An operating room at SimVET
Thanks to: SimVET
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 real ones.
The 53,000-square-foot building, located minutes from Orlando International Airport in Florida, is called the National Center for Simulation Validation, Evaluation and Testing, or SimVET. It serves as the primary hub where teams of VA frontline healthcare workers travel to practice procedures and test new technologies, all without posing unnecessary risks to patients.
For example, if a team of clinicians wants to tweak their response to opioid overdoses or test a new artificial intelligence tool, they can simulate the process repeatedly with SimVET. VA officials told CNBC that practicing in a controlled environment helps healthcare workers problem-solve and ensure new ideas are feasible and safe to implement.
SimVET, which opened in 2016, serves as an example of how simulation has become increasingly common and sophisticated in healthcare 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 SimVET facility in Orlando, Florida
Thanks to: SimVET
The Veterans Health Administration serves 9 million veterans at 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 “by far” the largest simulation center within the VA and one of the largest in the country, said Dr. Scott Wiltz, medical director of the VA’s Simulation Learning, Evaluation, Assessment and Research Network (SimLEARN).
Simulating high-risk scenarios is a staple of the military and industries like aviation, where pilots can spend hours practicing in flight simulators.
In healthcare, hospital systems and medical schools have long relied on professional actors to train doctors, and virtual reality headsets are becoming an increasingly popular tool for performing surgeries. But SimVET takes things a step further.
The goal is usually to get “as close to reality as possible.” [to] “As realistic a level 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, flashing lights, real anesthesia machines. We even have a manikin that reacts realistically to the anesthesia.”
CNBC visited SimVET in March, and the mannequins are a real asset to the facility. They have a range of skin tones, hairstyles and facial features, and some are programmed to speak, move and develop complications. One “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 meant to represent the VA’s veteran population, as well as the broader population of the country as a whole. There are “well over” two dozen mannequins at the facility, he said.
A mannequin at the SimVET facility
Thanks to: SimVET
In addition to the unusual patients, SimVET is home to many familiar healthcare scenes. Fluorescent lights line a long hallway lined with examination rooms, and operating rooms filled with machines look as if they were plucked straight from a nearby hospital.
To an unsuspecting visitor, the facility would appear to be a real medical center, with the building’s many classrooms and educational spaces being the only small 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 care for patients in that building,” Wiltz said. “And we do, it’s just that our patients are mannequins and actors.”
A space to ‘fail safely’
The SimVET building in Orlando, Florida
Thanks to: SimVET
Wiltz said there are about 60 full-time employees at SimVET, and they typically have multiple pilots and projects underway at once. National program offices and frontline staff within the VA approach SimVET with ideas for simulations, and sometimes employees at the facility itself are struck with inspiration, he said.
SimVET can offer services with funding directly from the VA. Wiltz says it often makes more sense for these groups to go to them rather than 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 last May. She said they wanted to improve their response to unexpected complications that can occur during surgery, so they reached out to SimVET in the winter of 2023 with ideas.
Borchers said some of the higher-risk veterans in her population have respiratory, cardiac and circulatory issues that can cause sudden problems during procedures. Her team wanted to develop a new protocol to better prepare for some of those challenges, such as how to quickly retrieve blood and get it to an operating room.
SimVET leadership helped Borchers and her four other teammates work out several simulations prior to their arrival on site, and they also got in touch with a number of experts from across the country.
The team had a busy week at SimVET: their first day started at 7am at a drawing board, after which they spent hours going through various procedures and discussing issues with the experts and SimVET staff.
“You can fail, but you fail safely, and then you use that to drive 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 unexpected emergency, was astonishing.”
Borchers said she has participated in simulations before, but she has never experienced anything quite like SimVET. She said the facility mimics the environment she works in every day, allowing her to practice “every detail” of what she does routinely.
“It’s exactly the same,” she said. “You could actually do surgery, right there, right there.”
An intensive care unit at SimVET
Thanks to: SimVET
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 healthcare workers respond after a patient goes into cardiac or respiratory arrest.
Borchers said the new code the team developed would be announced over the loudspeakers as a “code SET,” which stands for “surgical emergency team.” She said the code is designed to alert a special team that provides support when unexpected complications arise during or immediately after a surgery.
SimVET gave Borchers and her teammates the initial practice and certainty they needed for their idea, but they still had to get the rest of the Lexington VA Medical Center on board. They presented 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 refine the code within the organization. small portions of the hospital over the fall. They expanded their testing in the spring and began running simulations across the facility with the code.
The medical center is currently in the process of updating 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, code SET will be in use with real patients in the next two to three months.
Borchers said her ultimate goal is to use the SET code in VA medical centers across the country. Staff from states including 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, it wasn’t because of a negative event, it was because people said, ‘You know, we’re doing pretty well, but we think we can do even better,’” Wiltz said.