Patient Safety Escape Room: A Team Simulation in Recognizing and Reporting Patient Safety Hazards.

Medical errors harm patients and increase costs. Engaging early clinicians in patient safety (PS) is critical but challenging. We evaluated the impact of a Patient Safety Escape Room (PSER) simulation on intern engagement in PS. During the PSER, learner teams identified PS hazards in a simulated hospital room, revealing clues that allow "escape" via event report entry. One-hundred twenty interns from 14 training programs completed 2 PSERs each. Before the PSER, 5% reported experience entering an event report. Following the PSER, all interns had participated in entering an event report. Mean learner-reported comfort in identifying PS hazards improved significantly (6.3 ± 1.57 to 8.0 ± 1.2; P < 0.001). Individual safety hazards were identified by between 6% and 100% of teams. Mean observer-rated teamwork was lower than learner-rated teamwork (41.5 ± 5.18 versus 45.92 ± 3.87; P = 0.01). Subsequent resident reporting rates did not increase compared with historic controls. The PSER engaged early learners, however, translating improvements into the clinical environment remains challenging.

Making Room at the Bedside: Improving Communication Alongside Medical Education Through Interdisciplinary Rounds.

Interdisciplinary rounding has been shown to improve patient safety and provider engagement. Many models for interdisciplinary rounding have been proposed but few focus on preserving bedside medical education. The authors changed the interdisciplinary bedside rounding model to accommodate more time for medical education. The objective was to assess perceptions of communication, care coordination, and teamwork surrounding this change. Resident and attending physicians and unit-based nursing staff completed an anonymous online survey prior to and following the rounding intervention. Length of stay on medical units also was monitored prior to and following the rounding intervention. Following the intervention, there were perceived improvements in interdisciplinary communication, care coordination, and teamwork, and there were no significant changes in length of stay.

Leveraging Structural Changes in an Electronic Health Record Tool to Standardize Written Handoff.

Miscommunications during patient handoff can lead to harm. The I-PASS bundle has been shown to improve safety outcomes. Although effective training reliably improves verbal handoffs, research has demonstrated a lack of effect on written handoffs. The objective was to compare written handoff before and after integration of a standardized electronic health record (EHR) tool. Interns at a large urban academic medical center underwent I-PASS handoff training. The EHR handoff tool was then revised to prompt the I-PASS components. Handoff documents were obtained before and after the intervention. More handoffs included Illness Severity (33% to 59%, P < .001) and Action List (65% to 83%, P = .005) after the intervention. There was no change in handoffs with miscommunications (12.5% to 10%, P = .566) or omissions (8% to 11%, P = .447). Handoffs including tangential or unrelated information decreased (20% to 4%, P = .001). A written handoff tool can reinforce the effect of training and increase adherence to I-PASS.