Hospital errors account for more deaths in the United States than car wrecks and breast cancer. And those mistakes cost money.
One health care provider wants to reduce that cost — and make patients safer in the process — by training doctors and nurses with fake patients.
Peter O'Dowd for NPR
A mannequin patient at the Banner Simulation Medical Center in Mesa, Ariz. One of these artificial patients costs at least $40,000.
A mannequin patient at the Banner Simulation Medical Center in Mesa, Ariz. One of these artificial patients costs at least $40,000. Peter O'Dowd for NPR
Banner Health in Arizona is about to open this hospital ghost town of sorts. Lifeless mannequins will bleed, burp and give birth in the center's ICU and emergency room.
Thomas McTool is a middle-aged man made of plastic and rubber tubes. He came to the ICU two days ago complaining of chest pains, and now he's hooked up to machines that measure his breathing and blood pressure. In a room around the corner, a real person controls the mannequin's voice and vital signs.
When the technician stops McTool's virtual heart, the hospital staff jumps into action. Suddenly it's hard to tell the difference between real life and make-believe.
"I'm losing a pulse!" says one nurse.
Don't worry — McTool survives this heart attack, but he'll probably have a few hundred more in the next year. Full-scale training classes for nurses and doctors across Banner's seven-state network are about to begin here. And few private companies have made such an expensive investment to advance simulation training.
Mark Smith is the doctor in charge.
"The beauty of it is that it's what we call a consequence-free environment," Smith says. "It's much better to learn here and lose a patient than it is on the floor when you're taking care of live patients."
The building being used for the fake hospital was once a functioning hospital. The former emergency department is lined with identical patients. Plastic infants sleep in real baby warmers in the newborn ICU. And in the operating room, a patient is perpetually spread out on the table.
Smith says 60 of his plastic people can suffer from a medical menu of ailments: infection; septic shock; upper gastrointestinal bleeding; pulmonary embolisms; overdose of medication; breech birth.
A pregnant female dummy can talk about what she's going through: "My water broke! I'm having contractions!"
Denielle Headley, a training nurse, steps in to address this dummy's labor.
"OK, honey," Headley says. "I need you to breathe through it, OK?"
Headley is helping this rubber mother-to-be give birth. And by the way, the baby really is coming out of the mother's virtual uterus. Headley says nurses know the patient isn't real, but they sweat and shake with adrenaline anyway.
"You see?" Headley asks. "This is exactly how you will feel and what you will do in the code."
Peter O'Dowd for NPR
This mannequin patient is giving birth at the Banner Simulation Medical Center.
This mannequin patient is giving birth at the Banner Simulation Medical Center. Peter O'Dowd for NPR
After a third or fourth try, Headley says the nerves just melt away.
"They become more refined in their movements as they do things," she says. "And they become more efficient and even quicker."
That's why it's hard to find a medical school or hospital that doesn't praise this technology. Studies show residents who work on simulators develop skills faster than those who learn from more traditional methods.
Randolph Steadman runs the simulation lab at UCLA. He's a fan of the mannequins, but he's honest about their limitations. And there are at least two worth mentioning. Let's say you're practicing delivering a baby:
"Who comes out blue because of the cesarean section?" Steadman asks. "We don't have plastics that turn blue on command."
It's possible that one day a plastic baby will be able to turn blue on command. But that will probably make the next problem worse: money.
Worth The Investment?
Banner has spent more than $12 million on its training hospital. An inexpensive mannequin costs $40,000. But Steadman says there is little evidence that shows this technology actually saves the much-quoted 44,000 to 98,000 lives thought to be lost each year to hospital errors in the U.S.
"That has been the Achilles heel of the technology," Steadman says.
So why dump money into a talking dummy if you're not sure the simulated delivery will save a mother or her child's life?
Ray Mitchell, the dean of the Georgetown University Medical School, says doctors can innovate on a budget, with similar results. For example, you can build a rib cage with chicken wire, and then practice sewing sutures with beef lung from the butcher.
"That is satisfying to the curmudgeon in me, to say the BMW or the Lexus may not always be the best," Mitchell says. "It's how you use the tools you have."
Banner administrators in Arizona say they are satisfied that their investment will eventually pay off. That's because they believe the monetary cost caused by medical error will go down. And, they add, a safer patient is ultimately a happy returning customer.