Twelve tips for creating an escape room activity for medical education.

Communication, teamwork, and resilience all require active practice by healthcare teams. Games such as escape rooms can add variety, interactivity, and value to teaching sessions. Escape room activities typically include a variety of sequential puzzles that lead participants to break free of a room, or can be adapted into an 'escape box' challenge where participants work to successfully unlock a box. Escape room or escape box exercises can help healthcare teams develop and enhance team skills, as well as reinforce medical knowledge. We developed an escape box session to teach and reinforce organizational Safety II principles and the resilience potentials: monitor, respond, learn, and anticipate. We report 12 tips to effectively organize and develop an escape room or escape box activity for multidisciplinary healthcare teams.

Rapidly building surge capacity within a pandemic response using simulation-based clinical systems testing.

Introduction: As the SARS-CoV-2 virus spread across the globe, hospitals around the USA began preparing for its arrival. Building on previous experience with alternative care sites (ACS) during surge events, Texas Children's Hospital (TCH) opted to redeploy their mobile paediatric emergency response teams. Simulation-based clinical systems testing (SbCST) uses simulation to test preoccupancy spaces and new processes. We developed rapid SbCST with social distancing for our deployed ACS, with collaboration between emergency management, paediatric emergency medicine and the simulation team. Methods: A two-phased approach included an initial virtual tabletop activity followed by SbCST at each campus, conducted simultaneously in-person and virtually. These activities were completed while also respecting the need for social distancing amidst a pandemic response. Each activity's discussion was facilitated using Promoting Excellence and Reflective Learning in Simulation (PEARLS) for systems integration debriefing methodology and was followed by compilation of a failure mode and effects analysis (FMEA), which was then disseminated to campus leaders. Results: Within a 2-week period, participants from 20 different departments identified 109 latent safety threats (LSTs) across the four activities, with 71 identified as being very high or high priority items. Very high and high priority threats were prioritised in mitigation efforts by hospital leadership. Discussion: SbCST can be rapidly implemented to hone pandemic responses and identify LSTs. We used SbCST to allow for virtual participation and social distancing within a rapidly accelerated timeline. With prioritised FMEA reporting, leadership was able to mitigate concerns surrounding the four Ss of surge capacity: staff, stuff, structure and systems.