a $43 million Veterans Affairs simulation hospital;

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

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

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

Opened in 2016, SimVET serves as an example of how simulation has become in healthcare increasingly common and more sophisticated in recent years. As health systems try to evaluate hundreds of new AI tools that have recently hit the market, facilities like SimVET can help cut through the noise.

The Veterans Health Administration serves 9 million veterans at 172 medical centers in the US. Every medical center has a simulation program and some have a dedicated space on site.

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

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

In healthcare, 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 surgery. But SimVET goes one step further.

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

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

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

Wiltz said the data is supposed to represent the VA veteran population as well as the broader population of the country at large. There are “over two dozen” mannequins in the facility, he said.

Beyond its unusual patients, SimVET hosts many healthcare scenes that look familiar. Fluorescent lights line a long hallway full of exam rooms, and operating rooms filled with machines look like they came straight out of a nearby hospital.

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

“The diversity of the space that we have, the realism that it brings, it really gives you the ultimate feeling that you can actually care for the patients in this 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 about 60 full-time employees at SimVET, and they typically handle multiple pilots and projects at once. National program offices and frontline workers within the VA will approach SimVET with ideas for simulations, and sometimes facility workers are struck by the inspiration themselves, he said.

SimVET is able to offer services funded 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 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. He said they were trying to improve their response to unexpected complications that might arise during surgery, so they approached SimVET with ideas in the winter of 2023.

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

SimVET leadership helped Borchers and her four other teammates write several simulations before arriving on site, and they also connected with a number of experts in the field from around the country.

The team had a busy week at the SimVET facility: Their first day started around a drawing board promptly at 7am. and then spent hours walking through various processes and talking about problems with SimVET experts and staff.

“You can fail, but fail safely, and then you use it 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 could do in an unforeseen emergency, was amazing.”

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

“It’s exactly the same,” he said. “You could actually do a surgery right away, 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 example, TV shows and movies often refer to “code blue,” where health care workers take action when a patient goes into cardiac or respiratory arrest.

Borchers said the new code developed by the team will be called over the loudspeakers as “CODE SET”, which stands for “emergency surgery team”. He said it is designed to alert a dedicated support team when unexpected complications occur during or soon after a surgery.

SimVET gave Borchers and her teammates the initial practice and reassurance they needed for their idea, but they had to take the rest of the Lexington VA Medical Center. They gave the code to their executive leadership and began finalizing exactly which people and resources would respond to it.

Borchers said the medical center began running its own simulations and continued to optimize the code in small pockets of the hospital throughout the fall. They expanded their testing in the spring and began running simulations across the facility with the code.

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

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

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

“Fortunately, that 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.