Doctors clad in head-to-toe surgical gear clustered around an operating table in a brightly lit room at Cedars-Sinai Medical Center. Lying in a pool of blood on the table in front of them was 30-year-old David Escobar, who just had a tracheotomy tube inserted into his throat as the doctors accessed his chest to control bleeding.
The only signs that this emergency surgery was anything other than real were the video cameras circling the patient and the smattering of onlookers craning their necks to watch the procedure. Escobar is, in fact, a technician at the Women’s Guild Simulation Center for Advanced Clinical Skills, and he’s donned a $60,000, state-of-the art surgical training apparatus called a Cut Suit so that new and veteran doctors can sharpen their knife skills.
“If you have a real human being laying there, in a real operating room, and they’re cutting into what they think is a real person, that sticks in their mind,” said Russell Metcalfe-Smith, health systems manager for the simulation center. “It doesn’t have to be a real patient, but it’s a real experience.”
The Cut Suit has traditionally been used as a practice tool for military, law enforcement, and first responders, but an increasing number of medical schools and hospitals have been purchasing it for hands-on training. Cedars began using the suits a few months ago, investing in this new technology with the expectation it will pay off in both lives saved and reduced financial costs for patients, hospitals, and the health care system as a whole.
Medical error is the third leading cause of death in the United States, resulting in more than 250,000 deaths a year, according to a report released in May from Johns Hopkins University researchers.
Dr. Alistair Phillips, co-director of the Guerin Family Congenital Heart Program at Cedars, likened the necessity for medical simulation to that of pilots learning to fly. For example, Chesley “Sully” Sullenberger had practiced the famous emergency landing he executed on the Hudson River in 2009 in a simulation session prior to the actual event, said Phillips. While doctors can practice procedures on mannequins, the Cut Suit, worn by a live person, provides an added level of realism that allows residents to immerse themselves in the experience.
“Even though you’re cutting into, basically a costume, … there’s a person there,” said Phillips. “Team-based simulation is the future of medical education.”
Medicine meets Hollywood
The simulation center opened three years ago at Cedars, and the 10,000-square-foot space includes two fully functional operating rooms, an intensive care unit, an OB/GYN unit, and a trauma bay. Each room is set up to mirror an actual facility, complete with lifelike mannequins that have heartbeats, blink, talk, and breathe, and can even be used to practice obstetric procedures and heart surgery.
Over the course of a year, more than 20,000 staff and visiting medical personnel will use the simulation center’s services, said Metcalfe-Smith, from top-notch surgeons sharpening their skills to cleaning crews practicing decontamination of hospital rooms. In addition to internal medical staff, the center has hosted training sessions for local schools and emergency service teams, including paramedics from the Beverly Hills Fire Department.
“We can reduce the amount of error by making sure staff are confident and competent here in the simulation facility,” he added.
Even if a medical mistake isn’t fatal, it can result in costly, long-term health or financial complications for a patient and health care provider, said Metcalfe-Smith.
That’s where the Cut Suit comes in.
Cutting-edge
Designed and manufactured by San Diego-based Strategic Operations Inc., the Cut Suit is made of plastics and elastomers including silicon and urethane, a much safer material on which to practice than human tissue.
“If you can’t make a mistake, you don’t know how to recover from it,” said Kit Lavell, Strategic Operations’ executive vice president.
The company was founded in 2002 as part of Stu Segall Productions, a TV and film studio that specialized in action and adventure flicks. The studio saw a sharp decline in production demands after the 9/11 terrorist attacks, so Segall decided to repurpose the hyper-realistic sets, props, and special effects to go into the business of military and law enforcement training.
“We created a unique blend of military and Hollywood,” said Lavell.
Strategic Operations has been developing the surgical Cut Suit over the last five years, he said, building a three-dimensional, interactive training tool with skin that can be sliced open and ribs that can be broken. The surgical Cut Suit comes equipped with synthetic blood designed to look, and even smell, like the real thing and uses a patented “Liquid Ass” smell that gets released when an incision is made into the bowels.
Growing industry
While national medical school standards set by the Accreditation Council for Graduate Medical Education require residents in certain programs have access to simulation, the way in which this training is fulfilled is at a school’s discretion.
USC’s Keck School of Medicine doesn’t use Cut Suits, said Dr. Maura Sullivan, executive director of the surgical skills training and education center in the department of surgery.
Although they do provide a valuable level of realism, she said, it’s important to focus on what best serves the curriculum and get past the bells and whistles of new simulation technology.
“It’s expensive, and these products all cost money, so you have to decide the risk- benefit ratio,” she said.
In addition to cost, simulation mannequins and technology are still synthetic, said Sullivan, who believes in using real flesh whenever appropriate. That’s why at USC, she opts to teach with human cadavers, which cost anywhere from $1,500 to $3,000 each and can be used to practice six to seven procedures.
“It is more cost-efficient for us and we just tend to like practicing on human tissue,” she said.
USC has the added luxury of being able to store the cadavers for extended use, as the school has access to the crypts at Los Angeles County-USC Medical Center.
Whatever the method, the ultimate goal of medical training is to develop simulation scenarios that mimic actual clinical settings, Sullivan said, allowing doctors to practice technical skills, beef up their confidence, and learn how to respond in high-stress situations.
Strategic Operations’ surgical Cut Suit is just one facet of this rapidly growing industry.
In September of last year, Strategic Operations signed a distribution deal with CAE Healthcare, an international manufacturer of simulation technologies. In addition to Cedars, the Cut Suit is being used at a few dozen hospitals and medical schools throughout the country.
The suit is reusable and can be stitched or “welded” after each use, so it can be practiced on about 300 times before requiring replacement skin or organs, said Metcalfe-Smith. He touts it as a common-sense approach to improving quality of care that will save money for patients, doctors, and health care systems in general in the long run.
“We are going to see a reduction in problems, we are going to see a reduction in adverse events, we are going to start delivering better care,” he said.
