Dayton VA ‘Sets Sail’ to Create Escape Room, Enhance Interactive Training - VHA SimLEARN
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Dayton VA ‘Sets Sail’ to Create Escape Room, Enhance Interactive Training

By Catherine Anne Volkmer, MSN, RN, Simulation Fellow and
Violet Darden, MSN, AGCNS-BC, Simulation Nurse
Simulation Fellow, Simulation Nurse
Dayton VA Medical Center

DAYTON, Ohio – Through a VA Office of Rural Health (ORH) initiative, the Dayton VA Medical Center (VAMC) created and deployed an escape room to promote teamwork and communication utilizing knowledge of common chronic diseases. Escape rooms have emerged as a new learning opportunity in simulation that fosters teamwork and problem solving through a series of time-limited puzzles. Published literature describes escape rooms as engaging and interactive, while boosting participants’ knowledge of the educational topic presented (Brown, Coronel & Darby, 2019).

Health care staff collaborate to deliver Veteran care, and the use of communication is especially important. After conducting a needs assessment, the following chronic diseases were selected for inclusion in the training: diabetes, heart failure and chronic obstructive pulmonary disease (COPD). The chronic diseases selected require the Veteran to self-manage care for long-term outcomes, which highlights the need for nurse intervention with education and follow-up. Combining non-technical skills with clinical knowledge allows for exploration of multiple objectives during the escape room.

The development of the escape room began with a review of current literature regarding escape rooms. Various articles highlighted different puzzle types, participant populations and sequences of events. The development team consisted of Dayton staff Kateri Gabriele, Violet Darden, Anne Volkmer and Julie Lee, as well as Traci Ashworth of the Cleveland VAMC. They then held a series of brainstorming sessions to determine the room theme and type of puzzles to include. Escape rooms generally have a theme, and the team of participants engage with a backstory to achieve a goal in a limited amount of time. Dayton’s escape room adopted a pirate theme and the pirates were trying to retrieve a treasure chest while managing their chronic diseases. A 6-minute orientation video was created using basic software. It established escape room safety and ground rules, outlined a back story with time limitation and introduced the “pirates.” During the introduction portion, the pirates engaged in conversation revealing clues about their health which the participants needed to complete various puzzles in the escape room.

Drawing on past experiences with escape rooms, the development team narrowed the focus, highlighting key concepts of the selected chronic diseases. The team quickly decided to design the escape room puzzles in a linear format to maximize teamwork and ensure each participant’s knowledge of chronic disease management was reviewed. The linear format requires completion of one puzzle before progressing and encourages the participants to work together.

The first task of the escape room was a cup stacking activity, which is frequently used in team building exercises. This activity requires team members to communicate and is almost impossible to complete alone. Another puzzle included selecting appropriate foods for a diabetic meal and counting the carbohydrates to move forward. The last task of the escape room involved a unique puzzle, which combined clues from throughout the scenario regarding each chronic disease management principle such as medication education, diet modification, home care and exacerbation management. After developing each puzzle, the development team coordinated to create an operable flow. Piloting the escape room involved three interprofessional teams. Based on pilot feedback and observations, the team then adjusted the puzzles, clues and environment.

Dayton’s escape room involved many learner populations to include rural outpatient nursing and administrative staff, Dayton VAMC primary care staff, various employees from across the Dayton VAMC during its Healthcare Simulation Week, and Transition to Practice cohorts. Emphasis on teamwork and communication during creation and facilitation allowed these various participant populations to successfully complete the objectives.  

When the escape rooms were conducted in the Community Based Outpatient Clinics (CBOC’s), a special emphasis was placed on the objectives of teamwork and communication in the debriefing sessions. After the escape room, debriefing allowed the participants to reflect upon the activity and relate the experience to their daily Veteran care routines.

Participants of the escape room said, “I enjoyed doing this training,” and “great way to practice teamwork.” To date, Dayton has had over 100 participants, and feedback from evaluations has been positive, with over 90% of participants stating they enjoyed the training.


1Brown, N., Coronel, H. & Darby, W., (2019). An escape room as a simulation teaching strategy. Clinical Simulation in Nursing, 30(C), 1-6.