Presented By: Samuel Tisherman, University of Maryland Medical Center
Co-Authors: Nicholas Morris, University of Maryland Medical Center

Purpose
Delayed recognition of patient deterioration and poorly coordinated responses contribute to poor outcomes. The purpose of this project was to improve rapid response to the deteriorating patient through a layered learning model involving a gaming app and in-situ simulation. 

Methods 
The layered learning model was utilized to build from previous traditional didactics using a multi-platform game-based application to prime learners for the subsequent in-situ simulation. The game was distributed to first-line responders and focused on: Recognition of respiratory compromise, early activation of the rapid response team, preparation of critical care resources prior to rapid response team arrival, effective communication, and empowerment to advocate for patient safety. We coupled this experience with in-situ simulation followed by facilitated debriefing. Participants completed evaluations after the in-situ simulation. 

Results 
113 participants played the game a total of 465 times with an improvement of 24% noted over an average of 5 game plays. Successful attempts were measured by performing critical actions necessary to rescue the deteriorating patient. The mean percentage of critical actions on the first play was 52% compared to 70% on the third play and 76% by the fifth play. Additionally, 92 multidisciplinary team members (to include but not limited to nurses, patient care techs, rapid response team members, advanced practice partners, pharmacy staff) participated in an in-situ simulation. On evaluations, participants commented on an overall change in confidence and feeling more comfortable calling for help (as well as calling for the rapid response team), escalating care early, speaking up when needed, and performing closed-loop communication following the in-situ simulation. 

Conclusion 
Through a layered learning intervention comprised of a gaming app and in-situ simulation participants reported improvements in care delivery. Further quantitative and qualitative assessment of the intervention is warranted.