Robotic surgery has the potential to revolutionize the field of surgery and improve patient safety. However, despite the advantages robotic surgery can offer, there are multiple human factors-related issues that may prevent these systems from realizing their full benefit. This study identified some of the salient human factors issues and considerations that need to be addressed for integration of new technologies such as robotic systems into the Operating Room of the future. We conducted in-depth interviews with operating team members and other stakeholders who have experience with robotic surgery to identify workflow, teamwork, training, and other clinical acceptance issues. Addressing these and other human factors issues will help the integration of surgical robotic systems into use for the ultimate goal of improving patient safety and healthcare quality.

These findings have the potential for the identification of methods to help clinicians learn how to use statistical and probabilistic information to better assess risk and to promote integration of decision support tools into medical decision making for improvement of patient safety.

A research agenda for investigating the impact of team-work training on patient safety in the perioperative environment is presented. The current status of teamwork training is reviewed briefly, and conclusions based on existing research are presented. We present a roadmap for future research on how teamwork training should be structured, delivered, and evaluated to optimize patient safety in the operating room. For teamwork skills to be assessed and have credibility, team performance measures must be grounded in team theory, account for individual and team-level performance, capture team process and outcomes, adhere to standards for reliability and validity, and address real or perceived barriers to measurement. The interdisciplinary nature of work in the perioperative environment and the necessity of cooperation among team members play an important role in enabling patient safety and avoiding errors. Teams make fewer mistakes than do individuals, especially when each team member knows his or her responsibilities, as well as those of other team members. However, simply installing a team structure without addressing the organizational context of care--the culture--does not automatically ensure it will operate effectively. Factors associated with the design of teamwork training, measures of training effectiveness, and the assessment process that should be explored in near-term work (1 to 2 years) are addressed. We also address the impact of the organizational environment, including the role of institutional support and culture, that need to be explored in longer term research (3 to 5 years).

In the USA, several telestroke networks have been successfully implemented in which a stroke centre of excellence provides expertise to community and rural hospitals via telemedicine. Stroke patients can thus receive round-the-clock access to stroke expertise. The Remote Presence (RP) system is used in several of these telestroke networks. The stroke expert uses a laptop and wireless Internet to connect to the RP robot in the peripheral emergency department. This improves the geographical reach of stroke specialist care, and improves patient outcomes as well as conforming with best practice. The stroke network concept combined with telemedicine is a powerful way of transforming stroke care.

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