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January 23, 2017

Hartford Hospital expansion targets high-tech training

PHOTO | Steve Laschever Dr. Thomas Nowicki, medical director of Hartford Hospital's expanding CESI facility, uses virtual reality technology his staff is developing to train medical providers.
PHOTO | Steve Laschever A team of Hartford HealthCare providers train on one of the Center for Education, Simulation and Innovation’s mannequins.

Last month, contractors at Hartford Hospital were installing doors and making other finishing touches on a state-backed expansion of an already bustling high-tech medical training hub.

The nearly 30,000-square-foot addition to the Center for Education, Simulation and Innovation (CESI) will boost its longstanding and ever-evolving array of training capabilities and services, which include surgical and other medical certifications, mock training exercises and medical device and product testing. Administrators say the expansion will help them create new relationships with biomedical and medical device companies and other corporate players who need training centers located in real-world healthcare settings as well as feedback from doctors on new devices and products.

CESI already provides training certifications for various robotic surgery systems, such as da Vinci and MAKOplasty, and has forged research and development and other partnerships with major companies like Johnson & Johnson, Stanley Black & Decker and Medtronic.

Approximately 11,000 people from near and far train at CESI each year — from within and outside of Hartford HealthCare — including surgeons, nurses, U.S. Navy corpsmen, first responders and even paramedics from Israel.

“We're an importer,” Hartford HealthCare President Jeffrey Flaks said during a tour of the facility, which will more than double in size to about 50,000 square feet. “We bring people to Connecticut who get their training, they stay in our hotels, they fly into our airport, they eat in our restaurants. This is an economic driver.”

The state granted the project $15 million several years ago and the addition is taking over adjacent space that used to be an employee gym. The expansion was originally slated for completion in 2014, but the hospital said state funding cuts forced administrators to prioritize projects, and the recently opened $150 million Bone & Joint Institute came first. CESI's expanded facility is now expected to open in March.

The center, which has been in its current location since 2010, represents a total investment of more than $34 million. Besides being an economic driver for the surrounding area, administrators hope it can be a financial driver for Hartford Hospital.

Post expansion, Flaks said he expects CESI to break even on its annual budget, which he said is “north of several million dollars.”

The expansion aims to bring in more revenue from government training contracts, rental income, philanthropic donations, and manufacturers that want their products evaluated by doctors. Stanley has already donated $500,000 and could increase that amount in the near future, according to Stephen Donahue, the center's program director, who said CESI will be testing equipment for Stanley. A Stanley spokesman did not respond to a request for comment.

Some of the corporate arrangements are confidential, but one is with Massachusetts-based Zoll, which makes defibrillators and other devices. CESI and Hartford Hospital doctors provide feedback to Zoll on new products and also help train the company's sales staff. Zoll pays rent and CESI doctors receive stipends for evaluating products, Donahue said.

Another partnership is with MAKOplasty manufacturer Stryker. CESI is the exclusive Northeast training provider for the robotic-arm-assisted technology that helps with joint replacements. The device is used to perform knee surgeries at Hartford Hospital's newly constructed Bone & Joint Institute.

Another feature of the CESI expansion is a larger cadaver lab, which administrators say is in high demand among companies in the region wanting to test new products.

Flaks said there are early positive signs that the growing facility will stir more business. Hartford HealthCare officials are in talks with an out-of-state biomedical company, for example, to relocate its headquarters near the hospital campus. He declined to name the company, as the deal is not yet done.

While corporate partnerships were harder to forge a decade ago, Flaks said CESI has become a draw for companies and healthcare organizations that want a combination of simulation and real-world medical care and expertise.

Surgeons could go to an office park to train on a simulator, but being located within the heart of a hospital campus allows trainees to observe operating room activities, he said.

A century of technological advancement

In the 1910s, long before CESI was ever dreamt up, nurse trainees at Hartford Hospital used a mannequin named “Mrs. Chase” to practice bathing and dressing patients.

The hospital still has Mrs. Chase, which is stored in the closet of an operating room simulator, alongside much more advanced mannequins that CESI staff use for training.

The high-tech mannequins, made by Norwegian manufacturer Laerdal, can bleed, sweat, cry, have seizures and simulate various other symptoms.

The mannequins have been a vital tool in training residents at the hospital, said Dr. Thomas Nowicki, CESI's medical director, who recalls sometimes working 110-hour weeks during his days as a medical resident. Now the rules have changed, and residents aren't allowed to work as many hours.

“We have to find more efficient ways to train,” said Nowicki, who was standing in the observation room of an operating simulator, where he can alter the vital signs of a mannequin lying on the operating table and communicate with residents providing treatments.

Simulation exposes trainees to more diverse scenarios and allows them to be more hands on than they could be in the emergency room, with live patients, and learn from their mistakes.

“A resident may have seen one kind of heart attack,” Nowicki said. “It's luck of the draw. Here, we can show them the top five types of heart attacks.”

Besides their usefulness for training doctors, mannequins have also helped Hartford Hospital improve its procedures and patient outcomes. For example, after CESI training, the hospital lowered its rates of catheter infections and a birth condition known as shoulder dystocia, Donahue said.

Mere feet away from Mrs. Chase's storage closet is Christopher Madison, CESI's simulation technology developer, who is working on an HTC virtual reality headset. Madison, with the help of interns from the University of Hartford and Trinity College, is building training applications for surgeons and others.

In a demonstration, the headset displayed a human body, which can be “sliced” by a hand-held controller into various cross sections. There's also a virtual operating room, in which the user can pick up items from the counter and perform other actions.

Madison is still toying with the technology, but is hopeful it can be a useful training tool for surgeons and others. A virtual reality patient can display subtle symptoms that even the most advanced mannequin cannot, he said.

“You can do some neat stuff,” Madison said. “It has a lot of potential.”

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