Director of the Medical ICU and clinical professor in Pulmonary, Critical Care, and Occupational Medicine, Kevin Doerschug, MD, and Desmond Barber, MD, first-year pulmonary and critical care fellow, have designed a new method of instruction that combines puzzle-solving, teamwork, and didactic lessons. The pair devised an Escape Room around the steps and equipment necessary for a successful and safe intubation for members of the airway team to navigate.

“Every time an ICU intubation needs to be performed,” Doerschug says in an introductory video sent to participants, “these steps should be followed to maximize success and improve situational awareness.” He walks viewers through the APPROACH mnemonic, explaining the importance that everyone on the airway team shares the same understanding.

Three different teams of physicians, nurses, and respiratory therapists, who all work in the MICU, were invited to take part in the pilot course and give their feedback. In addition to the video, Doerschug and Barber also sent out an assessment to set a baseline of understanding of intubation specifics, to be later measured against a post-event assessment.

With a little discussion beforehand and while Doerschug and Barber observed, the teams had 20 minutes to locate the medicine and equipment necessary to effectively intubate a simulated patient in distress.

Everything the team needed to use the APPROACH method was located throughout the simulation center’s practice space. Clues led to more clues or to the means to open locks on cases. An oddly placed hand hygiene reminder deserved exploration, a black light pen was shined around on various surfaces, each clue relevant to aspects of the lesson.

In one team’s run, at first there was a lot of rushed rummaging but then as patterns began to emerge so did their excitement to share information with each other and suggest the use of clues they had discovered on other discovered pieces. Teamwork, especially once the pieces of the equipment were finally assembled, became essential. And the “patient” was successfully rescued.

Participants discussed afterward what went well, what they enjoyed, and most important how well they had retained the lessons Doerschug and Barber hoped to teach or to reinforce. These post-event interviews and the written surveys they completed will inform the pair’s revisions before the next “escape” event.

We would like to share more photos to accompany this story, but to do so would give away too many secrets and spoil the discovery for future participants. It is possible that new puzzles will be designed but for now, since the curriculum is still in its pilot phase, the secrets will remain safe.