title: Diagnosing barriers to safety and efficiency in robotic surgery.
abstract: Recent studies exploring the effects of surgical robots on teamwork are revealing challenges not reflected in clinical studies. This study is a sub analysis of observational data collected from 89 procedures utilising the da Vinci systems. Previous analyses had demonstrated interactions between flow disruptions and contextual factors. This study sought a more granular analysis to provide better insight for improvement. Raters sub-classified disruptions, based upon the original notes, grouped according to four operative phases (pre-robot; docking; surgeon on console; undocking; and finish). The need for repeated utterances; additional supplies retrieval; fogging or matter on the endoscope and procedure-specific training were particularly disruptive. Variations across phases reflect differing demands across the operative course. Combined qualitative and quantitative observational methodologies can identify otherwise undocumented sources of process variation and potential failure. Future observational frameworks should attempt to merge human reliability analysis, a priori modelling, and post hoc analyses of observational data. Practioner Summary: Robotic surgery introduces new challenges into the operating room. Direct observation was used to classify and identify flow disruptions in order to diagnose problems in need of improvement. This technique complements other error prediction and system diagnostic methods which may not account for the complexity and transparency of health care.
authors.affiliation: a SmartState Endowed Chair in Clinical Practice and Human Factors, Department of Anesthesia and Perioperative Medicine , Medical University of South Carolina , Charleston , SC , USA.
authors.forename: Ken R
authors.initials: KR
authors.lastname: Catchpole
authors.affiliation: b Department of Psychology , California State University , Long Beach , CA , USA.
authors.forename: Elyse
authors.initials: E
authors.lastname: Hallett
authors.affiliation: b Department of Psychology , California State University , Long Beach , CA , USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Curtis
authors.affiliation: b Department of Psychology , California State University , Long Beach , CA , USA.
authors.forename: Tannaz
authors.initials: T
authors.lastname: Mirchi
authors.affiliation: c Department of Surgery , Cedars-Sinai Medical Center , West Hollywood , CA , USA.
authors.forename: Colby P
authors.initials: CP
authors.lastname: Souders
authors.affiliation: c Department of Surgery , Cedars-Sinai Medical Center , West Hollywood , CA , USA.
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Anger
mesh_terms: D004526:Efficiency; D004869:Equipment Safety; D006801:Humans; D064887:Observational Studies as Topic; D065287:Robotic Surgical Procedures / Q000379:methods / Q000592:standards*
keywords: Health care ergonomics; complex systems; human–machine systems; patient safety; teamwork