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updated 7/22/2011 8:20:35 AM ET 2011-07-22T12:20:35

Hospitals can be hazardous to your health. This isn't an official Surgeon General's warning, but maybe it should be. As many as 98,000 Americans die every year as a result of medical mistakes. Others survive their stays but don't walk out on their own two feet because one was—oops!—accidentally amputated.

There is one hospital, however, where the mistakes aren't fatal and the accidents don't injure: Banner Simulation Medical Center, in Mesa, Arizona. Doctors and nurses go there to hone their skills without having to worry about harming patients. That's because the patients aren't people—they're computer-controlled mannequins designed to take a human's place in the medical learning curve. According to Carol N. Cheney, M.S., senior director of clinical education for Banner Health, the hope is that as more simulation hospitals open up, error rates in real hospitals will go down.

"It used to be that medical schools imparted the knowledge, and hospitals put the graduates on the floor," Cheney told me. "That was overwhelming for some. Nurses in particular have a huge first-year turnover. Simulation acts as a bridge. We still throw them in, but now their patients are plastic. If they make a mistake, we just reboot the patient."

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This type of training could save your life (and limbs) in the future, but what if you or a loved one needed hospital care today? You could still benefit from the beating taken by Banner's crash-test dummies. I traveled to Mesa and played doctor for 2 days to find out where the screwups happen in five common scenarios.

Before you or your child has a summer medical emergency, ease their fears—and yours—with this insider's guide to navigating the ER.

So let's say you're in the hospital and...

You're having surgery

If you're scheduled for an operation to, say, repair a hernia, remove a gallbladder, or fix a knee, you could be a candidate for a minimally invasive (a.k.a. laparoscopic) approach. A thin, snakelike tube called a scope is inserted through a small incision or orifice to light the problem area for viewing. Surgical instruments go in through other equally tiny openings, and the doctor then performs the procedure by looking at a monitor and manipulating the tools.

At Banner I did a virtual bronchoscopy, which involved steering a scope down my "patient's" bronchial passage and into its lungs. The technology was so advanced that I could feel resistance from the "tissue," and I even heard the dummy cough. With a press of a button I could suction to clear my view, administer lidocaine to numb an area, and even biopsy a polyp—one of which I found deep within the right lung. It's tricky, though. Because you're working indirectly, it takes a lot of hand-eye coordination and ambidextrous skill.

Your stay-safe checklist

Does your surgeon play video games?

A recent study of surgical residents at Banner concluded that the Nintendo Wii system—and the game Marble Mania in particular—is "an effective laparoscopic simulation device" because it hones many of the same motor skills used in scope procedures. Research at other facilities has demonstrated that surgeons who grew up playing video games at least 3 hours a week—and those who currently play—perform better and make fewer errors. While it's not a deal-breaker, having a doctor who can wield a Wii remote can't hurt.

How many operations has the doctor performed?

Studies of gallbladder-removal surgeries have found that physicians don't reach a "steady state of quality" until they've done 50 of them, says Robert Wachter, M.D., a professor of medicine at the University of California at San Francisco and a national expert on patient safety. "That means you don't want to be among numbers 1 through 49," he says. Ask your doctor how many operations he or she has done.

Is your doctor board certified?

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To be certified by the American Board of Surgery (ABS), a surgeon must complete 5 years of surgical residency training after medical school, and pass written and oral ABS exams. Also, as of 2009, the ABS requires completion of a program called Fundamentals of Laparoscopic Surgery (FLS). To check a surgeon's current status, go to home.absurgery.org and click on "Is Your Surgeon Certified?" If the certification was prior to 2009, find out if the doctor completed the FLS program.

Can everyone tell their right from their left?

It's not that easy when a patient is draped for surgery. So take a Sharpie and write "cut here" or "this knee" on the body part to be operated on, says Bryan Bledsoe, D.O., a professor of emergency medicine at the University of Nevada.

"I know it's hard to believe, but even at the best medical centers they still operate on the wrong side of a patient." And don't stop there.

"From the time you're admitted to the time you're wheeled into the OR, ask everyone you meet, 'What operation am I here for?' " he says.

5 Ways to get your doctor's attention—and keep it!

Do you have a pain plan?

Before the surgery, discuss with your nurse or doctor how to manage any pain you may have afterward. Although loading up on narcotics might be tempting, some drugs may slow your brain so much that "the next thing that can happen is you're not breathing," says Dr. Wachter. "It's better to accept a little pain—1 to 3 on a 0-to-10 rating scale—if the tradeoff is less risk."

You're hooked up to an IV

It's one of the most common hospital procedures: You're intravenously given medication, fluids, or blood, either though a peripheral line in your arm or a central venous catheter below your neck. While infections and complications can occur with both methods, the latter is the riskier one, says Peter Pronovost, M.D., Ph.D., a professor of critical-care medicine at Johns Hopkins University and the author of Safe Patients, Smart Hospitals. Roughly 20,000 people die from central-line infections each year, according to the CDC.

I can understand why. Using the mannequin's clavicle as my guide, I slowly pushed a needle toward the "vein." If I was off target, I could hit an artery, puncture a lung, or even trigger an arrhythmia or a heart attack. After a lot of coaching, I succeeded. Vital signs remained stable, and the syringe started filling with fake blood. That was my signal to withdraw the needle, slide in the thin flexible catheter, suck back the excess air in the syringe, flush everything with fluid, and then clamp and cap.

Your stay-safe checklist

What's the hospital's infection rate?

If you're scheduled for a procedure that will require a central line, ask your doctor for the hospital's "rate of central-line infection." According to Dr. Pronovost, "if it's less than 1 in 1,000, it's a well-performing organization; if it's between 1 and 3, it's not horrible but they can do better; and if it's above 3, consider another hospital."

Will ultrasound imaging be used?

Ultrasound isn't just for seeing infants in utero—it's increasingly being used as an aid for inserting central lines. Instead of having to rely on feel and experience, a doctor can now see the catheter entering the vein, which greatly increases accuracy and safety. "It's almost like shooting fish in a barrel," says Dr. Bledsoe. "Insist on it."

How's the hygiene level?

Before starting an IV, doctors and nurses should wash their hands and put on gloves (plus a mask in the case of a central line). If they don't have the necessary instruments handy and end up touching other things in the room, they should put on new gloves before touching you. And after disinfecting the injection site, they should not touch it again. This is a common error and a prime reason for infection. Finally, watch for bracelets, watches, and long-sleeved lab coats, all of which can harbor bacteria. Don't hesitate to request that sleeves be rolled up and bling removed.

5 Ways to get your doctor's attention—and keep it!


Is it in?

Certain intravenous drugs, as well as some of the contrast agents given with CT scans, can be extremely toxic to soft tissue. That's why Dr. Wachter recommends that you run through two checks: After the IV is in, make sure you see blood in the syringe when the nurse draws back the plunger. And before you receive the medication, fluid, or blood, ask the nurse to run some saline as a test. Now look at the skin around the injection site. Does it appear to be bulging with fluid? If it does, the IV is not in correctly.

Is it still necessary?

According to Dr. Pronovost, your risk of infection rises with each day you have a central-line catheter in place. "So ask your doctor every day, 'Are the benefits still outweighing the risk?' " he says.

A doctor gets a dose of his own medicine on the other side as a patient.

You're in the E.R.

The 20-bed emergency department at Banner Simulation Medical Center is bustling. Monitors are pinging, nurses and doctors are scurrying about, and the staff members have planted a variety of "surprises." One mannequin patient has a nosebleed, another has vomited, a third is about to have a reaction to a medication, and then . . .

Code blue! Code blue!

The PA instantly mobilizes the entire floor.

"I'm losing the pulse!" yells a nurse. "I need more hands!"

We rush to the room of 73-year-old Ernie Carlson, a "patient" who was admitted earlier with atrial fibrillation.

"Start CPR!"

"I need 1 milligram of epinephrine now!"

"Hooking up IV, circulating..."

"Check the rhythm and get ready to shock... Charging. Stand clear!"

Mr. Carlson's frail plastic body quakes.

"Feel for a pulse and continue CPR."

"I feel a pulse!"

"Give another epi in 2 minutes."

"Continue CPR!"

Slowly, Mr. Carlson's vital signs stabilize.

Brows relax.

"Good work, team," says the code doc. "You saved him."

The whole thing happened so quickly and was so realistic that my hands are damp. That's when I realize I never put on gloves.

Your stay-safe checklist

Is this an accredited trauma center?

The American College of Surgeons classifies trauma centers from Level I to Level IV. According to the CDC, receiving care at a Level I center lowers your risk of death by 25 percent over facilities that aren't equipped for trauma care. Find (and remember the name of ) the best trauma center near you at cdc.gov/traumacare.

Is your wristband accurate?

Because the pace is so fast in an ER, watch that they don't confuse you with someone else. Check the name and birth date on your wristband. If the hospital also uses other wristbands (to identify allergies or diabetes, for example) be sure they're accurate, too. "A few years ago, one hospital was using a yellow band to signify CPR preference," says Dr. Wachter. "So if you were wearing a LiveStrong band, you were suddenly in danger of not being resuscitated. They eliminated that pretty quickly."

Are all these tests necessary?

"Most ER docs take a shotgun approach to diagnostics," says Dr. Bledsoe, "and they do a lot of excess imaging with CT scanners. Those machines put out a lot more radiation than traditional x-rays do, and there's increasing concern about that. So always ask why a test has been ordered and if it's absolutely necessary."

Is this medication correct?

According to Dr. Bledsoe, the most common error in a busy ER is giving the wrong medicine. Before taking anything, he says, "ask the nurse three questions: 'What is this medication?' 'Who is it for?' and 'Why am I getting it?' That should prompt a double check."


Doctors on Call: Get expert advice and insight from the front lines of medicine.

You're having a baby!

Nowadays, when it's time for your wife to deliver, you need to do much more than hold her hand and remind her to breathe. According to Mark Smith, M.D., Ph.D., system director of simulation and innovation for Banner Health, 98 percent of labors and deliveries go smoothly. Here's how to avoid being among the 2 percent that don't.

Your stay-safe checklist

Do you have a backup plan?

Six weeks before the due date, find out if your doctor will be delivering your baby. "If the doctor has plans for a fishing trip in Alaska or may be otherwise unavailable, then you need to address that," says Dr. Bledsoe. Meet with (and be sure you're comfortable with) the replacement. And confirm that the new doctor is aware of anything in your wife's medical history that could complicate delivery. If you arrive at the hospital to find a resident physician in charge, and that makes you uncomfortable, ask for the attending physician or someone with more experience.

Is this a good team?

"Childbirth is like flying an airplane," says Dr. Wachter. "Most of the time it's straightforward. But when things go wrong, it turns chaotic fast. The outcome often depends on the level of communication." To gauge your crew's degree of teamwork, listen for gossip in the hall, note if doctors and nurses call each other by their first names, and trust your gut. You want a "flat hierarchy" of mutual respect, says Dr. Pronovost.

How's the baby doing?

Since you'll be spending a lot of time twiddling your thumbs, you might as well make yourself useful. Ask the nurse how to read the fetal heart-rate monitor, the primary indicator of the baby's health. "The monitors squiggle a lot," says Dr. Wachter, "but if it suddenly deviates by more than 10 percent or 20 percent, let someone know."

What's going on now?

These are the new four most important words for a dad to know, replacing "You're doing great, honey!" "The days of trusting that everyone knows best and everything will be all right are gone," says Dr. Smith. "Make sure you're involved."


Your father's in the hospital

Although my acting skills are even more limited than my medical ones, I've assumed the role of Jose. An ambulance has rushed my mannequin dad to the hospital with chest pain, and now I'm in his room trying to make sure he receives the best care possible. (Staff members regularly play the roles of distraught relatives to test trainees' patience and professionalism.)

"I got here as fast as I could," I say to the nurse. "What's wrong?"

"He was admitted with a PE and is on a heparin drip," she replies matter-of-factly.

I hesitate, worrying about sounding stupid and further delaying this obviously busy nurse, but I ask anyway. "What does that mean?"

"He has a pulmonary embolism," she explains. "That's a clot that traveled to his lungs and is restricting the flow of blood and oxygen, causing shortness of breath and chest pain. We're treating it with a blood thinner."

"What's all that beeping? Is that normal?"

"That's his heart monitor. His heart rate is high, but we're working to reduce it. Don't worry, sir, everything is under control."

Even though I'm supposed to keep asking questions, that last statement shuts me down. Despite having no idea how qualified this nurse and doctor are, I just nod. I've failed in my job.

Your stay-safe checklist

Is it clear that you're the patient's advocate?

In other words, are you listed on all necessary forms and has your parent/wife/friend told the medical staff that it's okay for them to share medical information with you? Otherwise, the health information privacy (HIPAA) rules preclude them from doing so.

Is a critical-care doc in charge?

If the patient is in intensive care, make sure one of these specialists is on the floor. "Having a critical-care doctor stationed in the ICU is key," says Dr. Pronovost. "Only 25 percent of hospitals have them, but having these doctors reduces the risk of mortality by 30 percent. Very few factors in medicine have that kind of impact. In fact, if the patient is quite sick and the hospital lacks such a specialist, it's worth looking into transferring to a facility that does have one."

Is he protected against blood clots?

Major surgery, broken bones, cancer treatments, or even long-term immobility or bed rest also can raise clotting risk. "These kill around 100,000 people each year in the hospital," says Dr. Pronovost. "We have medicines to prevent clotting, but unfortunately, many patients aren't receiving them. Ask."

Where are you taking him and why?

Many hospitals use volunteers (or personnel with less medical training) to transport patients for tests. Make sure whoever is wheeling Dad away checks his wristband to verify his identity. Ask where he's going and what's being done. Go with him, if possible.

Can you review everything one more time?

"One in five Medicare patients are readmitted to a hospital within 30 days," says Dr. Pronovost, "and in many cases it's because they simply didn't understand what they had to do when they went home." Review all medication instructions with a doctor or nurse, and ask about possible side effects or other complications. Get a printout of instructions.

"You can't take anything for granted," says Dr. Bledsoe. "Ultimately, what it comes down to is that you're the consumer and the hospital is the vendor. So just like with anything else, you need to step up, be proactive, and never forget that you have the right to ask questions and choose."

In other words, the days of being a trusting dummy are over.

© 2012 Rodale Inc. All rights reserved.

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