About the Game
OutSMA℞T Delirium is an educational serious game being developed by the CRoME Lab at the University of Kentucky to train nursing staff on the recognition, prevention, and management of delirium and agitation in acute and emergency care settings. The game gives learners a safe, low-pressure space to practice the clinical judgment that makes the biggest difference at the bedside: noticing the early signs of delirium and responding quickly and appropriately.
Developed with the UK HealthCare Emergency Department Team
OutSMA℞T Delirium is being developed in partnership with the UK HealthCare Emergency Department Team. The concept grew out of collaboration with Dr. Jessica Houck, who leads the Geriatric Emergency Department team at UK HealthCare, and is being shaped alongside emergency department nursing staff and clinical experts to ensure the training reflects real bedside practice.
Why Delirium?
Delirium is a common and serious condition among hospitalized patients, yet it is frequently missed. It has no cure — the most meaningful clinical lever is early recognition followed by swift, protocol-driven intervention. OutSMA℞T Delirium is grounded in evidence-based delirium care and uses game-based learning to build the observation, assessment, and decision-making skills that help nursing staff catch delirium sooner and care for patients more effectively.
Learning Objectives
By playing OutSMA℞T Delirium, nursing staff will be better able to:
- Identify the verbal, conversational, and behavioral signs of delirium and agitation.
- Distinguish delirium from agitation — and recognize when the two occur together.
- Apply evidence-based, non-pharmacological strategies to prevent and de-escalate delirium and agitation.
- Strengthen communication and clinical decision-making when caring for confused or agitated patients.
- Recognize that delirium risk is not limited to older adults — any hospitalized patient can be affected.
How It Works
OutSMA℞T Delirium takes inspiration from the escape-room genre — but instead of racing a clock, the player is racing a patient's deterioration. Each scenario is a self-contained puzzle where the “room” you have to escape is diagnostic uncertainty. The game is conversation-first: you learn to notice delirium the same way you would at a real bedside, by paying close attention to how a patient talks and behaves.
Observe
Meet the patient through conversation. Delirium often shows up in what a patient says — and fails to say — before it is visible any other way.
Assess
Read the cues, weigh the risk factors, and judge the patient’s state — is this delirium, agitation, both, or neither?
Respond
Choose an intervention. Get immediate feedback with the clinical reasoning behind it, and try again — the goal is learning, not a score.
There is no time pressure and no failure state. When a judgment or intervention is off, the game explains what was missed and lets the learner try again with that added context — an approach designed to reduce anxiety for newer clinicians while actively correcting misunderstandings.
How We're Building It
OutSMA℞T Delirium is being built with a new, AI-accelerated development approach — the same one behind the CRoME Lab's Crossroads game. Instead of building slowly from scratch, our developer uses AI tools to prototype and iterate rapidly.
Crucially, this is not an “all-AI” process. We practice human-in-the-loop development: by giving the AI precise information and a strong creative foundation up front, we dramatically speed up development while keeping the reliability of the content and the power of human decision-making firmly in people's hands.
Speed of AI, judgment of people.
- Clinical experts & stakeholdersReview the game and give feedback at every stage, so the content stays accurate and clinically sound.
- An artist’s hand-drawn artOriginal illustrations give the AI accurate visual reference and ready-to-use starting assets — not generic, generated imagery.
- Our project teamMakes the final calls on direction, content, and design — people stay in charge of every decision.
Team & Partners
OutSMA℞T Delirium brings together expertise in pharmacy practice, geriatric emergency care, delirium research, educational game development, and health professions education:
- CRoME Lab
- University of Kentucky College of Pharmacy
- UK HealthCare Emergency Department Team
- Geriatric Emergency Medicine collaborators
Development Status
OutSMA℞T Delirium is currently under active development. Our team is working closely with UK HealthCare Emergency Department nursing staff and clinical experts to build a meaningful, evidence-based learning experience. A playable version will be shared here as it becomes available — please check back soon.
Contact
For questions about OutSMA℞T Delirium or this research, please contact the Principal Investigator, Dr. Olufunmilola Abraham, by email: Olufunmilola.Abraham@uky.edu.
For questions about the CRoME Lab, our studies, becoming a participant, or joining the team, please contact the Research Coordinator by email: crome.lab@uky.edu.