{
  "abstract": "Introduction: Reliable delivery of paediatric resuscitation care depends on effective teamwork, leadership and timely application of Pediatric Advanced Life Support (PALS) principles. In teaching hospitals, infrequent exposure to real-life paediatric emergencies can lead to variability in team performance and decline in confidence and variability in application of resuscitation principles between certification cycles. Innovative, low-cost strategies are needed to support ongoing team readiness and reliability of emergency care.\n\nProblem: At a tertiary teaching hospital, paediatric resident doctors and nurses receive formal PALS certification early in training with limited opportunities for structured reinforcement thereafter. This created a local quality gap in maintaining consistent team performance and confidence during paediatric emergencies.\n\nObjectives: To assess the feasibility and preliminary impact of an escape room–based simulation intervention as a quality improvement strategy to reinforce PALS knowledge, team readiness, confidence and application of PALS principles among paediatric resident doctors and nurses.\n\nMethods: A single-centre, mixed-methods quality improvement feasibility initiative with educational outcome measures using a pre–post design was conducted over 6 months. An interprofessional escape room–based simulation comprising three paediatric emergency scenarios (cardiopulmonary arrest, respiratory emergencies and shock) was implemented. Outcome measures included changes in knowledge scores, self-efficacy ratings and team performance assessed using the validated Team Emergency Assessment Measure (TEAM). Qualitative feedback from structured debriefings informed process evaluation and iterative refinement.\n\nResults: The self-efficacy questionnaire significantly improved confidence across the cognitive, affective and psychomotor domains, with median scores increasing from 3.5 (IQR 2.6–4.0) to 4.8 (IQR 4.6–5.0), p=0.005. Immediate post-intervention knowledge scores increased from 66% to 70% (p=0.004). The TEAM scores indicated excellent teamwork, particularly in the cardiopulmonary scenario. The participants described the escape room as engaging, novel and helpful in enhancing clinical reasoning and collaboration.\n\nConclusions: Escape room–based simulation is a feasible and acceptable quality improvement intervention to reinforce paediatric resuscitation knowledge and support team readiness in paediatric emergency training. While not a replacement for formal PALS certification, it may serve as a sustainable adjunct to reduce variability in team performance between certification cycles. Further work is needed to evaluate longitudinal impact and scalability.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Paediatrics and Child Health, The Aga Khan University Hospital, Karachi, Sindh, Pakistan",
    "Department of Nursing, The Aga Khan University Hospital, Karachi, Sindh, Pakistan",
    "Centre of Innovation in Medical Education, The Aga Khan University Hospital, Karachi, Sindh, Pakistan"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Hina Mumtaz Hashmi",
      "orcid": "0000-0002-9309-2332"
    },
    {
      "affs": [
        0
      ],
      "name": "Naveed Rehman"
    },
    {
      "affs": [
        1
      ],
      "name": "Safina Shakeel Ali"
    },
    {
      "affs": [
        2
      ],
      "name": "Selina Hasan"
    },
    {
      "affs": [
        2
      ],
      "name": "Iqra Navroz"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4476n139phz2w.bib",
  "cited_by": 0,
  "doi": "10.1136/bmjoq-2026-004313",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13711611/",
  "id": "4476n139phz2w",
  "issns": [
    "2399-6641"
  ],
  "landing_url": "https://doi.org/10.1136/bmjoq-2026-004313",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "1506"
    ],
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2737|Simulation-Based Education in Healthcare"
    ]
  ],
  "openalex": "W7223279073",
  "pdf_url": null,
  "pmcid": "PMC13711611",
  "pmid": "42919614",
  "published": "2026-10-23",
  "publisher": "BMJ Publishing Group",
  "ris": "https://research.draconitic.com/paper/4476n139phz2w.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T12:22:21Z",
      "native_id": "PMC13711611",
      "source": "pmc",
      "url": "https://doi.org/10.1136/bmjoq-2026-004313"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2737|Simulation-Based Education in Healthcare",
      "subfield": "physiology"
    }
  ],
  "title": "Escape, Relearn and Retain: using escape rooms as a simulation based quality improvement project to reinforce Pediatric Advanced Life Support retention at a teaching hospital",
  "title_text": "Escape, Relearn and Retain: using escape rooms as a simulation based quality improvement project to reinforce Pediatric Advanced Life Support retention at a teaching hospital",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:22:21Z",
  "url": "https://research.draconitic.com/paper/4476n139phz2w",
  "venue": "BMJ Open Quality",
  "versions": []
}