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Format: 04/16/2014
Format: 04/16/2014


Poughkeepsie Journal: Vassar Brothers robot simulator teaches birthing caregivers

Friday, May 7th, 2010

In a birthing suite at Vassar Brothers Medical Center, a pregnant robot is told to push.


A team of delivery nurses holds the computerized mannequin's ankles. The laboring robot moans from pain as her obstetrician delivers baby Noah.

This time the labor goes smoothly, but most often, the robot's birthing experiences include rare and serious complications.

She may hemorrhage or stop breathing.

Her baby may have the umbilical cord around his neck or the shoulders may get lodged in the birth canal.

These are some of the most frightening emergencies that occur in the delivery room.

With the implementation of labor simulator S575 Noelle, Vassar's labor and delivery caregivers are getting state-of-the-art training.

The goal is to reduce medical errors at the City of Poughkeepsie hospital without risk to patients, specifically maternal and infant mortality and morbidity.

"Our staff will be better prepared to handle these rare but life-threatening situations," Vassar CEO and President Daniel Aronzon said.

About 2,600 babies were born at Vassar Brothers in 2008, the most at any mid-Hudson hospital and more than Albany and Westchester medical centers, state Department of Health data show.

Noelle was created by Florida-based Gaumard Scientific Company as an innovative teaching simulator.

The wireless, tetherless version was purchased by Vassar for about $50,000 — the cost being the main reason why no other regional hospital has a Noelle, Journal research found.

The new childbirth training equipment has a pulse and a mock placenta. Her water breaks. She bleeds, dilates, convulses and announces, "I'm having a contraction," and "The baby is coming."

Noelle can talk due to a wireless microphone operated by a simulation facilitator.

The computerized babies mimic biological readings and symptoms. They can even turn blue from lack of oxygen and can give vital signs through fetal monitoring during delivery.

Vassar Brothers purchased three infants.

There is Patrick, the premature-baby simulator; Bailey, the baby used during deliveries; and Noah, the full-term simulator.
The goal for Vassar is to become a Regional Perinatal Center (Level IV), like Westchester or Albany medical centers.



Perinatal refers to the care of the fetus-baby and mother during pregnancy, labor and delivery, particularly when the mother or the baby or both are at a high risk for complications.

That regional state designation is the highest for maternity services and means the hospital can handle the most acutely sick or at-risk pregnant women and newborns, according to the state Department of Health.

Currently, Vassar Brothers is a Level III Perinatal Center — the highest-ranked center in Dutchess and Ulster counties.

The other hospitals with maternity care, Northern Dutchess in Rhinebeck and Kingston Hospital, are Level I Perinatal Centers.

St. Luke's Cornwall Hospital with a campus in Newburgh is a Level II.

Kingston and St. Luke's don't have a Noelle, hospital representatives said. Benedictine Hospital in Kingston and Saint Francis Hospital in the Town of Poughkeepsie do not have maternity departments.

Gaumard wouldn't release details on how many Noelle simulators it has sold or which centers carry its products, with the exception of listing nine premier medical sites. None of the nine is in the Northeast.

Noelle is only one of several recent enhancements Vassar has made to its maternity services.

Historic surgery
In April, Vassar's Level III Neonatal Intensive Care Unit celebrated a major success when its first premature baby underwent cardiac surgery to fix a heart defect.

The surgery, which dealt with patent ductus arteriosus, was the first of its kind performed on a premature infant in the mid-Hudson region.

The baby is doing well, hospital spokeswoman Theresa Mulkins said.

Another achievement was the appointment of Dr. Kimberly Heller as director of maternal -fetal medicine in 2008. Her expertise helps make the hospital eligible for the referral status, Mulkins said.

If Vassar Brothers achieves regional perinatal center status, the hospital would be responsible for coordinating transfers from affiliate hospitals and overseeing support, education, consultation and improvements in the quality of care within the region.
Having state-of-the-art training equipment such as Noelle is "one step toward that direction," Aronzon said.

Cindy Lewis, the director of maternity at Kingston Hospital, said the hospital has regular labor and delivery training, but "nothing fancy like Noelle."

Lewis added she wished her hospital did have a simulator, but "it's extremely expensive."

Aronzon said that eventually Vassar Brothers would invite nonaffiliated regional hospitals to train with Noelle and her babies in addition to its affiliated family birthing center at Northern Dutchess Hospital.

"If we are going to be a regional referral center for the Hudson Valley, our task is to improve care for the entire region," Aronzon said.

Before Noelle was implemented in staff training earlier in the spring, Vassar Brothers used partial mannequins that didn't move or talk, said Helen Kimmet, the hospital's perinatal educator.

Vassar Brothers is doing simulations twice a week with Noelle, rotating training among its doctors, nurses and support staff.

"They enjoy doing it," Kimmet said. "First, they are very nervous. When she speaks to us, it feels real."

Neonatal Intensive Care Unit nurse Kerry LaSalvia said her co-worker cried during her first scenario training.

"Once the adrenaline wore off, she couldn't believe how real it felt," LaSalvia said.

During a drill, the training facilitators will pre-program Noelle and her baby for the specific scenario.

For example, in the case of a serious delivery emergency like shoulder dystocia, in which the shoulders become lodged in the birth canal, the robot baby's shoulders would be affected during delivery.

The staff would practice specific delivery maneuvers to relieve the shoulders and allow for a safe birth.

Vital signs of both Noelle and her baby are automatically logged. Caregiver actions are time-stamped and documented for review. The maximum six-person simulation team then receives performance feedback on how it performed.

The Simulation, Teaching and Academic Research Center, based in Pittsburgh at West Penn Allegheny Health System, has been training its doctors, nurses and medical students on Noelle since 2008, in addition to other simulation mannequins.

STAR simulation specialist Josh Franczyk said he was skeptical about training on robots until he went through a drill.



"My hands started to get sweaty. I was nervous. I was immersed in the environment of the simulation. Right then and there I was sold on simulation," Franczyk said.

As for using Noelle, Franczyk said his center did a drill with an obstetrician on a shoulder dystocia scenario.

"It wasn't two weeks after their training that the OB doctor was faced with shoulder dystocia. She was so happy because she had gone through the drill," he said.

Mostly, those who train on simulators gain confidence, he said.

"They are focused. They are more likely to remember the procedure. Prior to simulation that person would sit around and wait to see shoulder dystocia and they'd have another physician telling them what to do with a real baby," he said.

Simulation is about keeping up competencies .

"You still need that human interaction with a real patient, but I don't think that there's a better way to do that training than through simulation," he said.

STAR has 11 full-size simulators and 21 partial task trainers, the majority of which are made by Laerdal, a medical supplies company with U.S. headquarters in Wappingers Falls.

Laerdal sells mannequins used to train medical personnel, including the SimMan model with optional software simulations and Resusci Anne, used for resuscitation and emergency care.

Aronzon said Vassar's Noelle had opened the door to introducing other simulation mannequins in the future.

Vassar purchased the birthing model versus other types of simulators because obstetrics emergencies can be "catastrophic," he said.

"In the maternity ward, we always have happy stories. Bad stories are rare but tragic occurrences ," said Aronzon, whose medical background is in pediatrics.

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