Pillars of a Smart, Safe Operating Room

Major gains in patient safety can be achieved through development of innovative approaches to the care of surgical patients. Investigators and clinicians have conceived an “operating room of the future” (ORF) that epitomizes those current and future enhancements that can contribute to patient safety in the operative environment. In this article, we explore these enhancements in the context of their development as University of Maryland (UM) ORF initiatives. We discuss the four “pillars” of our research that affect patient safety: (1) surgical simulation, (2) “smart image,” (3) informatics, and (4) ergonomics/human factors. In surgical simulation, in addition to virtual reality and physical trainers of surgical skills, we are developing a cognitive simulator for teaching clinical decisionmaking in a manner that emulates the actual surgical and clinical experience. Smart image uses computer-enhanced imaging to provide safe rehearsal before surgery and image-based guidance during operations. Informatics analyzes and improves the processes within the perioperative environment, including accurate identification of the patient, care providers, and tools; establishment of clear communication among the surgical team members; and provision of real-time, graphically presented feedback. Ergonomics and human factors are used to design physical and informational workplaces for better outcomes, both for patients and care providers. Research in regard to these pillars shows the promise of an ORF as a vital component of a pervasive patient safety environment.