Lights. Camera. Robot Action!
With baby and mother dummies, Paul Preston directs a labor-and-delivery rehearsal that's become a smash hit
In 2001, Preston decided that his new mission in life would be to help create a healthcare system where no one would be intimidated. A minister's kid from Wheeling, W.Va., Preston is particularly well suited for the job. He is as affable and ingenuous as an 8-year-old and seemingly bereft of doctor ego. He knew that Kaiser wasn't about to pop for a multimillion-dollar simulation lab. So Preston--working with many colleagues and the advice of Gaba and aviation researchers--put together a robot roadshow. Since 2002, he has spent about half his time traveling to hospitals, running training sessions for the thousands of men and women who staff the labor-and-delivery units in Kaiser's 29 California hospitals. "He's the guy who will finish a day in the operating room, throw the robots in the car, drive for two hours, and spend the night setting up the robots," says Michael Leonard, Kaiser's physician leader of patient safety.
The robot patients, who can gasp, urinate, undergo surgery, and give birth, are surprisingly realistic, right down to their pulse rates. "You lay aside that it's pretend," O'Keeffe said after her first experience practicing medicine on a robot. "It's amazingly real." That's despite the fact that Preston, unable to spend $25,000 on another pregnant robot, improvised by oufitting the male model O'Keeffe used with a womb made of carpet padding and duct tape.
Playback. But Preston is the first person to say that the point is not that the robots are cool gizmos. "If I were the patient, would I want it to be the first time the doctor had done the procedure? Of course not! Clearly, we need robots," says Preston. "And clearly, we need people to be trained as part of a team." The program includes communication skills training as well as motivational data: For example, birth injuries to children are the most costly malpractice claims, and 1 in 4,000 deliveries ends in a bad outcome.
Thrilling though the robot theater may be, the heart of the session at Walnut Creek was the debriefing. The OR team watched a video playback of the delivery and quickly spotted where things went wrong. One nurse said she couldn't hear the anesthesiologist. Another said that because she doesn't work in a regular OR, she wasn't aware that malignant hyperthermia was a life-threatening emergency. But they also noted when things went right. For example, O'Keeffe recognized the condition as the first symptom appeared, and the whole team mobilized quickly once they realized what was afoot. One result: The hospital is considering putting a second cart with Dantrolene closer to the obstetrics operating suites. (Dantrolene is expensive and rarely used, so most hospitals stock just one cart.) "We find stuff that really should be attended to," says Preston. "When we go back later, we find out they've fixed it all."
Kaiser managers say that after team training, staff attitudes improve dramatically, doctors communicate better, and nurses are less likely to quit (high nurse turnover increases the odds of mistakes). And Preston is now taking the robots to Kaiser nationwide, branching out into cardiac catheterization labs and medical-surgical wards, and is training doctors and nurses to be robot impresarios, too. Ascension Health is launching a perinatal safety program building on the Kaiser model in 43 of its hospitals next month. "I don't go to these places with answers," he says. "I go with, gee, how can we work on this together? It's always fun."
Born: Wheeling, W.Va., 1959 Family: Married; one daughter Education:B.S., Transylvania University, Lexington, Ky., 1979; M.D., Johns Hopkins School of Medicine, 1983 Summer vacation:Volunteers to teach anesthesia at medical schools in Africa. This year, he's heading to Zimbabwe.
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