a $43 million Veterans Affairs simulation hospital

Inside a sprawling $43 million Veterans Affairs facility equipped with operating rooms, intensive care units and an outpatient clinic, there are no patients. At least not any real ones. 

The 53,000-square-foot building sits minutes away from the Orlando International Airport in Florida, and it’s called the National Center for Simulation Validation, Evaluation and Testing, or SimVET. It serves as the primary hub where teams of front-line health-care workers from the VA travel to practice procedures and pilot new technologies, all without posing unnecessary risks to patients.

For instance, if a team of clinicians wants to adjust their response to opioid overdoses or test out a new artificial intelligence tool, they can repeatedly simulate the process at SimVET. VA officials told CNBC that by practicing in a controlled environment, health-care workers can iron out problems and ensure that new ideas are feasible and safe to implement. 

SimVET, which opened in 2016, serves as an example of how simulation within health care has become increasingly common and more sophisticated in recent years. As health systems are looking to evaluate hundreds of new AI tools that have recently arrived on the market, facilities like SimVET can help cut through the noise.

The Veterans Health Administration services 9 million veterans in 172 medical centers across the U.S. Each medical center has a simulation program, and some have a dedicated space on site. 

The SimVET facility in Orlando is the largest simulation center within the VA “by far,” and also one of the biggest in the country, said Dr. Scott Wiltz, the medical director of the VA’s Simulation Learning, Evaluation, Assessment and Research Network, or SimLEARN. 

Simulating high-risk scenarios is a fixture of the military and industries like aviation, where pilots can spend hours practicing in flight simulators. 

In health care, hospital systems and medical schools have long relied on professional actors to help train doctors, and virtual reality headsets are becoming an increasingly popular tool for practicing surgeries. But SimVET goes a step further.

The goal is usually to get “as close [to] a level of realism as possible,” Wiltz told CNBC in an interview.

“The operating rooms are a great example,” Wiltz said. “We have two fully staffed operating rooms, all the equipment you would normally use: lights, booms, real anesthesia machines. We even have a mannequin that responds realistically to the anesthesia.”  

CNBC visited SimVET in March, and the mannequins are a true fixture of the facility. They sport a range of skin tones, hairstyles and facial features, and some are programmed to speak, move and develop complications. An “older” mannequin at the facility has wrinkles and more pronounced veins, and another can give “birth” to a “baby” mannequin. 

Wiltz said the figures are supposed to represent the VA’s population of veterans as well as the broader population of the country at large. There are “well over” two dozen mannequins at the facility, he said. 

Beyond its unusual patients, SimVET is home to many familiar-looking health-care scenes. Fluorescent lights line a long hallway full of exam rooms, and operating rooms stuffed with machinery look like they were plucked straight from a nearby hospital. 

To an unsuspecting visitor, the facility would look a lot like a real medical center. The building’s many classrooms and educational spaces are the only slight giveaway. 

“The diversity of the space that we have, the realism that it brings, it really gives you the complete feeling that you can actually take care of patients in that building,” Wiltz said. “And we do, it’s just that our patients are mannequins and actors.” 

A space to ‘fail safely’

Wiltz said there are around 60 full-time staffers at SimVET, and they are usually tackling several pilots and projects at a time. National program offices and front-line workers within the VA will approach SimVET with ideas for simulations, and sometimes employees at the facility are struck by inspiration themselves, he said. 

SimVET is able to offer services with funding directly through the VA, so Wiltz said it often makes more sense for these groups to come to them instead of trying to pay someone outside of the government. 

Amanda Borchers, a patient safety manager at the Lexington VA Medical Center in Kentucky, was part of a surgical emergency team that visited SimVET in May of last year. She said they were looking to improve their response to unexpected complications that can come up during surgery, so they reached out to SimVET with ideas in the winter of 2023.  

Borchers said some of the more high-risk veterans in her population have breathing, heart, circulation problems that can cause sudden issues during procedures. Her team wanted to develop a new protocol to better prepare for some of those challenges, like how to quickly retrieve blood and bring it to an operating room.

SimVET leadership helped Borchers and her four other teammates write up several simulations ahead of their arrival on site, and they were also connected with a number of field experts from across the country. 

The team spent a busy week at the SimVET facility: Their first day began around a drawing board promptly at 7 a.m., and then they spent hours walking through different procedures and talking through problems with the experts and SimVET employees. 

“You can fail, but fail safely, and then you use that to make a change. And then you do it again. And then you do it again,” Borchers told CNBC in an interview. “The transformation, and what we would be able to do in an unanticipated emergency, was amazing.” 

Borchers said she had participated in simulations before, but she had never experienced anything that compared to SimVET. She said the facility mimics the environment she works in every day, which allowed her to practice “every single detail” of what she does routinely. 

 “It is exactly the same,” she said. “You really could perform a surgery right then, right there.”

When the week came to a close, Borchers and her team left SimVET with the framework for a brand-new medical code, which is a facility-wide response to a specific type of emergency. For instance, TV shows and movies often reference “code blue,” where health-care workers spring into action after a patient goes into cardiac or respiratory arrest. 

Borchers said the new code the team developed would be called out in the overhead speakers as a “code SET,” which stands for “surgical emergency team.” She said it is designed to alert a dedicated team that provides support when unexpected complications occur during or immediately after a surgery. 

SimVET gave Borchers and her teammates the initial practice and assurance they needed for their idea, but they still had to get the rest of the Lexington VA Medical Center on board. They pitched the code to their executive leadership, and they began to finalize exactly which people and resources would respond to it. 

Borchers said the medical center began to carry out its own simulations and continued to fine-tune the code within small pockets of the hospital throughout the fall. They expanded their testing in the spring and began conducting facility-wide simulations with the code. 

The medical center is currently updating its paging system, and Borchers said the facility will simulate the code again once the new system is in place. If everything goes according to plan, code SET will be in use with real patients in the next two to three months. 

Borchers said her ultimate goal is to see code SET used in VA medical centers across the country, and staff from states including Tennessee, Mississippi, Louisiana, Arkansas and Texas have already participated in simulated trainings.     

Wiltz said the code is on its way to becoming a national program at the VA.

“Fortunately, this didn’t come from an adverse event, but it came from people saying, ‘You know what, we’re doing things pretty well, but we think we can do it even better,'” Wiltz said.