Tara Nicole Cohen

Tara Nicole Cohen
Cedars-Sinai Medical Center · Department of Surgery

PhD Human Factors

About

69
Publications
8,620
Reads
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447
Citations
Citations since 2016
66 Research Items
440 Citations
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Introduction
I am a Human Factors Research Scientist, Associate Professor of Surgery and Co-director of the Gewertz-Cohen Laboratory at Cedars-Sinai Medical Center. I have an interest in understanding how human behavior plays a role in complex healthcare environments, and what can be done to increase efficiency and safety throughout various systems. My current research involves investigating barriers to safe and efficient patient care in several areas of medicine.
Additional affiliations
December 2017 - March 2020
OR360
Position
  • Managing Director
Description
  • OR360 is a human factors research and innovation lab within Cedars-Sinai Medical Center in Los Angeles, CA. We apply human factors engineering and process improvement principles to understand and design safer and more efficient healthcare systems.
December 2017 - April 2020
Cedars-Sinai Medical Center
Position
  • Professor (Assistant)
May 2017 - present
Cedars-Sinai Medical Center
Position
  • Professor (Assistant)
Description
  • I conduct research to understand the relationships between humans and systems in healthcare in an effort to improve safety, efficiency and wellbeing.
Education
August 2015 - May 2017
Embry-Riddle Aeronautical University
Field of study
  • Human Factors
April 2013 - May 2015
Embry-Riddle Aeronautical University
Field of study
  • Human Factors
August 2009 - May 2013
University of Southern California
Field of study
  • Psychology

Publications

Publications (69)
Article
Despite a variety of attempts to infer measurements of workload through more objective means, the NASATLX remains the most preferred tool in various industries. Interest in patient safety and healthcare systems design has seen a frequent application of the NASA-TLX over other methods within a range of surgical settings and has generated other adapt...
Article
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....
Article
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 col...
Article
Introduction Female sexual dysfunction (FSD) is an orphaned field due to numerous barriers faced by both providers and patients. Internet platforms, such as mobile applications, are potential tools to overcome these barriers and improve patient access to education and management options for FSD. Objective The purpose of this review is to identify...
Article
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 s...
Article
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 o...
Article
Background: Challenges associated with turnover time are magnified in robotic surgery. The introduction of advanced technology increases the complexity of an already intricate perioperative environment. We applied a human factors approach to develop systematic, data-driven interventions to reduce robotic surgery turnover time. Methods: Researche...
Article
Study Objective To apply a structured human factors analysis to understand conditions contributing to vaginal retained foreign objects (RFO). Design All potential vagina RFO events from January 1, 2000, to May 21, 2019, were analyzed by trained human factors researchers. Each narrative was reviewed to identify contributing factors, classified usin...
Article
Full-text available
Background The introduction of new technology into the operating room (OR) can be beneficial for patients, but can also create new problems and complexities for physicians and staff. The observation of flow disruptions (FDs)—small deviations from the optimal course of care—can be used to understand how systems problems manifest. Prior studies showe...
Article
This systematic review provides information on the methodologies, measurements and classification systems used in observational studies of flow disruptions in clinical environments. The PRISMA methodology was applied and authors searched two databases (PubMed and Web of Science) for studies meeting the following inclusion criteria: (a) were conduct...
Article
Full-text available
Medication errors continue to harm many hospitalized patients. In other high-risk industries, voluntary incident reporting is widely used to improve safety. Reporting is widely used in hospitals, but not as effectively. This AHRQ-funded cluster RCT will assess the effects of the SAFE Loop, which includes five enhancements in incident reporting impl...
Article
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 optimizin...
Article
Today’s workforce is dependent on teams. Organizations are interested in positively influencing antecedents to team effectiveness such as team composition. While many factors have been studied thoroughly concerning team composition and effectiveness, team roles have not received comparable attention. Team roles refer to groups of generalizable, goa...
Article
Today’s workforce is dependent on teams. Organizations are interested in positively influencing antecedents to team effectiveness such as team composition. While many factors have been studied thoroughly concerning team composition and effectiveness, team roles have not received comparable attention. Team roles refer to groups of generalizable, goa...
Article
Full-text available
The introduction of surgical technology into existing operating rooms (ORs) can place novel demands on staff and infrastructure. Despite the substantial physical size of the devices in robotic-assisted surgery (RAS), the workspace implications are rarely considered. This study aimed to explore the impact of OR size on the environmental causes of su...
Article
We developed an in-situ interprofessional simulation program to study system factors to establish a congenital cardiac arrest activation tree and test it using human factors engineering principles. We used the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model to understand the structure, processes, and outcomes related to the cong...
Article
Full-text available
Background The introduction of a robot into the surgical suite changes the dynamics of the work-system, creating new opportunities for both success and failure. An extensive amount of research has identified a range of barriers to safety and efficiency in Robotic Assisted Surgery (RAS), such as communication breakdowns, coordination failures, equip...
Article
Objectives To apply a human factors approach, the study of interactions between humans and complex systems, to investigate patient preparedness, satisfaction, and perceived usability with sacral neuromodulation (SNM) and develop interventions aimed at improving patient experience. Materials and Methods Ten patients with overactive bladder undergoi...
Article
Surgical team members are exposed to many challenging experiences , including intraoperative death (ID). The influence of these very rare incidents on staff morale is poorly defined; the few published studies 1,2 are highly focused on specific clinical specialties and service roles, not the full range of surgical staff members. We sought to define...
Article
Full-text available
Objective An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams. Methods This research was conducted at a nonprofi...
Article
The RN circulator role includes maintaining situational awareness and mitigating risks to patient safety in the OR. Flow disruptions—deviations that threaten the safe and efficient flow of surgery—may contribute to the occurrence of errors and negatively affect safety for patients and health care providers. We used an existing data set to explore t...
Article
Abstract Introduction: As a result of COVID-19, several clinics have adopted telemedicine to safely deliver care. However, the introduction of a new technology into an already complex system creates new challenges that have the potential to negatively impact patient and provider experience. We aimed to use a human factors approach (the science conc...
Article
This article explores the role of human factors engineering in patient safety in surgery. The authors discuss the history and evolution of human factors and the role of human factors in patient safety and provide a description of human factors methods used to study and improve patient safety.
Article
This article reviews several key aspects of the Theory of Active and Latent Failures, typically referred to as the Swiss cheese model of human error and accident causation. Although the Swiss cheese model has become well known in most safety circles, there are several aspects of its underlying theory that are often misunderstood. Some authors have...
Article
Personal communication devices (PCDs) (ie, smartphones) have become an essential part of medical practice. While mobile instant communication allows physicians to intervene in a patient’s care from any location at any time, this constant access may also expose physicians to negative consequences. Jarvenpaa and Lang¹ discuss these paradoxes that sur...
Article
A roboticist by the name of Rodney Brooks once said, “the benefits of having robots could vastly outweigh the problems.” While this may be true, it is important to assess these problems and understand how they may be mitigated. The use of robots is growing in many industries and can be found in areas such as manufacturing, healthcare, agriculture,...
Preprint
Full-text available
BACKGROUND The integration of high technology into healthcare systems is intended to provide new treatment options and improve the quality, safety, and efficiency of care. Robotic-assisted surgery (RAS) is an example of high technology integration in healthcare that has become ubiquitous in many surgical disciplines. OBJECTIVE The goal of the proj...
Article
Background The integration of high technology into health care systems is intended to provide new treatment options and improve the quality, safety, and efficiency of care. Robotic-assisted surgery is an example of high technology integration in health care, which has become ubiquitous in many surgical disciplines. Objective This study aims to und...
Article
Full-text available
Turnover time (TOT) has remained the subject of numerous research articles and operating room (OR) committee discussions. Inefficiencies associated with TOT are multiplied when complex technology, such as surgical robots, is involved. Using a human factors approach, this study investigated impediments to efficient robotic TOT and team members' perc...
Chapter
This chapter serves as the conclusion to this book and provides a broad overview of lessons learned throughout the chapters.
Chapter
This chapter serves as the introduction to the Human Factors section of this book and provides a broad overview of human factors as it relates to surgery. The authors define the science of human factors; describe a brief history of its use; and discuss various system factors (e.g., humans, tools/technology, tasks, environments, and organizations) a...
Chapter
This chapter focuses on identifying ways to improve trauma care using human factors approaches. Two cases are analyzed: one demonstrates the effects of a system that is not functioning optimally, while the other represents a situation where things go well. The authors discuss interventions that have been both successful and unsuccessful in improvin...
Article
Objectives To use a human factors approach to conduct a needs assessment of patient preparedness, education, device usability and satisfaction regarding all stages of sacral neuromodulation therapy and identify opportunities for improvement. Sacral neuromodulation (SNM), though minimally invasive, involves an initial testing phase that requires act...
Article
Background. Modern organizations are increasingly reliant on teams, and many organizations are subsequently concerned with the development of interventions that can improve the performance of teams. Escape rooms are beginning to receive attention as a potential avenue to facilitate team-based research. Escape rooms are team-based recreational activ...
Article
Objectives To compare differences in the characteristics and outcomes of inpatient consults between academic and private practice urologists. Materials and Methods We performed a retrospective review of urology consults at a large tertiary-care hospital from June 1st, 2017 to June 30th, 2018. Patient demographics, timing of consult, location of co...
Book
This book delivers a comprehensive review of human factors principles as they relate to surgical care inside and outside of the operating theatre. It provides multi-dimensional human-centered insights from the viewpoint of academic surgeons and experts in human factors engineering to improve workflow, treatment time, and outcomes. To guide the read...
Article
Background: Negative appendectomy rates (NAR) historically ranged from 15 to 25%, but have decreased recently. Methods: Using the 2016 ACS-NSQIP database, we identified patients who underwent appendectomies for appendicitis. Patients with and without appendicitis on pathology were compared. Multivariate analysis was used to identify predictors o...
Article
This prospective investigation describes the process of designing a targeted, data-driven team training aimed at reducing identified process inefficiencies or flow disruptions (FDs) that threaten the optimal delivery of trauma care. Trained researchers observed and classified FDs during 34 trauma cases in a Level II trauma center. Multidisciplinary...
Article
Introduction and hypothesis The purpose of this study was to apply a human factors research approach to identify flow disruptions, deviations in the optimal course of care, in robotic abdominal sacrocolpopexy procedures with the ultimate goal of developing system interventions to improve the safety and efficiency of robotic surgery. Methods Twenty...
Article
The Human Factors Analysis and Classification System for Healthcare (HFACS-Healthcare) was used to classify surgical near miss events reported via a hospital’s event reporting system over the course of 1 year. Two trained analysts identified causal factors within each event narrative and subsequently categorized the events using HFACS-Healthcare. O...
Article
Background The purpose of this paper is to identify personal electronic device (PED) use by cardiac team members during a series of cardiovascular surgeries. Authors make the case that these devices contribute to the cognitive disconnect between practitioners and their primary task of taking care of the surgical patient. Methods This prospective o...
Article
Full-text available
Objectives: This investigation explores flow disruptions observed during cardiothoracic surgery and how they serve to disconnect anesthesia providers from their primary task. We can improve our understanding of this disengagement by exploring what we call the error space or the accumulated time required to resolve disruptions. Methods: Trained h...
Article
Full-text available
Introduction: This article examines the reliability of the Human Factors Analysis and Classification System (HFACS) for classifying observational human factors data collected prospectively in a trauma resuscitation center. Methods: Three trained human factors analysts individually categorized 1,137 workflow disruptions identified in a previously...
Presentation
MOTIVATION: Anecdotally, humor has been cited as a coping strategy for individuals living and working in extreme environments, such as submariners, astronauts, and Arctic and Antarctic expeditioners. Due to the isolation, confinement and subsequent potential emotional repercussions of these environments, a sense of humor is an important quality to...
Poster
Full-text available
Introduction: Efforts to optimize performance and increase patient safety in healthcare are often focused on reactive approaches that utilize incident and accident reports to identify areas of human error. While these methods have certainly been effective for identifying adverse events, they may not be the best or only techniques for investigating...
Article
Full-text available
Background The purpose of the current study was to explore the use of SBAR (Situation, Background, Assessment, Recommendation) for handoffs between surgical team members six years after implementation in a large academic tertiary care center. Methods Researchers observed 23 operative procedures for the presence of SBAR components (“S”,“B”,“A”,“R”)...
Article
Background The aim of this investigation is to place surgical disruptions in a different light. Rather than viewing these disruptions as isolated events which may affect the surgical team, we represent them as an aggregated space which serves to disconnect the team from the task at hand. Furthermore, we make the case that by understanding this erro...
Article
Full-text available
The reliability of the Human Factors Analysis and Classification System (HFACS) for classifying retrospective observational human factors data in the cardiovascular operating room is examined. Three trained analysts independently used HFACS to categorize observational human factors data collected at a teaching and nonteaching hospital system. Resul...
Article
Full-text available
Objectives: Historically, health care has relied on error management techniques to measure and reduce the occurrence of adverse events. This study proposes an alternative approach for identifying and analyzing hazardous events. Whereas previous research has concentrated on investigating individual flow disruptions, we maintain the industry should...
Article
Medical care providers recognize nonadjustable examination tables in clinics as a barrier to comprehensively and safely providing routine healthcare for disabled, elderly and obese patients. The aim of this study was to understand how the availability of the adjustable examination table may affect the medical care provider’s perception of the quali...
Article
Full-text available
The objectives of this study were to identify the frequency and nature of flow disruptions in the operating room with respect to three cardiac surgical team members: anaesthetists; circulating nurses; and perfusionists. Data collected from 15 cases and coded using a human factors taxonomy identified 878 disruptions. Significant differences were ide...
Presentation
Introduction: To improve a common source of communication breakdown in patient care, the Institute for Healthcare Improvement published a standardized handoff communication tool known as ‘SBAR’ (Situation (S), Background (B), Assessment (A) and Recommendation (R)). This study explored the use of SBAR for handoffs between surgical team members 6 yea...
Article
Full-text available
Sociometers are wearable sensors that continuously measure body movements, interactions, and speech. The purpose of this study is to test sociometers in a smart environment in a live clinical setting, to assess their reliability in capturing and quantifying data. The long-term goal of this work is to create an intelligent emergency department that...
Article
Full-text available
INTRODUCTION: This paper examines the reliability of the Human Factors Analysis and Classification System (HFACS) as tool for coding human error and contributing factors associated with accidents and incidents. METHODS: A systematic review of articles published across a 13-yr period between 2001 and 2014 revealed a total of 14 peer-reviewed manusc...
Presentation
A Prospective Investigation to Identify and Classify Flow Disruptions in a Level II Trauma Center

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