this was the first time the Tampa VA tried one," stated Program Director, Janet Sprehe, "and the result was unbelievable!"

Due to COVID-19, we only allow 4-5 staff in the simulation conference room to participate in our escape room so social distancing and wearing masks was maintained. The simulation conference room was a perfect room to hide the things the group would need to solve the puzzles to accomplish the final task. Sherri and Michelle joined us online to view and collaborate with the trainings. They helped us with making sure we had the correct items and specific equipment needed for each clue. COVID-19 Escape Room participants included physicians, nurses, transporters, and the Environmental Management Service (EMS). At first, some asked "why are we having to find clues to have fun when we need to get back to our work?”

After the training, participants commented that they learned a lot especially about a useful communication tool one should use, how team building was really practiced in this setting and not just preached and how the game tested real knowledge of how well one knew the donning and doffing processes. The most beneficial comment to this type of training was on how it was fun and not stale so they could really learn and remember it.

So, what really is an escape room? It is a gamification modality that uses hidden puzzles for participants to put together in order to get to the next clue to complete the objectives of the game. Escape rooms also have rules. For example, the saying of “What happens in Vegas stays in Vegas” is a rule that many simulation centers have so the next participants will experience the same experiences of thinking and puzzle solving to accomplish the goals of learning. That is an example of one of rules we have for our COVID-19 Escape room. Escape rooms provide participants to practice communication, clinical skills, leadership, team building and problem solving in a dynamic and innovative new way for training.

As our hospital COVID-19 units were having more and more of their Powered Air Purifying Respirators (PAPRs) breakdown, we needed to introduce a different kind of PAPR the hospital obtained. This new PAPR had many different steps to follow with donning and doffing compared to the first PAPR we used. Tampa decided to introduce the new PAPR training to the escape room participants in the beginning as it would also help them during the game as they learned more about the COVID-19 policies and procedures.

One rewarding take away from having our EMS learn with our direct care staff in the COVID-19 escape room was that they wanted to also wear a PAPR when cleaning a COVID-19 room after a COVID-19 patient was discharged. After participating in the COVID-19 escape room the EMS department was then supplied their own PAPR units for use. Our EMS trainer, Thomas Miller, was so elated with the COVID-19 escape room that now his department sends their housekeepers to our weekly COVID-19 Escape Room trainings. He said: “Many of our EMS staff have stated, that (Escape Room, SimLEARN), is one of the best trainings they have participated in throughout their working career at the James A. Haley Medical Center. The training is practical, fun and helps with the tools that our staff use daily making outcomes second nature. Escape room training has motivated, changed attitudes, and has created an enthusiasm for training. No boring moment with great impact!”

Highlights of the Escape Room included: 1) a Cipher wheel which Tampa revised to match their donning and doffing processes. We had made our cipher wheel three feet diameter, so it was very large and more visible with distance. To ensure the group of participants did not gather closely at the wheel, we had laminated index cards for the letters for each letter of word they had needed to spin the wheel. Each participant received one or two index cards of the letters they needed to spell out the certain word. Those numbers then were put together to unlock the next clue. This way, all had a chance to participate in the cipher spinning wheel which they all enjoyed.

Another station’s clue started with counting colored gummy bears. We realized the colors were a little hard to distinguish for a few staff. For example, the red color was light red, and some thought it was orange and the blue and green gummy bear colors were also questioned by a few staff each session. We then switched this clue to use different kind of candy bars to count the items that revealed the code to unlock a locked box with further clues. The candy bars worked better than the gummy bears; however, one of Tampa's simulation staff decided to try different colored dice for the same clue realizing this effect added more disparity in finding the correct numbers that was needed to unlock for the clue. A facility can adapt different variations of the clues to still have an effective escape room experience.

On the first clue, the team had to learn about a communication tool which uses an Identify, Situation, Background, Assessment and Recommendation (ISBAR). Our EMS service was unaware of this tool but after seeing it being used saw how it could be utilized in their department. Working with an interdisciplinary team also exposed all participants on how this communication tool was used with other services. Former EMS worker, Jessica Ramsdell commented on how she learned “the ISBAR was an effective communication tool that I can use with other staff.”

The most loved team building exercise was a game where the participants had to build a pyramid using cups. Each participant had a string attached to a rubber band and together as a team, they stacked the cups in the correct doffing order using illustrations of the doffing process on cups. They could not touch the cups with their hands but had to manipulate the rubber band holding each string held by each participant to make the pyramid with the six cups. This task was not easy as each participate had to work together as a team to coordinate their moves to achieve the goal of making the pyramid.

Tampa is building a new bed tower to the facility so we had some issues with construction that made sharing the game with SimLEARN somedays impossible. At times, we lost our WIFI connection so SimLEARN could not join us. Tampa saved the COVID-19 escape room power point in case we could not connect using Wi-Fi; thus, we still were able to successfully conduct the training when our internet was not working. Tampa also had days where the pounding of drills and construction noise was almost unbearable however, by working with the construction team to limit the noise on days and times these classes are conducted improved our ability to carry out better trainings.

Our COVID-19 escape room training lasts about 90 minutes. After the participants see the new PAPR and review the donning and doffing policy demonstration, the participants are ready to start the game. Participants then have thirty minutes to solve the clues to safely transport the COVID-19 patient safely in the game. When the team achieves their goal of securely transporting the patient to the different department, participants receive a prize of simulation money and chocolates. The participants also receive an evaluation after we debrief of went well in the game, what they saw as areas they could have improved on and what we and they could do to improve the game for the next time.

All in all, Team Tampa and SimLEARN perfected this concept of a COVID-19 escape room and have seen the positive ways to engage our learners. Thus far we have had over 32 staff attend the escape room. Just as Tampa needed to build upon what SimLEARN made for us to be a most effective training, your facility can do the same and both of our sites are happy to assist you. If you want to join a session with us, our contacts at Tampa are Janet.Sprehe@va.gov or Jennifer.Prinsen@va.gov and SimLEARN our contacts are Sherri.Boisvert@va.gov and Michelle.Regragui@va.gov. Let us know if you wish to observe the game in action or if you just want to learn more about incorporating this wonderful new innovative teaching modality into your simulation center.