Tara Cohen

EDUCATION

PhD - Human Factors - Embry-Riddle Aeronautical University

Scopus Publications

Training Hospital Nurses to Write Detailed Narratives and Describe Contributing Factors in Incident Reports: The SAFER Education Program
Tara N Cohen, T. K. Nuckols, Carl T Berdahl, E. Seferian, Sara G. McCleskey, A. Henreid, Donna Leang, Maria Andrea Lupera and Bernice L. Coleman




Trials and Tribulations of a Urinary Incontinence Screening Tool
Falisha F. Kanji, Tara Cohen, Claire S. Burton, Catherine Bresee, Joshua Pevnick, Teryl Nuckols, Neil Wenger, and Jennifer T. Anger
Ovid Technologies (Wolters Kluwer Health)
Importance Women experiencing symptoms of urinary incontinence (UI) may be reluctant to discuss their symptoms with their primary care physicians (providers) due to embarrassment and stigma surrounding the condition. Objectives As part of a primary care quality improvement pilot intervention for UI, this study aimed to assess the success of an online screening tool in identifying bothersome urinary UI in a primary care setting. A secondary analysis sought to determine the percentage of women who discussed the condition with their providers. Study Design Providers from a regional medical group in Southern California and their female patients 18 years of age and older were invited to participate between July 2019 and February 2020. Female patients were recruited via a screening survey. Providers were alerted by email and the patient's electronic health record when a patient screened positive. Results Twenty-four providers participated in the study. A total of 6,360 screening surveys were sent to female patients. Seven hundred nine (11.15%) responses were received. Three hundred two patients reported experiencing symptoms of UI, but only 166 patients chose to participate. Of the 166 participating patients, 35 (21.08%) spoke with their providers about their symptoms after they were screened. Conclusions Online screening for UI is feasible. The observation that only 21% of patients had conversations with their providers about their symptoms during the appointment, even after the provider was notified of the positive screen, suggests the need for better tools, such as alerts in the medical record, to enhance provider awareness of their patients’ UI.


Rethinking Surgical Safety: Investigating the Impact of Gamified Training on Severe Flow Disruptions in Surgery
Tara Cohen, Falisha Kanji, Jennifer Zamudio, Catherine Breese, Ray Avenido, Christine Yoshizawa, Stephanie Bartkowicz, Kenneth Catchpole, and Jennifer Anger
Ovid Technologies (Wolters Kluwer Health)
Objectives There is a need for effective and engaging training methods to enhance technical and nontechnical skills in robotic-assisted surgery (RAS), where deficiencies can compromise safety and efficiency. This study aims to evaluate the impact of a gamified team training intervention, the “RAS Olympics,” on the safety and efficiency of RAS procedures. Methods The study was conducted at a 958-bed tertiary care academic medical center in with a robust robotic surgery program. A total of 56 RAS procedures (general, urology, and gynecology) were included in the analysis, with a mix of procedure types representative of the surgical caseload at the medical center. A pretest posttest experimental design was employed, comparing the frequency and severity of flow disruptions (FD) between preintervention, postintervention without “RAS Olympics” participants, and postintervention with “RAS Olympics” participants. The “RAS Olympics” involved safety hazard identification, troubleshooting, workspace navigation, instrument retrieval, and turnover optimization. Results Postintervention cases with “RAS Olympics” participants exhibited significantly lower overall FDs compared to the postintervention control group. The reduction was particularly notable during phase 3 (surgeon on console) and in cases involving more severe FDs. Conclusions Gamified team training interventions may improve the safety and efficiency of RAS procedures. The positive outcomes underscore the potential of innovative and engaging training methods to address the evolving challenges in surgical practice, emphasizing the relevance of gamification in healthcare education. As the healthcare landscape continues to advance, incorporating such interventions may be crucial in ensuring the adaptability and competence of surgical teams.


The Application of Human Factors Approaches to Improve Safety, Efficiency and Well-being in Urology: A Systematic Scoping Review
Tara N. Cohen, Falisha F. Kanji, and Jennifer T. Anger
Elsevier BV



The impact of resident training on robotic operative times: is there a July Effect?
Falisha F. Kanji, Eunice Choi, Kai B. Dallas, Raymund Avenido, Juzar Jamnagerwalla, Stephanie Pannell, Karyn Eilber, Ken Catchpole, Tara N. Cohen, and Jennifer T. Anger
Springer Science and Business Media LLC
AbstractIt is unknown whether the July Effect (a theory that medical errors and organizational inefficiencies increase during the influx of new surgical residents) exists in urologic robotic-assisted surgery. The aim of this study was to investigate the impact of urology resident training on robotic operative times at the beginning of the academic year. A retrospective chart review was conducted for urologic robotic surgeries performed at a single institution between 2008 and 2019. Univariate and multivariate mix model analyses were performed to determine the association between operative time and patient age, estimated blood loss, case complexity, robotic surgical system (Si or Xi), and time of the academic year. Differences in surgery time and non-surgery time were assessed with/without resident presence. Operative time intervals were included in the analysis. Resident presence correlated with increased surgery time (38.6 min (p < 0.001)) and decreased non-surgery time (4.6 min (p < 0.001)). Surgery time involving residents decreased by 8.7 min after 4 months into the academic year (July–October), and by an additional 5.1 min after the next 4 months (p = 0.027, < 0.001). When compared across case types stratified by complexity, surgery time for cases with residents significantly varied. Cases without residents did not demonstrate such variability. Resident presence was associated with prolonged surgery time, with the largest effect occurring in the first 4 months and shortening later in the year. However, resident presence was associated with significantly reduced non-surgery time. These results help to understand how new trainees impact operating room times.


Challenges With Robot-Assisted Surgery Setup for Complex Minimally Invasive Upper Gastrointestinal Surgery
Falisha F. Kanji, Aleeque Marselian, Miguel Burch, Monica Jain, and Tara N. Cohen
SAGE Publications
Background The utilization of robot-assisted approaches to surgery has increased significantly over the last two decades. This has introduced novel complexities into the operating room environment, requiring management of new challenges and workflow adaptation. This study aimed to analyze challenges in the surgical setup for complex upper gastrointestinal robot-assisted surgery (UGI-RAS) and identify opportunities for solutions. Methods Direct observations of surgical setup processes for UGI-RAS were performed by a trained Human Factors researcher at a non-profit academic medical center in Southern California. Setup tasks were subdivided into five phases: (1) before wheels-in; (2) patient transfer and anesthesia induction; (3) patient preparation; (4) surgery preparation; and (5) robot docking. Start/end times for each phase/task were documented along with workflow disruption (FD) narratives and timestamps. Setup tasks and FDs were analyzed using descriptive statistics. Results Twenty UGI-RAS setup procedures were observed between May-November 2023: sleeve gastrectomy +/− hiatal hernia repair (n = 9, 45.00%); para-esophageal hernia repair +/− fundoplication (n = 8, 40.00%); revision to Roux-en-Y gastric bypass (n = 2, 10.00%); and gastric band removal (n = 1, 5.00%). Frequent FDs included planning breakdowns (n = 20, 29.85%), equipment/supply management (n = 17, 25.37%), patient care coordination (n = 8, 11.94%), and equipment challenges (n = 8, 11.94%). Eleven of 20 observations were first-start cases, of which 10 experienced delayed starts. Discussion Interventions aimed at improving workflows during UGI-RAS setup include performing pre-operative team huddles and conducting trainings aimed at team coordination and equipment challenges. These solutions could result in improved teamwork, efficiency, and communication while reducing case start delays and turnover time.


Author Correction:: The IDEAL framework for surgical robotics: development, comparative evaluation and long-term monitoring (Nature Medicine, (2024), 30, 1, (61-75), 10.1038/s41591-023-02732-7)
Hani J. Marcus, Pedro T. Ramirez, Danyal Z. Khan, Hugo Layard Horsfall, John G. Hanrahan, Simon C. Williams, David J. Beard, Rani Bhat, Ken Catchpole, Andrew Cook,et al.
Springer Science and Business Media LLC



Human Factors Integration in Robotic Surgery
Ken Catchpole, Tara Cohen, Myrtede Alfred, Sam Lawton, Falisha Kanji, Daniel Shouhed, Lynne Nemeth, and Jennifer Anger
SAGE Publications
Objective Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice. Background New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes. Results Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system. Conclusion There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care. Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.


Gaps in Workplace Injury Reporting Among Physicians to the United States Bureau of Labor Statistics
Andrew T. Gabrielson, Kristin Chrouser, M. Susan Hallbeck, Tara Cohen, and Claudia Corwin
Ovid Technologies (Wolters Kluwer Health)
Abstract Objective To identify gaps in nonfatal injury and illness (NII) reporting between physicians and other occupations. Methods Bureau of Labor Statistics data (2011-2019) were analyzed, comparing annualized NII incidence rates using incidence rate ratios (IRR), with physicians as the reference. Results Between 2011-2019, physicians reported significantly lower NII rates compared to high-hazard non-medical occupations (IRR 17.2-70.8, all p < 0.01) and most low-hazard non-medical occupations (IRR 1.2-6.3, all p < 0.01), except lawyers. NII rates among physicians were also lower than those in non-physician medical occupations (IRR 1.4-27.6, all p < 0.01). In 2020, relative NII rates between physicians and non-physician medical occupations decreased but returned to pre-pandemic levels by 2021. Conclusions Physicians report significantly lower NII rates than other occupations, likely due to underreporting or undercounting, highlighting a potential gap in occupational injury data.


Interdisciplinary operating room ergonomics needs and priorities: a survey of operating room staff
Alexis Mah, Fahad Alam, Jeremie Larouche, Marie-Antonette Dandal, Tara Cohen, Susan Hallbeck, Hamid Norasi, Csilla Kallocsai, Sapna Sriram, James D. Helman,et al.
Ovid Technologies (Wolters Kluwer Health)
Objective: To examine perceived OR ergonomics facilitators and barriers, with a focus on the interdisciplinary team. Summary Background Data: Poor ergonomics causes musculoskeletal injuries affecting all operating room (OR) staff with repercussions on patient care, outcomes, and sustainability. Lack of ergonomic awareness and education are risk factors. Methods: We conducted a self-administered web-based survey of OR nurses, surgeons, and anesthesiologists at a single centre (n=238). We developed a questionnaire through items generation and reduction, followed by reliability and validity testing. Results: Response rate was 53.8%. Respondents perceived that on average 80% of nurses, 70% of surgeons, and 40% anesthesiologists experienced MSK injuries, with no difference in professional groups’ perceptions. Guideline ergonomics interventions were rarely used (<25%) except for specialized clothing (33%), equipment repositioning (59%), and seating (37%), though perceived beneficial by 80-90%. Reported barriers to optimal ergonomics were organizational/structural (lack of time, space, equipment, funding), whereas solutions were individual. Fear of unfavourable perception from others was a concern for 62%. Teams discussing, prioritizing, monitoring, or helping with ergonomics was indicated by <50%. Individual ergonomic adaptations were perceived as convenience by other staff. Conclusions: While structural/organizational issues are reported as barriers to ergonomics, solutions appeared as individual responsibilities. Team dynamics did not prioritize nor support ergonomics. Education tools leveraging the interdisciplinary team are warranted. This work will be supplemented by interviews and live observations to build tailored educational tools for OR teams.


Why can’t we improve turnover time? A systematic review
Tara N. Cohen, Falisha F. Kanji, Jennifer Zamudio, Daniel Shouhed, Bruce L. Gewertz, and Harry C. Sax
Wiley
AbstractBackgroundDespite substantial efforts to reduce operating room (OR) turnover time (TOT), delays remain a frustration to physicians, staff, and hospital leadership. These efforts have employed many systems and human factor‐based approaches with variable results. A deeper dive into methodologies and their applicability could lead to successful and sustained change. The aim of this study was to conduct a systematic review to evaluate relevant research focused on improving OR TOT and clearly defining measures of successful intervention.Material and MethodsA systematic review of OR TOT interventions implemented between 1980 through October 2022 was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) methodology. Research databases included: 1) PubMed; 2) Web of Science; and 3) OVID Medline.ResultsA total of 38 articles were appropriate for analysis. Most employed a pre/post intervention approach (29, 76.3%), the remaining utilized a control/intervention approach. Nine intervention methods were identified: the majority included a process redesign bundle (24, 63%), followed by overlapping induction, dedicated unit/team/space feedback, financial incentives, team training, education, practice guidelines, and redefinition of roles/responsibilities. Studies were further categorized into one of two groups: (1) those that utilized predetermined interventions based on anecdotal experience or prior literature (18, 47.4%) and (2) those that conducted a prospective analysis on baseline data to inform intervention development (20, 52.6%).DiscussionThere are significant variability in the methodologies utilized to improve OR TOT; however, the most effective solutions involved process redesign bundles developed from a prospective investigation of the clinical work‐system.


The IDEAL framework for surgical robotics: development, comparative evaluation and long-term monitoring
Hani J. Marcus, Pedro T. Ramirez, Danyal Z. Khan, Hugo Layard Horsfall, John G. Hanrahan, Simon C. Williams, David J. Beard, Rani Bhat, Ken Catchpole, Andrew Cook,et al.
Springer Science and Business Media LLC



Medication Safety Event Reporting: Factors That Contribute to Safety Events During Times of Organizational Stress
Tara N. Cohen, Carl T. Berdahl, Bernice L. Coleman, Edward G. Seferian, Andrew J. Henreid, Donna W. Leang, and Teryl K. Nuckols
Ovid Technologies (Wolters Kluwer Health)
Background: Incident reports submitted during times of organizational stress may reveal unique insights. Purpose: To understand the insights conveyed in hospital incident reports about how work system factors affected medication safety during a coronavirus disease-2019 (COVID-19) surge. Methods: We randomly selected 100 medication safety incident reports from an academic medical center (December 2020 to January 2021), identified near misses and errors, and classified contributing work system factors using the Human Factors Analysis and Classification System-Healthcare. Results: Among 35 near misses/errors, incident reports described contributing factors (mean 1.3/report) involving skill-based errors (n = 20), communication (n = 8), and tools/technology (n = 4). Reporters linked 7 events to COVID-19. Conclusions: Skill-based errors were the most common contributing factors for medication safety events during a COVID-19 surge. Reporters rarely deemed events to be related to COVID-19, despite the tremendous strain of the surge on nurses. Future efforts to improve the utility of incident reports should emphasize the importance of describing work system factors.


The POCKET study: personal-device-based point-of-care-ultrasound versus standard ultrasound machine use for inpatient obstetric workflow: a time and motion study
Cecilia B. Leggett, Tara Cohen, Erica Sauro, and Melissa S. Wong
Elsevier BV



Comparing the Safety Action Feedback and Engagement (SAFE) Loop with an established incident reporting system: Study protocol for a pragmatic cluster randomized controlled trial
Carl T. Berdahl, Andrew J. Henreid, Tara N. Cohen, Bernice L. Coleman, Edward G. Seferian, Donna Leang, Sungjin Kim, Marcio A. Diniz, Matthew Grissinger, Karen Kaiser,et al.
Elsevier BV



Demands of surgical teams in robotic-assisted surgery: An assessment of intraoperative workload within different surgical specialties
Jennifer Zamudio, Jeffrey Woodward, Falisha F. Kanji, Jennifer T. Anger, Ken Catchpole, and Tara N. Cohen
Elsevier BV



Understanding ultrarare adverse events - Lessons learned from a twelve-year review of intraoperative deaths at an academic medical center
Tara N. Cohen, Falisha F. Kanji, Andrew S. Wang, Edward G. Seferian, Harry C. Sax, and Bruce L. Gewertz
Elsevier BV



Female sexual health digital resources: women and health care providers need more options
Alexandra Dubinskaya, John R Heard, Eunice Choi, Tara Cohen, Jennifer Anger, Karyn Eilber, and Victoria Scott
Oxford University Press (OUP)
Abstract Introduction Female sexual health and female sexual dysfunction (FSD) are usually poorly diagnosed and treated because of the numerous barriers providers and patients face. Internet platforms, such as mobile applications (apps) are potential tools that help overcome these barriers and improve patient access to education and management options for FSD. Objectives The aim of this review was to identify existing applications on female sexual health and evaluate their educational content and services. Methods We searched the internet and Apple App Store using multiple keywords. A panel of physicians specialized in the treatment of FSD reviewed the apps for content quality, the scientific basis of provided information, interactivity, usability, and whether they would recommend it as a reference tool for patients. Results Of the 204 apps identified, 17 met the inclusion criteria and were reviewed further. The selected apps were organized into groups based on common themes such as educational (n = 6), emotions and communication (n = 2), relaxation and meditation (n = 4), general sexual health (n = 2), and social and fun (n = 3). All apps from the educational category provided scientific information in collaboration with health experts. When assessed for usability, 1 app received good and 5 received excellent scores based on the System Usability Scale. Most apps (n = 5) provided information on pathology and treatments of orgasmic dysfunction, but only 1 app, created by a physician, provided comprehensive information on all the types of FSD. Conclusion Digital technology could be an effective way to overcome barriers to accessing information and ultimately care for female sexual health. Our review demonstrated that there is still a need for more accessible educational resources addressing female sexual health and FSD for patients and providers.


Identifying Workflow Disruptions in Robotic-Assisted Bariatric Surgery: Elucidating Challenges Experienced by Surgical Teams
Jennifer Zamudio, Falisha F. Kanji, Connor Lusk, Daniel Shouhed, Barry R. Sanchez, Ken Catchpole, Jennifer T. Anger, and Tara N. Cohen
Springer Science and Business Media LLC



Planning an Escape: Considerations for the Development of Applied Escape Rooms
Shawn M. Doherty, Andrew C. Griggs, Elizabeth H. Lazzara, Joseph R. Keebler, Bruce L. Gewertz, and Tara N. Cohen
SAGE Publications
Background Teams are essential to a wide array of applications and organizations often utilize varying interventions to improve the effectiveness of their teams. Due to their collaborative and modifiable characteristics, escape rooms are being increasingly utilized as an avenue to both deliver team interventions and to function as testbeds in research. Escape rooms are complex, interdependent activities which warrant careful planning to be effectively implemented. Despite the growing literature base concerning escape rooms, there is still limited practical guidance to inform the development of an escape room. Aim The purpose of this article is to provide seven considerations that are relevant to the development, implementation, and effectiveness of an escape room. Specifically, guidance is provided in determining the objectives, identifying a theme, assigning the roles, establishing participant interdependence, selecting a venue, designing the puzzles, and creating the assessments. Conclusion The considerations provided in this article can advance the science underlying the use of escape rooms and preclude difficulties associated with their use.


Association of Parental Status and Gender With Burden of Multidisciplinary Tumor Boards Among Oncology Physicians
Brittney L. Chau, Jonnby S. LaGuardia, Sungjin Kim, Samuel C. Zhang, Eric Pletcher, Nina N. Sanford, Ann C. Raldow, Lisa Singer, Jun Gong, Sukhmani K. Padda,et al.
American Medical Association (AMA)
ImportanceTumor boards are integral to the care of patients with cancer. However, data investigating the burden of tumor boards on physicians are limited.ObjectiveTo investigate what physician-related and tumor board–related factors are associated with higher tumor board burden among oncology physicians.Design, Setting, and ParticipantsTumor board burden was assessed by a cross-sectional convenience survey posted on social media and by email to Cedars-Sinai Medical Center cancer physicians between March 3 and April 3, 2022. Tumor board start times were independently collected by email from 22 top cancer centers.Main Outcomes and MeasuresTumor board burden was measured on a 4-point scale (1, not at all burdensome; 2, slightly burdensome; 3, moderately burdensome; and 4, very burdensome). Univariable and multivariable probabilistic index (PI) models were performed.ResultsSurveys were completed by 111 physicians (median age, 42 years [IQR, 36-50 years]; 58 women [52.3%]; 60 non-Hispanic White [54.1%]). On multivariable analysis, factors associated with higher probability of tumor board burden included radiology or pathology specialty (PI, 0.68; 95% CI, 0.54-0.79; P = .02), attending 3 or more hours per week of tumor boards (PI, 0.68; 95% CI, 0.58-0.76; P < .001), and having 2 or more children (PI, 0.65; 95% CI, 0.52-0.77; P = .03). Early or late tumor boards (before 8 am or at 5 pm or after) were considered very burdensome by 33 respondents (29.7%). Parents frequently reported a negative burden on childcare (43 of 77 [55.8%]) and family dynamics (49 of 77 [63.6%]). On multivariable analysis, a higher level of burden from early or late tumor boards was independently associated with identifying as a woman (PI, 0.69; 95% CI, 0.57-0.78; P = .003) and having children (PI, 0.75; 95% CI, 0.62-0.84; P < .001). Independent assessment of 358 tumor boards from 22 institutions revealed the most common start time was before 8 am (88 [24.6%]).Conclusions and RelevanceThis survey study of tumor board burden suggests that identifying as a woman or parent was independently associated with a higher level of burden from early or late tumor boards. The burden of early or late tumor boards on childcare and family dynamics was commonly reported by parents. Having 2 or more children, attending 3 or more hours per week of tumor boards, and radiology or pathology specialty were associated with a significantly higher tumor board burden overall. Future strategies should aim to decrease the disparate burden on parents and women.


Unlocking the Methodology of Escape Rooms: Considerations for Conducting Applied Escape Rooms in Research
Andrew C. Griggs, Elizabeth H. Lazzara, Shawn M. Doherty, Joseph R. Keebler, Bruce L. Gewertz, and Tara N. Cohen
SAGE Publications
Background Teams are the foundation of modern organizations. Many organizations are interested in interventions to bolster the effectiveness of their workforce. One viable intervention is an escape room. Escape rooms are engaging, team-based activities that require individuals to work together to complete multiple tasks in a limited amount of time. Purpose The purpose of this article is to provide ten considerations that are relevant to leveraging escape rooms as a means for data collection. Specifically, we offer guidance regarding pilot testing, equipment set-up, participant recruitment, briefing participants, progress monitoring, hints, room maintenance, data maintenance and analysis, and revising the room and study. Conclusion The considerations provided in this article can assist researchers when attempting to employ an escape room as a mechanism to collect data.


A Novel Approach for Engagement in Team Training in High-Technology Surgery: The Robotic-Assisted Surgery Olympics
Tara N. Cohen, Jennifer T. Anger, Falisha F. Kanji, Jennifer Zamudio, Elise DeForest, Connor Lusk, Ray Avenido, Christine Yoshizawa, Stephanie Bartkowicz, Lynne S. Nemeth,et al.
Ovid Technologies (Wolters Kluwer Health)
Introduction There is ongoing interest in the development of technical and nontechnical skills in healthcare to improve safety and efficiency; however, barriers to developing and delivering related training programs make them difficult to implement. Unique approaches to training such as “serious games” may offer ways to motivate teams, reinforce skill acquisition, and promote teamwork. Given increased challenges to teamwork in robotic-assisted surgery (RAS), researchers aimed to develop the “RAS Olympics,” a game-based educational competition to improve skills needed to successfully perform RAS. Methods This pilot study was conducted at an academic medical center in Southern California. Robotic-assisted surgery staff were invited to participate in the “RAS Olympics” to develop their skills and identify opportunities to improve processes. Impact of the activity was assessed using surveys and debriefs. Results Sixteen operating room team members participated and reacted favorably toward the RAS-Olympics (average score, 4.5/5). They enjoyed the activity, would recommend all staff participate, felt that it was relevant to their work, and believed that they practiced and learned new techniques that would improve their practice. Confidence in skills remained unchanged. Participants preferred the RAS Olympics to traditional training because it provided an interactive learning environment. Conclusions The successful implementation of the RAS Olympics provided insight into new opportunities to engage surgical staff members while also training technical and nontechnical skills. Furthermore, this shared experience allowed surgical staff members to gain a greater appreciation for their teammates and an understanding of the current challenges and methods to improve teamwork and communication while promoting safety and efficiency in RAS.


A better way: Training for direct observations in healthcare
Myrtede Alfred, John Del Gaizo, Falisha Kanji, Samuel Lawton, Ashley Caron, Lynne S Nemeth, A V Alekseyenko, Daniel Shouhed, Stephen Savage, Jennifer T Anger,et al.
BMJ
Direct observation is valuable for identifying latent threats and elucidating system complexity in clinical environments. This approach facilitates prospective risk assessment and reveals workarounds, near-misses and recurrent safety problems difficult to diagnose retrospectively or via outcome data alone. As observers are an instrument of data collection, developing effective and comprehensive observer training is critical to ensuring the reliability of the data collection and reproducibility of the research. However, methodological rigour for ensuring these data collection properties remains a key challenge in direct observation research in healthcare. Although prior literature has offered key considerations for observational research in healthcare, operationalising these recommendations may pose a challenge and unless guidance is also provided on observer training. In this article, we offer guidelines for training non-clinical observers to conduct direct observations including conducting a training needs analysis, incorporating practice observations and evaluating observers and inter-rater reliability. The operationalisation of these guidelines is described in the context of a 5-year multisite observational study investigating technology integration in the operating room. We also discuss novel tools developed during the course our project to support data collection and examine inter-rater reliability among observers in direct observation studies.


Addressing misconceptions of flow disruption studies in “Is non-stop always better? Examining assumptions behind the concept of flow disruptions in studies of robot-assisted surgery”
Ken Catchpole, Connor Lusk, Matthias Weigl, Jennifer Anger, and Tara Cohen
Springer Science and Business Media LLC
This letter to the editor provides a response to “Is non-stop always better? Examining assumptions behind the concept of flow disruptions in studies of robot-assisted surgery.” The authors provide much needed clarification on misconceptions of flow disruption studies. The evolving methodology is not aimed at creating a “non-stop” flow, or optimizing efficiency, but understanding the clinical process from a systems perspective.

RECENT SCHOLAR PUBLICATIONS

Training Hospital Nurses to Write Detailed Narratives and Describe Contributing Factors in Incident Reports: The SAFER Education Program
TN Cohen, TK Nuckols, CT Berdahl, EG Seferian, SG McCleskey, ...
The Joint Commission Journal on Quality and Patient Safety 2025



Trials and Tribulations of a Urinary Incontinence Screening Tool
FF Kanji, T Cohen, CS Burton, C Bresee, J Pevnick, T Nuckols, N Wenger, ...
Urogynecology, 10.1097 2024



Challenges With Robot-Assisted Surgery Setup for Complex Minimally Invasive Upper Gastrointestinal Surgery
FF Kanji, A Marselian, M Burch, M Jain, TN Cohen
The American Surgeon™ 90 (10), 2403-2410 2024



The Application of Human Factors Approaches to Improve Safety, Efficiency and Well-being in Urology: A Systematic Scoping Review
T Cohen, FF Kanji, JT Anger
Urology 2024



10 Safety and efficacy of nebulized phage in people with cystic fibrosis with chronic Pseudomonas aeruginosa pulmonary infection: A phase 1b/2a randomized, double-blind
U Rappo, I Maimon, A Cohen, E Kario, J Gold, H Nevenzal, IL Saar, ...
Journal of Cystic Fibrosis 23, S5-S6 2024



WS06. 06 safety and efficacy of a nebulized phage cocktail in cystic fibrosis patients with chronic Pseudomonas aeruginosa pulmonary infection: a phase 1b/2a randomized, double
E Kerem, U Rappo, A Cohen, I Maimon, E Kario, J Gold, HT Nevenzal, ...
Journal of Cystic Fibrosis 23, S12 2024



The impact of resident training on robotic operative times: is there a July Effect?
FF Kanji, E Choi, KB Dallas, R Avenido, J Jamnagerwalla, S Pannell, ...
Journal of Robotic Surgery 18 (1), 208 2024



Human factors integration in robotic surgery
K Catchpole, T Cohen, M Alfred, S Lawton, F Kanji, D Shouhed, L Nemeth, ...
Human factors 66 (3), 683-700 2024



Quantifying and Visualizing Emergency Physician Workflow: Results of an Observational Time-Motion Study
AJ Henreid, KLH Ioannides, JM Pevnick, TN Cohen, SS Torbati, ...
medRxiv, 2024.11. 27.24318109 2024



Interdisciplinary Operating Room Ergonomics Needs and Priorities: A Survey of Operating Room Staff
A Mah, F Alam, J Larouche, MA Dandal, T Cohen, S Hallbeck, H Norasi, ...
Annals of surgery, 10.1097 2024



Why can’t we improve turnover time? A systematic review
TN Cohen, FF Kanji, J Zamudio, D Shouhed, BL Gewertz, HC Sax
World Journal of Surgery 48 (1), 72-85 2024



1392: PLACING EQUITY IN CARDIOPULMONARY RESUSCITATION PERFORMANCE WITH SIMULATED PATIENTS
P Nawathe, B Reaport, F Kanji, T Cohen
Critical Care Medicine 52 (1), S667 2024



Medication safety event reporting: factors that contribute to safety events during times of organizational stress
TN Cohen, CT Berdahl, BL Coleman, EG Seferian, AJ Henreid, ...
Journal of Nursing Care Quality 39 (1), 51-57 2024



Curriculum for Improving Surgeon-Pathologist Communication
K Ojukwu, M Kozak, C Bui, T Lee, T Imai, B Balzer, K Waters, TN Cohen, ...
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 237 (5), S407-S407 2023



Association of parental status and gender with burden of multidisciplinary tumor boards among oncology physicians
BL Chau, JS LaGuardia, S Kim, SC Zhang, E Pletcher, NN Sanford, ...
JAMA Network Open 6 (10), e2340663-e2340663 2023



Association of Parental Status and Gender with Burden of Multidisciplinary Tumor Boards
BL Chau, JS LaGuardia, S Kim, SC Zhang, E Pletcher, NN Sanford, ...
International Journal of Radiation Oncology, Biology, Physics 117 (2), S113-S114 2023



The POCKET study: personal-device-based point-of-care-ultrasound versus standard ultrasound machine use for inpatient obstetric workflow: a time and motion study
CB Leggett, T Cohen, E Sauro, MS Wong
American Journal of Obstetrics & Gynecology MFM 5 (10) 2023



Comparing the Safety Action Feedback and Engagement (SAFE) Loop with an established incident reporting system: Study protocol for a pragmatic cluster randomized controlled trial
CT Berdahl, AJ Henreid, TN Cohen, BL Coleman, EG Seferian, D Leang, ...
Contemporary Clinical Trials Communications 35, 101192 2023



Demands of surgical teams in robotic-assisted surgery: An assessment of intraoperative workload within different surgical specialties
J Zamudio, J Woodward, FF Kanji, JT Anger, K Catchpole, TN Cohen
The American Journal of Surgery 226 (3), 365-370 2023



Understanding ultrarare adverse events-Lessons learned from a twelve-year review of intraoperative deaths at an academic medical center
TN Cohen, FF Kanji, AS Wang, EG Seferian, HC Sax, BL Gewertz
The American Journal of Surgery 226 (3), 315-321 2023

MOST CITED SCHOLAR PUBLICATIONS

Assessment of the Human Factors Analysis and Classification System (HFACS): Intra-rater and inter-rater reliability
A Ergai, T Cohen, J Sharp, D Wiegmann, A Gramopadhye, S Shappell
Safety science 82, 393-398 2016
Citations: 170



Understanding the “Swiss Cheese Model” and its application to patient safety
DA Wiegmann, LJ Wood, TN Cohen, SA Shappell
Journal of patient safety 18 (2), 119-123 2022
Citations: 97



Identifying workflow disruptions in the cardiovascular operating room
TN Cohen, JS Cabrera, OD Sisk, KL Welsh, JH Abernathy, ST Reeves, ...
Anaesthesia 71 (8), 948-954 2016
Citations: 67



Imaging utilization affects negative appendectomy rates in appendicitis: an ACS-NSQIP study
J Tseng, T Cohen, N Melo, RF Alban
The American Journal of Surgery 217 (6), 1094-1098 2019
Citations: 59



Evaluating the reliability of the human factors analysis and classification system
TN Cohen, DA Wiegmann, SA Shappell
Aerospace medicine and human performance 86 (8), 728-735 2015
Citations: 59



Using HFACS-healthcare to identify systemic vulnerabilities during surgery
TN Cohen, SE Francis, DA Wiegmann, SA Shappell, BL Gewertz
American Journal of Medical Quality 33 (6), 614-622 2018
Citations: 52



Using escape rooms for conducting team research: understanding development, considerations, and challenges
TN Cohen, AC Griggs, JR Keebler, EH Lazzara, SM Doherty, FF Kanji, ...
Simulation & Gaming 51 (4), 443-460 2020
Citations: 46



Intelligent emergency department: Validation of sociometers to study workload
D Yu, RC Blocker, MY Sir, MS Hallbeck, TR Hellmich, T Cohen, ...
Journal of medical systems 40, 1-12 2016
Citations: 43



Optimizing the user experience: identifying opportunities to improve use of an inpatient portal
DM Walker, T Menser, PY Yen, AS McAlearney
Applied clinical informatics 9 (01), 105-113 2018
Citations: 34



Human factors integration in robotic surgery
K Catchpole, T Cohen, M Alfred, S Lawton, F Kanji, D Shouhed, L Nemeth, ...
Human factors 66 (3), 683-700 2024
Citations: 26



Work-system interventions in robotic-assisted surgery: a systematic review exploring the gap between challenges and solutions
F Kanji, K Catchpole, E Choi, M Alfred, K Cohen, D Shouhed, J Anger, ...
Surgical endoscopy 35, 1976-1989 2021
Citations: 26



Proactive safety management in trauma care: applying the human factors analysis and classification system
TN Cohen, JS Cabrera, TL Litzinger, KA Captain, MA Fabian, SG Miles, ...
The Journal for Healthcare Quality (JHQ) 40 (2), 89-96 2018
Citations: 22



Distracted doctoring: the role of personal electronic devices in the operating room
TN Cohen, SA Shappell, ST Reeves, AJ Boquet
Perioperative Care and Operating Room Management 10, 10-13 2018
Citations: 21



Flow disruptions impacting the surgeon during cardiac surgery: defining the boundaries of the error space
AJ Boquet, TN Cohen, ST Reeves, SA Shappell
Perioperative Care and Operating Room Management 7, 1-6 2017
Citations: 21



Barriers to safety and efficiency in robotic surgery docking
L Cofran, T Cohen, M Alfred, F Kanji, E Choi, S Savage, J Anger, ...
Surgical endoscopy, 1-10 2021
Citations: 20



Coding human factors observations in surgery
TN Cohen, DA Wiegmann, ST Reeves, AJ Boquet, SA Shappell
American Journal of Medical Quality 32 (5), 556-562 2017
Citations: 20



Discovering the barriers to efficient robotic operating room turnover time: perceptions vs. reality
TN Cohen, JT Anger, K Shamash, KA Cohen, Y Nasseri, SE Francis, ...
Journal of Robotic Surgery 14, 717-724 2020
Citations: 19



Advancing team cohesion: Using an escape room as a novel approach
TN Cohen, AC Griggs, FF Kanji, KA Cohen, EH Lazzara, JR Keebler, ...
Journal of Patient Safety and Risk Management 26 (3), 126-134 2021
Citations: 18



Using broken windows theory as the backdrop for a proactive approach to threat identification in health care
AJ Boquet, TN Cohen, JS Cabrera, TL Litzinger, KA Captain, MA Fabian, ...
Journal of Patient Safety 17 (3), 182-188 2021
Citations: 18



A human factors approach to surgical patient safety
TN Cohen, BL Gewertz, D Shouhed
Surgical Clinics 101 (1), 1-13 2021
Citations: 18