As a baby in the 1980s, I got very ill. When my condition worsened instead of improved, my mother found herself desperately pleading with ER nurses that I be admitted. My family would soon learn I was severely septic. Relatives came to the hospital to say good-bye. I lost almost a third of my body weight, my skin tone turned grey, and parts of my head were shaven to allow tubes to disappear into my small skull. While I don’t consciously remember this, it shaped my identity each time my mother, still visibly upset, told me the story.
However, I’ve learned that my story is not unique. In 2012, 12-year-old Rory Staunton’s sepsis diagnosis was also delayed, and when he returned to the ER, also in severe septic shock, it was too late to save him in the ICU. Rory’s story was highly publicized in the New York Times, but sepsis isn’t a new story.
Sepsis is everywhere. Each year, more than a million people in the United States will develop severe sepsis, and up to half of those people will die. Think about that for a moment: That’s the entire population of Cincinnati, Ohio. That’s more than all annual U.S. deaths from prostate cancer, breast cancer, and AIDS combined. How is it possible that, even after the 30 years of medical evolution since I was septic in the ICU, delayed sepsis diagnoses are still this common?
We know that every hour septic shock is untreated, the risk of death increases by 8%. Early recognition is important. In 2011, a multidisciplinary team at Stanford brainstormed an effective way to educate health care professionals to recognize and treat sepsis earlier. A free, mobile gaming platform seemed more accessible, engaging, and effective than a traditional lecture; this platform was also less expensive than traditional simulation (e.g., mannequins). The basic concepts of Tetris, a popular video game developed in the mid-1980s, were utilized as the framework for Septris. Septris is a game where multiple patients “fall” to their deaths and learners receive points and immediate feedback on clinical decisions (e.g., ordering fluids, cultures, diagnostics, antibiotics, consults). Septris emphasizes implementing evidence-based guidelines into practice.
Preliminary study of Septris’s impact has been positive. By October 2014, Septris had garnered over 61,000 visits worldwide. After playing Septris, both pre- and postgraduate groups at Stanford significantly improved their knowledge on written testing in recognizing and managing sepsis. Retrospective self-reporting on their ability to identify and manage sepsis significantly improved as well. Eighty-five percent of learners reported they would or would maybe recommend Septris (for more information on Septris, see our recent innovation report).
Moving forward, I invite you to try on some new ideas for the old news at your institution. Two areas to consider: (1) Rory Staunton’s story impacted New York hospitals’ approach to sepsis screening. How will your institution screen for early identification of sepsis and standardize treatment through sepsis bundles? (2) Soon after the creation of Septris, Stanford developed SICKO. Currently, Stanford is developing a new game to teach residents about quality improvement and patient safety concepts/best practices (e.g., hand hygiene, root cause analysis, safety culture/reporting). What is your institution’s vision of how gaming can improve medical education and clinical outcomes? What health epidemic in your practice would benefit from a free, mobile gaming platform? The possibilities are infinite and critical.