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
- 1Department of Paediatrics and Child Health, The Aga Khan University Hospital, Karachi, Sindh, Pakistan
- 2Department of Nursing, The Aga Khan University Hospital, Karachi, Sindh, Pakistan
- 3Centre of Innovation in Medical Education, The Aga Khan University Hospital, Karachi, Sindh, Pakistan
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.
Problem: 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.
Objectives: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Related
- Improving Awareness of Oman Medical Specialty Board Training Bylaws Among First-Year Pediatric Residents Using a Flipped Classroom Intervention: A Quality Improvement Project
- Greater and Clinically Meaningful Improvement in Health-Related Quality of Life After Device-Aided Therapy in Younger Patients Earlier Within Advanced Parkinson’s Disease: Real-World Evidence from the DATs-PD GETM Spanish Registry
- Case Report: Improvement in neurologic symptoms and remission following non-operative management of locally advanced cutaneous squamous cell carcinoma of the head and neck following cemiplimab therapy: two cases
- Delayed Retention of Technical Surgical Skills Following Virtual, Augmented, and Mixed-Reality Simulation: A Systematic Review and Meta-analysis
- Improvement of survival in advanced gastric cancer over 15 years: real-world analysis by 5-year periods.
BibTeX
@article{hashmi2026escape,
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}},
author = {Hina Mumtaz Hashmi and Naveed Rehman and Safina Shakeel Ali and Selina Hasan and Iqra Navroz},
journal = {BMJ Open Quality},
year = {2026},
month = oct,
doi = {10.1136/bmjoq-2026-004313},
url = {https://doi.org/10.1136/bmjoq-2026-004313},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Hina Mumtaz Hashmi
AU - Naveed Rehman
AU - Safina Shakeel Ali
AU - Selina Hasan
AU - Iqra Navroz
PY - 2026
DA - 2026/10/23
JO - BMJ Open Quality
DO - 10.1136/bmjoq-2026-004313
UR - https://doi.org/10.1136/bmjoq-2026-004313
AB - 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. Problem: 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. Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.
SN - 2399-6641
ER -