$43 Million Veterans Affairs Simulation Hospital

Inside a massive $43 million VA facility, complete with operating rooms, intensive care units and an outpatient clinic, there are no patients. At least no real patients.

Located minutes from Orlando International Airport in Florida, the 53,000-square-foot facility is called the National Simulation Validation, Evaluation and Testing Center, or SimVET. It serves as the primary hub where teams of front-line health care workers from the Veterans Administration travel to practice procedures and test new technologies, all without exposing patients to unnecessary risk.

For example, if a team of doctors wanted to modify their response to an opioid overdose or test a new AI tool, they could repeatedly simulate the process in SimVET. By practicing in a controlled environment, health care workers can solve problems and ensure that new ideas can be implemented safely, VA officials told CNBC.

The SimVET Center, which opened in 2016, is an example of how simulation in healthcare has become increasingly prevalent and advanced in recent years. As healthcare systems look to evaluate the 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 across the United States. Each medical center has a simulation program, and some have dedicated space on site.

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

Simulating high-stakes scenarios is a constant part of the military and aviation industries, where pilots can spend hours training in flight simulators.

In healthcare, hospital systems and medical schools have long relied on professional actors to help train doctors, and virtual reality headsets have become an increasingly popular tool for practicing surgery. But SimVET goes further.

The goal is usually to get “as close to realism as possible,” Wiltz told CNBC.

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

CNBC visited the Simfit Center in March, and the dolls are an integral part of the facility. They come in a range of skin tones, hairstyles and facial features, and some are programmed to speak, move and suffer complications. The facility’s “oldest” doll has more visible wrinkles and veins, and another doll can “give birth” to a “baby” doll.

The figures are supposed to represent the VA's veteran population as well as the country's population as a whole, Wiltz said, adding that there are “more than two dozen” dolls at the facility.

Along with the unusual patients, the Symvit Center features many familiar health-care scenes. Fluorescent lights line a long corridor filled with examination rooms, and operating rooms filled with machines look like they were ripped straight from a nearby hospital.

To the unwary visitor, the facility would look like a real medical center. The only thing that sets the building apart are the many classrooms and educational spaces.

“The diversity of space we have, the realism of it, gives you a sense that you’re actually taking care of patients in this building,” Weltz said. “And that’s what we do, but our patients are puppets and actors.”

room to fail safely

There are about 60 full-time employees at SimVET, who typically juggle multiple experiments and projects at once, Weltz said. National program offices and front-line workers at VA will approach SimVET with ideas for simulations, and sometimes the facility staff is inspired, he said.

SimVET is able to provide services with direct funding through the VA, so Wiltz said it often makes more sense for these groups to come to them than to try to pay someone outside the government.

Amanda Borchers, director of patient safety at the Lexington VA Medical Center in Kentucky, was part of a surgical emergency team that visited Symvit in May of last year. She said they were looking to improve their response to unexpected complications that could arise during surgery, so they approached Symvit with ideas in the winter of 2023.

Borchers said some of the most vulnerable veterans in her group have breathing, heart and circulatory problems that can cause sudden problems during surgeries. 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 into the operating room.

SimVET leadership helped Borchers and four other colleagues write several simulations before they arrived on site, and they were also connected with a number of field experts from across the country.

The team had a busy week at the SimVET facility: their first day around the drawing board started at 7 a.m., then they spent hours walking through different procedures and talking through issues with experts and SimVET staff.

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

Borchers said she had been involved in simulations before, but had never experienced anything quite like SimVET. The facility replicates the environment she works in every day, she said, allowing her to practice “every detail” of what she does on a routine basis.

“It’s exactly the same thing,” she said. “You could have surgery right then and there.”

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

Borchers said the new code the team developed will be called out over the overhead speakers as a “SET code,” short for “surgical emergency team.” She said it’s designed to alert a specialized support team when unexpected complications occur during or immediately after surgery.

SimVET gave Borchers and her teammates the initial training and reassurance they needed to implement their idea, but they still needed to convince the rest of the Lexington VA Medical Center to buy in. They presented the code to their executive leadership, and began identifying the people and resources that would specifically respond to it.

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

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

Borchers said her ultimate goal is to see Code SET used at VA medical centers across the country, and employees from states including Tennessee, Mississippi, Louisiana, Arkansas and Texas have already participated in simulation exercises.

The code is on its way to becoming a national program at the Veterans Administration, Wiltz said.

“Fortunately, it didn't come from a negative event, it came from people saying, 'You know what, we do things well, but we think we can do it better,'” Wiltz said.