Lessons Learned from an Escape Room Educational Intervention for Telephone Triage Nurses

Purpose: This study examined the impact of an escape room educational intervention on the knowledge, preparedness, confidence, and perceptions of teamwork of nurses working in pediatric telephone triage (PTT).
Background/significance: In PTT, nurses assess pediatric health concerns with caregivers, using guiding documents and algorithms. These services have been shown to decrease emergency department and urgent care visits. However, misinterpreted or absent data could create delayed access to care. This is enhanced in pediatric settings, where the triage nurse depends on caregivers’ interpretations. Ongoing educational efforts are vital to review good catches and missed opportunities and ensure that all team members have access to updated information. This intervention was chosen as literature showed that escape rooms are enjoyable and stimulate.
Methods: This study used a quantitative pre-/post-study on two dates in August 2024. The convenience sample was comprised of PTT nurses within a hospital. Six Likert-scale questions focused on pre- and post-intervention comparisons while four questions addressed participant satisfaction with the process. The intervention included activities surrounding an educational activity. Correct answers allowed participants to collect miniature ducks. Winning activities included getting the ducks in a row.
Results: The sample had a long tenure in nursing, with 81.57% having 15 years or more of nursing experience. Length of time working in telephone triage was fairly equally divided among groups who had worked for 0-2 years (26.32%), 3-5 years (23.68%), 6-8 years (21.05%), and 9-11 years (21.05%). Education levels were high with 86.84% of the sample holding a BSN and/or MSN degree.
A Wilcoxon signed-rank test showed that there were significant improvements in nurses’ confidence (Z = -2.308, p = 0.021), preparedness (Z = -2.232, 0.026), and knowledge (Z = -2.414, p = 0.016) after the escape room intervention. Positive trends were also observed in comfort with peers, feeling part of the team, and teamwork, although these changes were not statistically significant (p > 0.05). The median scores for all measured aspects were consistently 10 for both pre- and post-intervention.
Conclusions/implications: The sample comprised a highly experienced cadre of nursing professionals, many of whom have worked together for several years. Despite high pre-intervention levels of confidence, preparedness, and knowledge, participants showed statistically significant improvement. Questions on teamwork and collegiality also had high pre-intervention levels, but improvement on these scores lacked statistical significance.
The intervention became a competitive and engaging activity which was rated highly by participants both in the survey and in discussions about the experience. Teams were on their feet, huddled around the tables and shouting out answers.
Lessons learned from this activity included the need to design measurement strategies that did not “give away” answers to the case studies. The need to describe or select specific answers exposed learning needs that had not been previously discovered with lecture or discussion activities. This created new insight into educational needs that arose through the interactive nature of the activity.