The growing use and sophistication of medical simulation centers by universities, hospitals and other health care systems can potentially reduce medical errors on patients and is getting positive response from liability underwriters.

Simulation centers provide education using simulated patients, events and scenarios that are used by nurses, technicians, physicians, residents, medical students, emergency responders and others in the medical field.

“We look at this as a risk aversion tool more than anything,” said Peggy King, assistant vp of risk management and legal affairs at NorthShore University HealthSystem in Evanston, Ill.

The NorthShore Center for Simulation and Innovation opened May 2011 with two facilities totaling 16,000 square feet. Since January, the center has provided medical simulation courses to more than 1,500 users and surgical simulation courses to more than 400 users.

“We prefer to anticipate what the challenges may be, train in the sim lab for them, then move to the actual situation,” Ms. King said.

Simulation centers “absolutely” reduce risks for health care organizations and professionals, said Nancy Towne, senior consultant manager at IMA Consulting in Syracuse, N.Y.

While physicians in residency traditionally learned many hospital and medical procedures while working with patients, “now they have the option to go into the laboratory setting,” she said. “Because mistakes are inevitable, they can make those mistakes without hurting the patient.”

Simulation centers are ideal for high-risk, low-volume procedures, Ms. Towne said. “We could throw any kind of unique situation from the past and they would be able to practice that in a safe setting instead of coming about it in a real patient care situation.”

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In the past four years, a growing number of health systems have invested in simulation centers to train new employees as well as update the credentials of experienced physicians, said Holly D. Meidl, managing director and national health care practice leader for Marsh Inc. in Nashville, Tenn.

“We're seeing patterns of change across most medical schools in the country as well as nursing schools where they're trying to do more role-playing or simulation of the patient experience,” she said.

Though there are hundreds of simulation centers across the United States, “there's varying degrees of sophistication,” said Linda E. Jones, managing director of the health care practice for Riggs, Counselman, Michaels & Downes Inc. in Baltimore.

Simulation training includes everything from Resusci Anne, the popular training mannequin for cardiopulmonary resuscitation, to 3-D simulations, Ms. Jones said, noting that some computer-driven mannequins can cost $25,000 to $50,000 each and that sim centers can cost well into the millions depending on the size and equipment used.

To address those costs, large health systems with a mature captive insurer often use surplus capital from the captive to fund simulation programs, experts say (see related story).

While insurers have not specifically applied a quantifiable credit for health systems that use simulation centers, underwriters do take them into account in some fashion, experts said.

Ms. Jones said a Lloyd's of London syndicate asked its client to provide six measurable areas where they are reducing risk, and medical simulations could be part of that list.

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“I do believe that the insurance carrier does give them some measure of credit for the use of it,” Ms. Meidl said. “That reflects favorably on them in front of the underwriters because it's a move towards going the extra mile to do things for patient safety and making a significant investment in order to try and reduce medical errors.”

The best use of simulation centers is when a health system examines its claims data and potential compensable amounts and then focuses on those areas, Ms. Meidl said.

At NorthShore, Ms. King and the risk management department work with physicians and technologists to design scenarios to manage certain risks.

“As they build a scenario that they're going to program into the computer that an individual or a team may be faced with, we can use not only our own claims experience but publicly acknowledged claims experience from other organizations to say, "Why don't you train for this or train for that?'” Ms. King said.

For instance, an obstetrics team's response to the condition of shoulder dystocia during birth is critical to the outcome of the infant, Ms. King said.

“We train for the presentation of shoulder dystocia in our labor and delivery simulation area so that the team gets very good at identification and response,” she said. “We find that outcomes have improved, and we can only assume that it's from the team training in the sim lab.”

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As the complexity of medical procedures has increased, simulated training for all the medical professionals involved is essential, said Kevin Lachapelle, director of the Arnold and Blema Steinberg Medical Simulation Center at McGill University in Montreal.

Medical errors often result from teams not working well together and poor communications, he said.

“That's where you're going to be having a lot of impact on issues that have to do with communication, teamwork, leadership (and) collaboration that, in the end, probably have a larger component on patient safety than pure knowledge and skill of an individual,” Mr. Lachapelle said.